摘要：Objectives . This study presents results from a national survey of US physicians that assessed screening, case reporting, partner management, and clinical practices for syphilis, gonorrhea, chlamydia, and HIV infection. Methods . Surveys were mailed to a random sample of 7300 physicians to assess screening, testing, reporting, and partner notification for syphilis, gonorrhea, chlamydia, and HIV. Results . Fewer than one third of physicians routinely screened men or women (pregnant or nonpregnant) for STDs. Case reporting was lowest for chlamydia (37%), intermediate for gonorrhea (44%), and higher for syphilis, HIV, and AIDS (53%–57%). Physicians instructed patients to notify their partners (82%–89%) or the health department (25%–34%) rather than doing so themselves. Conclusions . STD screening levels are well below practice guidelines for women and virtually nonexistent for men. Case reporting levels are below those legally mandated; physicians rely instead on patients for partner notification. Health departments must increase collaboration with private physicians to improve the quality of STD care. More than 15 million sexually transmitted diseases (STDs) occur annually in the United States. 1, 2 Rates of curable STDs in the United States, the highest in the developed world, are higher than in some developing countries. 1, 2 STDs account for 87% of the diseases most frequently reported to public health authorities in the United States 3 ; of the 10 most frequently reported diseases, 5 are STDs. 2, 3 The direct and indirect costs of STDs are also substantial. In 1994 dollars, the total cost for common STDs and their sequelae is estimated to be $10 billion annually. 2 Federal resources for the control and prevention of STDs are largely distributed to state and local health departments, which for more than 50 years have provided disease surveillance, screening of at-risk individuals, partner contact tracing, and STD clinics that offer a safety net for medically underserved populations. The science base that informs STD control and prevention in the United States is generated primarily from research conducted in these publicly funded STD clinics. However, recent evidence suggests that most STD care in the United States takes place in the private sector. The National Health and Social Life Survey, a population-based household survey, revealed that STDs are frequently treated in private practice settings. Almost three quarters (71%) of the respondents diagnosed with an STD in the previous year had received their care from a private practice, community health center clinic, emergency room, or family planning clinic rather than from a publicly funded STD clinic. Only 5% reported that they were treated in an STD clinic. The remaining 24% received their STD care in a variety of settings other than those mentioned above. 4 Relatively little is known about current STD practices outside of dedicated STD clinics. Although some small regional studies have been conducted, the last national STD survey of physicians was in 1968; it was very limited in scope, containing only 2 questions (number of STD cases that physicians diagnosed and number reported to public health departments). 5 The health care climate has changed markedly since that time, with shifts toward managed care and advances in STD diagnostics and treatment. 6 In addition, dwindling resources have closed or limited the hours of operation of publicly funded clinics in several geographic areas, raising concerns that financial constraints might contribute to an increasing prevalence of treatable STDs. This report presents results from a national survey of US physicians that assessed screening, case reporting, partner management, and clinical practices for syphilis, gonorrhea, chlamydia, and HIV infection.
