Syphilis Time-to-Treatment in STD Clinics Versus Private Clinics Arizona, 20092012

Monday, June 23, 2014: 2:44 PM
103, Nashville Convention Center
Candice L Williams , Arizona Department of Health Services, Phoenix, AZ
Lauren Young , Arizona Department of Health Services, Phoenix, AZ
Kristine Bisgard , Centers for Disease Control and Prevention, Atlanta, GA
Melanie Taylor , Maricopa County Department of Public Health, Phoenix, AZ

BACKGROUND: During 2011, in the United States, ~46,000 syphilis cases were reported. In a 2007 Arizona syphilis study, the time-to-treatment was longer for private, compared with public-funded, clinics, yet health care reform might provide more access to private clinics and less need for public-funded clinics. We sought to compare time-to-treatment by syphilis screening site (public-funded versus private clinics).

METHODS: We reviewed reported incident syphilis cases from 2 Arizona counties during 2009–2012 and formed 3 categories: (1) screened and treated at public-funded STD clinics; (2) screened at private clinics but treated at public-funded STD clinics; and (3) screened and treated at private clinics. The median time-to-treatment (days) was calculated for each category and assessed with the Kruskal-Wallis test.

RESULTS: Of 884 reported syphilis cases, 818 (93%) were among males; 813 (92%) had documented treatment. Untreated patients were more likely to have been screened at a private clinic (54 [76%]), compared with at a public-funded clinic (17 [24%]; P <.001). Category 1 patients (290 [36%]) received the timeliest treatment (median: 0 days; interquartile range [IQR]: 0–6.5 days); Category 2 patients (151 [19%]) received the least timely treatment (median: 8 days; IQR 2–25 days; P <.01); and Category 3 patients (372 [46%]) received less timely treatment, compared with Category 1 patients (median: 5 days; IQR: 0–18 days; P <.001). Patients seeking care at public-funded clinics, compared with private clinics, were younger (mean age: 32.4, compared with 36.2 years; P <.001), and more likely Hispanic (66% versus 47%; P <.001).

CONCLUSIONS: Fewer patients were evaluated and treated at public-funded STD clinics but received the timeliest treatment; these clinics remain crucial to syphilis disease control.