Identifying Provider Attitudes, Practices, and Barriers to Extra-Genital Testing for Neisseria Gonorrheae and Chlamydia Trachomatis Infections Among Adolescents and Young Adults.

Abstract

Purpose: Despite increasing rates of Neisseria gonorrheae and Chlamydia trachomatis nationally, prior studies indicate suboptimal screening in pediatric and young adult settings. This study surveyed provider attitudes, knowledge, practices, and barriers around sexually transmitted infection testing to identify potential contributing factors.

Methods: Pediatric providers at a large urban hospital system across different levels of practice and settings completed a survey anonymously via Research Electronic Data Capture. Likert scales and Fisher's exact test were used to quantify and compare provider responses.

Results: Analysis of the 130 respondents indicated discomfort with asking adolescents about their sexual behaviors (61.5% residents vs. 40.0% attendings, p = .002). 50.0% of residents and 73.3% of attendings felt trained to talk about sexual practices (p = .02). Resident (30.8%) and attending (36.0%) physicians were not likely to counsel patients regarding safer sex practices. Attendings (30.8%) and advanced practice providers (48.0%) responded correctly that either providers or patients can self-collect vaginal/rectal and pharyngeal samples. Outpatient and inpatient providers reported some barrier to extra-genital testing, including confidentiality concerns (46.4% and 43.1%, respectively), lack of swabs (41.1% and 31.4%, respectively), and lack of knowledge on performing/ordering the test (57.1% and 49.0%, respectively).

Discussion: Provider discomfort, knowledge and practice gaps, and barriers to extra-genital Neisseria gonorrheae/Chlamydia trachomatis testing were widespread in our study population. Potential targets for improvement include addressing logistic challenges to sample collection, reducing confidentiality concerns, and improving provider training in counseling and clinical decision-making related to adolescent sexual health.