Factors associated with delays in accessing care for gonorrhea

Introduction: Delaying treatment for sexually transmitted diseases (STDs) increases duration of infection and contributes to ongoing transmission. In order to identify modifiable barriers to care, we sought factors that predicted delays between symptom onset and presentation for treatment of gonorrhea.

Methods: We analyzed gonorrhea cases reported from 3 counties in Washington State from 2006-2008. Selected cases were interviewed by state and local staff in collaboration with the STD Surveillance Network (SSuN), a multi-site network collecting enhanced data on reported STD cases. We reviewed cases that had been interviewed and that reported symptoms. We excluded subsequent interviews for the same patient. Because gonococcal infection is more likely to present symptomatically in men than in women, we reviewed only male cases for this analysis. Associations between case characteristics and delay to care, defined as >3 days between onset of symptoms and presentation for care, were evaluated using chi-square tests with a 2-sided significance level of 0.05.

Results: 3849 male gonorrhea cases were reported. 1279 cases were interviewed; 1030 reported symptoms; 953 reported duration of symptoms. 15 cases were excluded because they represented repeat interviews with patients. Patients reported symptoms for a median of 3.0 days (25th percentile 2.0, 75th percentile 6.0, range 1-300) prior to care. Delay to care was reported by 41% and was more common among men who were younger (56% of those <19, 44% of those 20-29, and 32% of those >30, p<0.001), never had an HIV test (56% vs. 38%, p<0.001), or did not have gonorrhea within the last year (44% vs. 34%, p=0.006). Factors not significantly associated with delay to care included race/ethnicity, sex of partners, employment status, internet use to meet partners, drug use, HIV status, provider type (STD clinic, primary care, or emergency room), and distance between home and care location. Among those symptomatic <1 week (n=715), day of symptom onset predicted delay to care (41% if symptoms began Thursday, 32% if Friday, 27% if Saturday, 19% if Sunday, 18% if Monday or Wednesday, 11% if Tuesday, p<0.001).

Conclusions: Lack of access to care on weekends may have been a barrier to timely treatment. Increased weekend hours at STD clinics and other care settings might shorten the interval to treatment for many patients. Efforts to bring younger patients into care more quickly are needed. Results suggesting that those with previous experience with health services accessed care more quickly than others should be explored further.