UCLA

Background: Approximately 80% of gonorrhea (GC) and chlamydia (CT) infections are missed when healthcare providers do not screen for pharyngeal and rectal (extra-genital) GC and CT infections among men who have sex with men (MSM). Some factors may include under-identification of MSM as a high-risk population, implicit biases, and under-appreciation of the problem’s magnitude in this population. Undiagnosed and poor treatment of GC and CT infections in MSM may result in further spread and poor clinical outcomes for index and subsequent cases. Objectives: Measure knowledge, perceptions, and beliefs about screening and acceptability of an electronic medical record (EMR) dot-phrase template for clinician history taking. Methods: This observational study compared self-reported baseline knowledge and comfort for GC and CT screening for MSM, and approval of the dot-phrase template over eight weeks between training and availability of the EMR tool. Northern California federally-qualified health center adult primary care providers were enrolled in the study. We gathered self-report for sociodemographic characteristics, practice-specific knowledge, perceptions, and beliefs about extra-genital screening in MSM patient populations using online administered, anonymous, linked surveys over the study period. Results: Nine participants participated in the initial training and six completed the follow-up evaluation. Physicians comprised the largest group: 6 family medicine, 1 internal medicine, 2 family nurse practitioners, of whom 56% reported 3 to 5 years of clinical experience. Most were female (77%). 33% of initial participants (3/9) believe that consistent condom use does not put a patient at risk for GC or CT. While 55% initially disagreed that GC can be transmitted via kissing, most agreed following in-service education (1 “strongly disagreed” vs. 3.5 “slightly to strongly agree”). 83% of subjects who participated in both surveys report feeling more compelled to offer extra-genital screening upon completion of the training and introduction of the dot-phrase. No provider reported being able to implement the dot-phrase protocol over the study period. Conclusion: A six week in-service education and structured dot-phrase history taking tool intervention improved evidence-based understanding of GC/CT transmission risk factors. Participants completing the program expressed that they felt more compelled to offer extra-genital screening in applicable patient encounters following the educational intervention.