Evaluation of a testing-only "express" visit option to enhance efficiency in a busy STI clinic.

OBJECTIVE To evaluate the use of a testing-only "express" visit option to enhance efficiency in a busy STI clinic. METHODS At the Denver Metro Health Clinic, clients at low risk for sexually transmitted infections (STI) are offered an express visit comprised of a urine test for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) as well as optional syphilis and human immunodeficiency virus (HIV) testing, but no physical examination. Higher risk clients (STI-related symptoms, contact to STI, men having sex with men, injection drug use, exchange of sex for money or drugs) are offered a comprehensive visit that includes a physical examination. The triage system was evaluated for the period April 2005--July 2006 by comparing rates of CT, GC, syphilis, and HIV between the 2 visit options. RESULTS Of 13,447 clients with new visits, 3284 (24.4%) were express visits. When compared with clients with comprehensive visits, express visit clients had lower rates of CT (8.1% vs. 17.2%), GC (0.9% vs. 7.4%), syphilis (0.7% vs. 1.2%), and HIV (0.1% vs. 0.2%). Of 2969 STI cases, only 10.8% were diagnosed among clients with express visits. Express visits resulted in a 39% time saving for men and a 56% for women. With the possible exception of asymptomatic urethritis among men, underdiagnosis of STI beyond CT, GC, syphilis, and HIV among express visit clients appeared to be low. CONCLUSION The triage system at DMHC effectively selects clients at highest risk for STI and increases clinic efficiency.