September 11, 2017
2 min read

Improved primary care access linked to fewer STIs among women

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Danielle Haley
Danielle F. Haley

Women residing in areas with greater health care access were less likely to have sexually transmitted infections, according to research recently published in Sexually Transmitted Diseases.

“The United States has experienced a dramatic increase in the rate of reportable sexually transmitted infections [STIs] in the past decade. STIs cost the U.S. health care system nearly $16 billion a year, contribute to comorbidities (eg, pelvic inflammatory disease), ongoing transmission of STIs including HIV, and may result in congenital or neonatal transmission of STIs,” Danielle F. Haley, PhD, MPH, of the University of North Carolina at Chapel Hill and Institute for Global Health and Infectious Diseases, and colleagues wrote.

“The U.S. has also simultaneously experienced a decline in safety net services for STI testing and treatment,” the researchers continued. “In this changing landscape, access to health care may be an important determinant of STI testing and treatment.”

Haley and colleagues collected data regarding HIV-seropositive and HIV-seronegative status in 666 women who lived in several southern states. Researchers recorded each woman’s access to health care (eg, whether or not she had health insurance and a primary care provider), along with whether or not she had insurance and an STI (eg, early syphilis, trichomoniasis, gonorrhea or chlamydia).

Researchers found that 70% of the participants were HIV-seropositive, and 11% had an STI. A four-unit increase in the percentage of participants with a primary care provider yielded a 39% lower risk for STIs (RR = 0.61; 95% CI, 0.38-0.99).

“When people in a community have poor access to health care, they are more likely to have undiagnosed and untreated STIs. This means that a woman living in this community may be more likely to have a sexual partner who has an STI, even if she has lower-risk sexual behaviors,” Haley told Healio Family Medicine in an interview. “Our findings highlight that access to health care benefits the people who get health care, as well as the broader community. Having health insurance and making affordable services available in communities may help identify and treat STIs.”

She added that CDC data indicate more than 72% of reported chlamydia, gonorrhea and syphilis cases were diagnosed in places such as private physicians’ offices, and that primary care providers are a critical component in averting the spread of STIs.

“[These] physicians play a big role in helping people prevent and/or treat their STIs. Regular screening can help ensure that people who have an STI are aware of this infection and get proper treatment,” Haley said in an interview. “Screening also helps identify and treat sex partners who may also have STIs.”

Although STIs may not be an easy topic for some primary care providers to bring up with their patients, she offered advice to doctors who are uneasy discussing the subject matter.

“People sometimes feel stigmatized by having an STI. Providers can help reduce this stigma by asking people about their sex life in a non-judgmental way, and by including STI education and screening as part of routine care,” she said. – by Janel Miller

Disclosures: The researchers report no relevant financial disclosures.