STI care: Urban ED utilization in the setting of fluctuating public clinic services

Introduction: Closure of public STI clinics results in decreased detection and treatment of STIs (1,2,3). Genesee County in southeast Michigan represents a substantial proportion of Neisseria gonorrhea (GC) and Chlamydia trachomatis (Ct) (4.7% of GC and 5.7% of Ct statewide) (4). Fiscal constraints led the Genesee County Health Department to eliminate its full-time STI clinic (GCHD) in 2010. Hurley Medical Center (HMC) in downtown Flint is the only public hospital in Genesee County and thus may represent an alternate venue for STI care. Methods: We compared demographic data, including primary care physician (PCP) and insurance status, among patients diagnosed with GC or Ct by the HMC Emergency Department (ED) for one year subsequent to and prior to closure of the clinic. Results: Preliminary data show a 40.1% increase (332 vs. 237) in cases of GC/Ct reported by the HMC ED in the first four months after clinic closure (as compared to the same four months of the previous year), an increase almost entirely accounted for by male cases and not explained by a county-wide increase in incidence. Demographic data will be shared in the full presentation. Conclusions: The increase in ED cases may represent patients who would have presented to the GCHD in previous years. To the extent that these patients can be identified by demographics, this may represent an increased public health and financial burden on a public city hospital that is neither equipped for patient follow-up and partner notification nor an appropriate venue for non-emergent STI care.