Increasing Extra-genital Gonorrhea and Chlamydia Screening in the College Health Setting

Abstract

Extra-genital gonorrhea and chlamydia infections affecting the throat and rectum continue to increase among young adults. People aged 24 years and younger are the most at-risk. Low rates of extra-genital screening present the problem of a missed diagnosis of gonorrhea and chlamydia. Any missed diagnosis delays evidenced-based treatment and contributes to the spread of sexually transmitted infections (STIs) and avoidable complications. This project aimed to implement a standardized process for screening patients and increase extra-genital testing. The Theoretical Domains Framework and a multidisciplinary team approach were adopted as the operational framework to guide the project. The project was conducted in a college health setting at a university student health center. Established goals were to modify and implement a sexual history-taking tool, educate nursing staff and providers on use of the tool, introduce the Five Ps of sexual history-taking: Partners, Practices, Protection, Past-History, and Prevention of Pregnancy, track compliance with use of the tool, and evaluate for an increase in extra-genital screening rates. Quantitative results revealed a 93% overall use rate of the sexual history-taking tool. There was a 38% increase in extra-genital testing during the project implementation compared to the pre-data timeframe. Findings support the importance of the project as nurses and providers increased their knowledge of the Five Ps of sexual history-taking and confidence when discussing sexual health. An important finding was that the efficient use of extra-genital testing far outweighs the cost of a missed diagnosis of gonorrhea and chlamydia and untreated infection complications.