{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T05:42:11Z","timestamp":1777268531861,"version":"3.51.4"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T00:00:00Z","timestamp":1620604800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Clinical Scholars Program, University of Michigan"},{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>The United States is experiencing a surge in C<jats:italic>hlamydia trachomatis<\/jats:italic>(CT) infections representing a critical need to improve sexually transmitted infection (STI) screening and treatment programs. To understand where patients with STIs seek healthcare, we evaluated the relationship between CT infections and the place where individuals report usually receiving healthcare.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>Our study used a nationally representative sample from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2016. The study population is adult patients, aged 18 to 39 years in whom a urine CT screen was obtained. Logistic regression models were used to determine if location of usual healthcare was predictive of a positive urine CT screen result. Models were adjusted for known confounders including age, gender, race\/ethnicity, education, and insurance status.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>In this nationally representative sample (n = 19,275; weighted n = 85.8 million), 1.9% of individuals had a positive urine CT result. Participants reported usually going to the doctor\u2019s office (70.3%), \u201cno place\u201d (24.8%), Emergency Department (ED) (3.3%), or \u201cother\u201d place (1.7%) for healthcare. In adjusted models, the predicted probability of having a positive urine CT result is higher (4.9% vs 3.2%, p = 0.022; OR = 1.58) among those that reported the ED as their usual place for healthcare compared to those that reported going to a doctor\u2019s office or clinic.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>Individuals having a positive urine CT screen are associated with using the ED as a usual source for healthcare. Understanding this association has the potential to improve STI clinical and policy interventions as the ED may be a critical site in combatting the record high rates of STIs.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0251113","type":"journal-article","created":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T18:51:52Z","timestamp":1620672712000},"page":"e0251113","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Association between Chlamydia and routine place for healthcare in the United States: NHANES 1999\u20132016"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9411-2473","authenticated-orcid":true,"given":"Cornelius D.","family":"Jamison","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret","family":"Greenwood-Ericksen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline R.","family":"Richardson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hwajung","family":"Choi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tammy","family":"Chang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,5,10]]},"reference":[{"key":"pone.0251113.ref001","volume-title":"Sexually Transmitted Disease Surveillance 2018","author":"Centers for Disease Control and Prevention","year":"2019"},{"key":"pone.0251113.ref002","unstructured":"Centers for Disease Control and Prevention. Chlamydia\u2014CDC Fact Sheet (Detailed). 2016. Available from: https:\/\/www.cdc.gov\/std\/chlamydia\/stdfact-chlamydia-detailed.htm."},{"issue":"4","key":"pone.0251113.ref003","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1097\/OLQ.0b013e3181d5e01e","article-title":"Improving clinical operations: can we and should we save our STD clinics?","volume":"37","author":"MR Golden","year":"2010","journal-title":"Sex Transm Dis"},{"issue":"4","key":"pone.0251113.ref004","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1097\/OLQ.0b013e3181901e32","article-title":"Sexual partner characteristics and sexually transmitted diseases among adolescents and young adults","volume":"36","author":"SA Staras","year":"2009","journal-title":"Sex Transm Dis"},{"issue":"1","key":"pone.0251113.ref005","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1097\/PEC.0000000000000322","article-title":"Screening adolescents for sexually transmitted infections in the pediatric emergency department","volume":"31","author":"A Uppal","year":"2015","journal-title":"Pediatr Emerg Care"},{"issue":"9","key":"pone.0251113.ref006","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1197\/j.aem.2006.04.017","article-title":"Emergency department sexually transmitted disease and human immunodeficiency virus screening: findings from a national survey","volume":"13","author":"TL Gift","year":"2006","journal-title":"Acad Emerg Med"},{"issue":"4","key":"pone.0251113.ref007","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.annepidem.2010.11.015","article-title":"Are neighborhood sociocultural factors influencing the spatial pattern of gonorrhea in North Carolina?","volume":"21","author":"AB Sullivan","year":"2011","journal-title":"Ann Epidemiol"},{"key":"pone.0251113.ref008","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.ypmed.2017.04.028","article-title":"An increase in sexually transmitted infections seen in US emergency departments","volume":"100","author":"WS Pearson","year":"2017","journal-title":"Prev Med"},{"key":"pone.0251113.ref009","unstructured":"Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey. 2019. Available from: https:\/\/www.cdc.gov\/nchs\/nhanes\/index.htm."},{"key":"pone.0251113.ref010","unstructured":"Centers for Disease Control and Prevention. Lab Protocol, Chlamydia trachomatis in Urine. 2002. Available from: https:\/\/wwwn.cdc.gov\/nchs\/data\/nhanes\/2001-2002\/labmethods\/l05_b_met_chlamydia.pdf."},{"key":"pone.0251113.ref011","unstructured":"Centers for Disease Control and Prevention. Laboratory Procedure Manual, Chlamydia trachomatis and Neisseria gonorrhoeae in Urine. 2008. Available from: https:\/\/wwwn.cdc.gov\/nchs\/data\/nhanes\/2007-2008\/labmethods\/chlmda_e_met_chlamydia.pdf."},{"key":"pone.0251113.ref012","unstructured":"Centers for Disease Control and Prevention. Laboratory Procedure Manual, Chlamydia trachomatis in Urine. 2016. Available from: https:\/\/wwwn.cdc.gov\/nchs\/data\/nhanes\/2015-2016\/labmethods\/CHLMDA_I_MET.pdf."},{"issue":"161","key":"pone.0251113.ref013","first-page":"1","article-title":"National health and nutrition examination survey: analytic guidelines, 1999\u20132010","author":"CL Johnson","year":"2013","journal-title":"Vital Health Stat 2"},{"issue":"1","key":"pone.0251113.ref014","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1136\/ewjm.175.1.4","article-title":"Does continuity of care matter? Yes: consistent contact with a physician improves outcomes","volume":"175","author":"DA Christakis","year":"2001","journal-title":"West J Med"},{"issue":"3","key":"pone.0251113.ref015","doi-asserted-by":"crossref","first-page":"461","DOI":"10.2105\/AJPH.91.3.461","article-title":"Emergency department screening for asymptomatic sexually transmitted infections","volume":"91","author":"CS Todd","year":"2001","journal-title":"Am J Public Health"},{"issue":"2","key":"pone.0251113.ref016","doi-asserted-by":"crossref","first-page":"227","DOI":"10.5811\/westjem.2013.12.18989","article-title":"Dysuria in the emergency department: missed diagnosis of Chlamydia trachomatis","volume":"15","author":"MD Wilbanks","year":"2014","journal-title":"West J Emerg Med"},{"issue":"6","key":"pone.0251113.ref017","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1097\/OLQ.0b013e3181666ab7","article-title":"Health care access and follow-up of chlamydial and gonococcal infections identified in an emergency department","volume":"35","author":"AA Al-Tayyib","year":"2008","journal-title":"Sex Transm Dis"},{"issue":"4","key":"pone.0251113.ref018","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1111\/acem.12952","article-title":"Reasons for Frequent Emergency Department Use by Medicaid Enrollees: A Qualitative Study","volume":"23","author":"R Capp","year":"2016","journal-title":"Acad Emerg Med"},{"key":"pone.0251113.ref019","unstructured":"Centers for Disease Control and Prevention. Recommendations for the Laboratory-Based Detection of Chlamydia trachomatis and Neisseria gonorrhoeae\u20142014. 2014. Available from: https:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/rr6302a1.htm."},{"issue":"7","key":"pone.0251113.ref020","doi-asserted-by":"crossref","first-page":"e383","DOI":"10.1097\/PEC.0000000000001456","article-title":"Adolescent Sexual Behavior and Emergency Department Use","volume":"36","author":"J Weisman","year":"2018","journal-title":"Pediatr Emerg Care"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0251113","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,26]],"date-time":"2022-12-26T22:55:07Z","timestamp":1672095307000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0251113"}},"subtitle":[],"editor":[{"given":"Sylvia Maria","family":"Bruisten","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,5,10]]},"references-count":20,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0251113","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,10]]}}}