title: Sexually transmitted infection clinics as safety net providers: exploring the role of categorical sexually transmitted infection clinics in an era of health care reform.
abstract: BACKGROUND
  For many individuals, the implementation of the US Affordable Care Act will involve a transition from public to private health care venues for sexually transmitted infection (STI) care and prevention. To anticipate challenges primary care providers may face and to inform the future role of publicly funded STI clinics, it is useful to consider their current functions.
  
  
  METHODS
  Data collected by 40 STI clinics that are a part of the Sexually Transmitted Disease Surveillance Network were used to describe patient demographic and behavioral characteristics, STI diagnoses, and laboratory testing data in 2010 and 2011.
  
  
  RESULTS
  A total of 608,536 clinic visits were made by 363,607 unique patients. Most patients (61.9%) were male; 21.9% of men reported sex with men (MSM). Roughly half of patients were 20 to 29 years old (47.1%) and non-Hispanic black (56.2%). There were 212,765 STI diagnoses (mostly nonreportable) that required clinical examinations. A high volume of chlamydia, gonorrhea, and HIV testing was performed (>350,000 tests); the prevalence was 11.5% for chlamydia, 5.8% for gonorrhea, 0.9% for HIV, and varied greatly by sex and MSM status. Among MSM with chlamydia or gonorrhea, 40.1% (1811/4448) of chlamydial and 46.2% (3370/7300) of gonococcal infections were detected at extragenital sites.
  
  
  CONCLUSIONS
  Sexually Transmitted Disease Surveillance Network clinics served populations with high STI rates. Given experience with diagnoses of both nonreportable and reportable STIs and extragenital chlamydia and gonorrhea testing, STI clinics comprise a critical specialty network in STI diagnosis, treatment, and prevention.
authors: From the *New York City Department of Health and Mental Hygiene, Queens, NY; †Los Angeles County Department of Public Health, Los Angeles, CA; ‡San Francisco Department of Public Health, San Francisco, CA; §Public Health-Seattle & King County and University of Washington Center for AIDS and STD Research, Seattle, WA; ¶Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; ║Baltimore City Health Department, Baltimore, MD; **Chicago Department of Public Health, Chicago, IL; and ††Denver Public Health Department, Denver, CO.
authors: Preeti
authors: P
authors: Pathela
authors: Ellen J
authors: EJ
authors: Klingler
authors: Sarah L
authors: SL
authors: Guerry
authors: Kyle T
authors: KT
authors: Bernstein
authors: Roxanne P
authors: RP
authors: Kerani
authors: Lisa
authors: L
authors: Llata
authors: Hayley D
authors: HD
authors: Mark
authors: Irina
authors: I
authors: Tabidze
authors: Cornelis A
authors: CA
authors: Rietmeijer
mesh_terms: D000328:Adult; D005260:Female; D018166:Health Care Reform / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act / Q000191:economics; D015995:Prevalence; D064876:Safety-net Providers / Q000191:economics* / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000191:economics* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology