Improving STI Screening in Adolescent and Young Adult Men in a Primary Care Setting

Adolescents and young adults (AYAs) account for approximately half of all new diagnoses of sexually transmitted infections (STIs) in the United States. Screening AYA men is imperative to stopping the spread of infection as well as preventing long-term sequelae. Although our AYA medical practice has consistently screened AYA women at rates more than 80% annually, the baseline screening rate for men was less than 70%.

Between May 2021 and October 2023, we conducted a quality improvement initiative among male primary care patients older than 15 years who had an annual physical within the past 3 years. Interventions included adding a bathroom sign clearly stating urine would not be used for drug testing and creating and implementing a chlamydia and gonorrhea (GC/CT) testing alert in the electronic health record for all male medical visits. Our primary outcome was the percentage of patients who received GC/CT screening.

Statistical process control p-chart analysis showed special cause variation with improved GC/CT screening rates among AYA men in primary care, including a significant increase in the mean screening rate from 73.5% to 83.5% following our second intervention, demonstrating a mean shift from previous results.

Clinic-level interventions-bathroom signage indicating urine would not be used for drug testing did not improve STI screening rates, whereas an electronic health record prompt for clinic staff regarding the need for STI testing-improved GC/CT screening rates among AYA men in primary care.