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Delay in Seeking Health Care Services After Onset of Urethritis Symptoms in Men

Aaron, Kristal J. DrPH, MSPH*; Van Der Pol, Barbara PhD, MPH*; Jordan, Stephen J. MD, PhD; Schwebke, Jane R. MD*; Hook, Edward W. III MD*

Sexually Transmitted Diseases: May 2019 - Volume 46 - Issue 5 - p 317–320
doi: 10.1097/OLQ.0000000000000976
Original Studies

Background Symptom awareness, behavioral factors, and other barriers associated with timely sexually transmitted infection (STI) health care provision in men is not well studied.

Methods Men attending an STI clinic answered a questionnaire regarding their symptoms, sexual behavior, and sociodemographic and behavioral characteristics. Characteristics of symptomatic men were compared between those who did and did not delay seeking health care services. Delayed care seeking was defined as clinic attendance longer than 7 days after symptoms, whereas early care seeking was defined as clinic attendance of 7 days or less.

Results Over a quarter (n = 43 [27.7%]) of men with urethritis symptoms (urethral discharge or dysuria) delayed seeking care for more than 7 days. Compared with men who sought treatment within 7 days, those that delayed care worried for longer periods that their symptoms were STI-related, were more likely to attempt self-treatment of STI symptoms, were more likely to continue engaging in sexual activity, and were less likely to use a condom during their last sexual encounter. Conversely, men that delayed care seeking were less likely to have urethral discharge on physical examination, to have 5 or more polymorphonuclear leukocytes, and to test positive for Neisseria gonorrhoeae. When compared with men that sought care earlier, men that delayed care seeking had fewer overall and new partners in the past 30 days.

Conclusions Our data suggest that over a quarter of men aware of STI symptoms delay seeking health services. Interventions that promote better patient understanding of the importance of symptom recognition and that facilitate timely access to care may provide new opportunities to reduce STI transmission.

A study in a sexually transmitted disease clinic in Birmingham, AL, found that over a quarter of men aware of sexually transmitted infection symptoms delay seeking health care for over 7 days.

From the *Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; and

Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN

Acknowledgments: The authors are grateful to the nurses at Jefferson County Department of Health, Hanne Harbison and Meghan Whitfield, for specimen collection and to Paula Dixon and Austin Culver for assistance with specimen processing/testing.

Conflicts of interest: J.R.S. is a consultant for Talis Corporation, Hologic, Lupin Pharmaceuticals, Toltec, and StarPharma; B.V.D.P. receives research support, consulting fees and/or honorarium from the following: Abbott Molecular, BD Diagnostics, Binx Health, BioFire Diagnostics, Hologic, Rheonix, Roche and SpeeDx; and E.W.H. has received honoraria, research support, or consulting fees from Cepheid, BD Diagnostics, Gen-Probe Hologic, and Roche Diagnostics.

Sources of Funding: National Institute of Allergy and Infectious Diseases of the National Institutes of Health Sexually Transmitted Infection Cooperative Research Center grant U19AI113212 (E.W.H., P.I.).

Reagents and test kits for this study were supplied by Cepheid (Sunnyvale, CA).

Correspondence: Kristal J. Aaron, DrPH, MSPH, Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, ZRB 234 703 19th St, South Birmingham, AL 35294. E-mail:

Received for publication November 2, 2018, and accepted January 5, 2019.

© Copyright 2019 American Sexually Transmitted Diseases Association