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Background: The COVID-19 pandemic reduced the general accessibility of health services. Many sexually transmitted infection (STI) testing and treatment sites modified services (e.g., reduced hours, limited walk-in availability, decreased testing capacity), changes that may result in permanent change in STI service availability. At the same time, systems were driven to innovate in ways that could benefit patients. This study aimed to describe how the COVID-19 pandemic changed STI clinical services, with a focus on long-term impacts. Methods: In July 2022, a phone survey was designed to assess services for STIs at the 105 STI testing and treatment providers in the St. Louismetropolitan statistical area. Sexually transmitted infection testing providers included STI clinics, primary care clinics that cater to a broad population, and community-based organizations, and excluded emergency departments and urgent care centers. In most cases, the survey was completed by a clinic manager, medical director, or nursing staff member. Results: Of the 75 locations that were interviewed, 12 (16%) had not returned to prepandemic capacity and operations as of July 2022. Five sites had closed completely since the pandemic began, 3 of which are in the northwestern region of the metropolitan statistical area. Most (58.6%) of the open clinics had added telehealth appointments. Conclusions: Sexually transmitted infection testing sites decreased during the pandemic with lasting impact in one area of the Midwest. Resources to support STI infrastructure should be expanded. Maintaining updated information on STI care providers in the region can aid future assessments. [ABSTRACT FROM AUTHOR]

Introduction: Women with gestational diabetes are 7 times more likely to develop type 2 diabetes and require lifelong diabetes screening. Loss of health coverage after pregnancy, as occurs in states that did not expand Medicaid, limits access to guideline-driven follow-up care and fosters health inequity. This study aims to understand the factors associated with the receipt of postpartum diabetes screening for women with gestational diabetes in a state without Medicaid expansion.Methods: Electronic health record and Medicaid claims data were linked to generate a retrospective cohort of 1,078 women with gestational diabetes receiving care in Federally Qualified Health Centers in Missouri from 2010 to 2015. In 2019-2020, data were analyzed to determine the factors associated with the receipt of recommended postpartum diabetes screening (fasting plasma glucose, 2-hour oral glucose tolerance test, or HbA1c in specified timeframes) using a Cox proportional hazards model through 18 months of follow-up.Results: Median age in this predominantly urban population was 28 (IQR=24-33) years. Self-reported racial or ethnic minorities comprised more than half of the population. Only 9.7% of women were screened at 12 weeks, and 20.8% were screened at 18 months. Prenatal certified diabetes education (adjusted hazard ratio=1.74, 95% CI=1.22, 2.49) and access to public transportation (adjusted hazard ratio=1.70, 95% CI=1.13, 2.54) were associated with increased screening in a model adjusted for race/ethnicity, the total number of prenatal visits, the use of diabetes medication during pregnancy, and a pregnancy-specific comorbidity index that incorporated age.Conclusions: This study underscores the importance of access to public transportation, prenatal diabetes education, and continued healthcare coverage for women on Medicaid to support the receipt of guideline-recommended follow-up care and improve health equity. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes increases risk for type 2 diabetes seven-fold, creating a large public health burden in a young population. In the US, there are no large registries for tracking postpartum diabetes screening among women in under-resourced communities who face challenges with access to care after pregnancy. Existing data from Medicaid claims is limited as women often lose this coverage within months of delivery. In this study, we aim to leverage data from electronic health records and administrative claims to better assess postpartum diabetes screening rates among low income women.Methods: A retrospective population of 1078 women with gestational diabetes who delivered between 1/1/2010 and 10/8/2015 was generated by linking electronic health record data from 21 Missouri Federally Qualified Health Centers (FQHCs) with Medicaid administrative claims. Screening rates for diabetes were calculated within 12 weeks and 1 year of delivery. Initial screening after the first postpartum year was also documented.Results: Median age in the final population was 28 (IQR 24-33) years with over-representation of black non-Hispanic and urban women. In the final population, 9.7% of women had a recommended diabetes screening test within 12 weeks and 18.9% were screened within 1 year of delivery. An additional 125 women received recommended screening for the first time beyond 1 year postpartum. The percentage of women who had a postpartum visit (83.9%) and any glucose testing (40.6%) in the first year far exceeded the proportion of women with recommended screening tests.Conclusions: Linking electronic health record and administrative claims data provides a more complete picture of healthcare follow-up among low income women after gestational diabetes. While screening rates are higher than reported with claims data alone, there are opportunities to improve adherence to screening guidelines in this population. [ABSTRACT FROM AUTHOR]

CD4 cell count at entry into human immunodeficiency virus (HIV) care is a useful indicator of success of multiple steps in HIV public health programming. We demonstrate that CD4 cell count at care initiation was stable in St Louis between 2017 and 2019 but declined in 2020. Missouri efforts in the Ending the HIV Epidemic plan should focus on rapidly identifying individuals with undiagnosed HIV infection. [ABSTRACT FROM AUTHOR]

Background: The true prevalence of COVID-19 is difficult to estimate due to the absence of random population-based testing. To estimate current and past COVID-19 infection prevalence in a large urban area, we conducted a population-based survey in St. Louis County, Missouri.Methods: The population-based survey of active infection (PCR) and seroprevalence (IgG antibodies) of adults (≥18 years) was conducted through random-digit dialing and targeted sampling of St. Louis County residents with oversampling of Black residents. Infection prevalence of residents was estimated using design-based and raking weighting.Results: Between August 17 and October 24, 2020, 1245 residents completed a survey and underwent PCR testing; 1073 residents completed a survey and underwent PCR and IgG testing or self-reported results. Weighted prevalence estimates of residents with active infection were 1.9% (95% CI, 0.4%-3.3%) and 5.6% were ever infected (95% CI, 3.3%-8.0%). Overall infection hospitalization and fatality ratios were 4.9% and 1.4%, respectively.Conclusions: Through October 2020, the percentage of residents that had ever been infected was relatively low. A markedly higher percentage of Black and other minorities compared to White residents were infected with COVID-19. The St. Louis region remained highly vulnerable to widespread infection in late 2020. [ABSTRACT FROM AUTHOR]

Background: Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) rates continue to increase in the US. Near point of care (nPOC) testing can improve proper treatment of STIs in Emergency Departments (ED), but the COVID-19 pandemic disrupted the US healthcare system for nonemergent care like sexual health. This study details the impact on antimicrobial stewardship for GC and CT in a large, academic ED. Methods: Via electronic medical records from January 2019 through March 2022, we assessed GC and CT testing results in monthly increments. Rates of antibiotic treatment including proper treatment of GC and CT were examined and compared before and after the initiation of an nPOC testing protocol (The Cepheid Gene Infinity returned NAAT results on ED patients in 2-3 hours starting in August 2019). Antibiotic treatment of GC and CT was also examined through COVID-19 (March 2020 forward). Results: From January through July of 2019 the average rate of proper antibiotic treatment was 85.2% (Figure 1). Via nPOC testing, proper antibiotic treatment of GC and CT increased by 5.8% (85.2% to 91%) and overtreatment decreased by 5% (9.9% to 4.9%). However, from March through June 2020 (COVID-19 disruption), proper treatment declined immediately by 2.1%. This decline in proper treatment rates is 35.1% of the growth of proper treatment rates in the former 6-month period. The prevalence of GC and CT increased from 12.2% to 13.8% at the same time. Conclusions: We observed a disproportionate decline in proper antibiotics use for GC/ CT management in the COVID-19 pandemic in one large ED. The pandemic and supply shortages disrupted the nPOC testing protocol and improved antibiotic stewardship for GC and CT. There was an initial increase in positive test rates between March 2020 to June 2020 indicating that patients were unable to access routine STI testing and likely only presented for STI testing in the ED with symptoms, so antibiotic treatment was more likely. This study will inform changes needed to improve antimicrobial stewardship in the ED's care of STIs. [ABSTRACT FROM AUTHOR]

Problem The current coronavirus disease 2019 (COVID‐19) pandemic underscores the need for building and sustaining public health data infrastructure to support a rapid local, regional, national, and international response. Despite a historical context of public health crises, data sharing agreements and transactional standards do not uniformly exist between institutions which hamper a foundational infrastructure to meet data sharing and integration needs for the advancement of public health. Approach: There is a growing need to apply population health knowledge with technological solutions to data transfer, integration, and reasoning, to improve health in a broader learning health system ecosystem. To achieve this, data must be combined from healthcare provider organizations, public health departments, and other settings. Public health entities are in a unique position to consume these data, however, most do not yet have the infrastructure required to integrate data sources and apply computable knowledge to combat this pandemic. Outcomes Herein, we describe lessons learned and a framework to address these needs, which focus on: (a) identifying and filling technology "gaps"; (b) pursuing collaborative design of data sharing requirements and transmission mechanisms; (c) facilitating cross‐domain discussions involving legal and research compliance; and (d) establishing or participating in multi‐institutional convening or coordinating activities. Next steps While by no means a comprehensive evaluation of such issues, we envision that many of our experiences are universal. We hope those elucidated can serve as the catalyst for a robust community‐wide dialogue on what steps can and should be taken to ensure that our regional and national health care systems can truly learn, in a rapid manner, so as to respond to this and future emergent public health crises. [ABSTRACT FROM AUTHOR]

A possibly prominent role for Green Rust minerals in life's emergence is inferred from a comparison of their structural, mechano-dynamic and electrochemical properties and of the layout of bioenergetic, i.e. free energy converting processes in extant organisms. From fundamental thermodynamic considerations, the conversion of environmental free energy into the decrease of entropy that defines life is an indispensable ingredient for life to emerge. A specific scenario for life's emergence mediated by Green Rust minerals in the framework of the alkaline hydrothermal vent hypothesis is proposed. • The potential roles of clay minerals in the emergence of life (EoL) are reassessed. • Fe-LDHs (Green Rusts, GR) are singled out as particularly promising candidates. • Previously characterized relevant properties of Green Rusts are reviewed. • Biology-inspired putative but plausible GR-mediated processes are discussed. • A scenario for a GR-assisted EoL resembling bioenergetic systems is proposed. [ABSTRACT FROM AUTHOR]

Background: The national rate of syphilis has increased among persons who inject drugs (PWID). Missouri is no exception, with increases in early syphilis (ES), congenital syphilis, and PWID, especially in nonurban counties.Methods: Disease intervention specialist records for ES cases in Missouri (2012-2018) were examined. Drug use was classified as injection drug use (IDU) (opioid or methamphetamine) or non-IDU (opioid, methamphetamine, or cocaine). Rates were compared based on residence, sex of sex partner, and drug use.Results: Rates of ES in Missouri increased 365%, particularly in small metropolitan and rural areas (1170%). Nonurban areas reported a higher percentage of persons with ES who used injection drugs (12%-15%) compared with urban regions (2%-5%). From 2012 to 2018, women comprised an increasing number of ES cases (8.3%-21%); 93% of women were of childbearing age. Increasingly more women in rural areas with ES also reported IDU during this time (8.4%-21.1%).Conclusions: As syphilis increases in small metropolitan and rural regions, access to high-quality and outreach-based sexual health services is imperative. Healthcare policy to equip health departments with harm reduction services and drug treatment resources offers an opportunity to impact both syphilis increases as well as health outcomes associated with IDU. [ABSTRACT FROM AUTHOR]

Background: In December 2020, due to antimicrobial resistance to N. gonorrhea (GC), CDC published updated treatment guidelines for GC, increasing the recommended dose of ceftriaxone (CTX) from 250mg to 500mg. This study uses Electronic Health Record (EHR) data from a large Midwestern health system to examine the adoption of these guidelines, including patient-level and system-level factors potentially related to delayed adoption of guidelines. Methods: All prescriptions of CTX linked to a diagnosis of GC or C. trachomatis between Jan. 2020 and Jun. 2022 were captured, with patient-level characteristics (sex, race, age) and system-level characteristics (encounter setting [ED, other outpatient, inpatient], encounter location [urban v. rural]). Prescriptions were classified as correct if the dosage was congruent with the CDC guideline for the year it was written. Bivariate analysis and Chi-square testing were performed to identify significant differences in guideline adoption. A regression model was fitted to elucidate factors related to nonadoption of CDC guidelines. Results: A total of 6,495 prescriptions met inclusion criteria, creating a largely young (65.9% aged 18-29), male (57.5%), urban (87.8%), Black (85.0%) cohort. The majority of encounters occurred in Emergency Departments (92.4%). Adoption of guidelines occurred rapidly: 2.3% of prescriptions from Nov. 2020 were 500mg CTX, versus 90.1% in Jan. 2021, with 97.2% of prescriptions meeting criteria for correct dosage. Regression modelling indicated that compared to white patients, Black patients had increased odds of receipt of correct CTX dosing (OR: 0.03, 95% CI 0.01, 0.04). However, encounters that occurred in non-ED outpatient settings or in inpatient settings both had lower odds of correct CTX dosage (OR: -0.11, 95% CI: -0.13, -0.08; OR: -0.07, 95% CI: -0.09, -0.05). Discussion: This study describes adoption of CDC guidelines for CTX dosing using a large, retrospective cohort of CTX prescriptions linked to GC/CT diagnosis within 2.5 years across a large, demographically diverse health system. While overall adoption rates were high, differences of adoption rates were identified in both patient- and system-level characteristics, suggesting overtreatment of some groups (Black) and undertreatment of others (non- ED patients). Studies of the causes of these differences may increase guideline adoption and mitigate risk of MDRO GC. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic reduced the accessibility of health services, including sexual healthcare. Many sexually transmitted infection (STI) testing and treatment sites modified services (e.g. reduced hours, limited walk-in availability, decreased testing capacity) perhaps leading to permanent change in STI service availability. At the same time, many healthcare providers were driven to innovate in ways that may benefit their patients during the pandemic. This study aims to describe how COVID-19 changed STI clinical services, with a focus on longterm impacts. Methods: A 5-10 minute phone survey was designed to assess services for STIs at the 105 STI testing and treatment providers in the St. Louis, USA Metropolitan Statistical Area. STI testing providers included STI clinics, primary care clinics that cater to a broad population, and community-based organizations, and excluded emergency departments and stand-alone urgent care centers. In most cases, the survey was completed by a clinic manager, medical director, or member of the nursing staff. Results: Of the 75 locations that were reached, 12 (16%) had not returned to pre-pandemic operations as of July 2022. Five sites had shut completely since the pandemic began, three of which were in one rural region of St. Louis. Of the open clinics, 41 (58.6%) added telehealth appointments, removing barriers to accessing care and indicating one positive lasting effect. When prompted to voice their needs for future pandemic/disruption preparedness, the most recurrent need was funding, mentioned by 35 (50%) of the clinics that had remained open. 30 (42.9%) of these clinics reported needing more or enough staff to support their operations, 10 (14.3%) expressed a need for testing kits, and 9 (12.9%) would need more space to continue operations. Conclusions: Resources should be allocated to support sexual health infrastructure, such as telehealth and at-home testing. Furthermore, maintaining updated information on STI care providers regionally is essential for future direction. [ABSTRACT FROM AUTHOR]

Abstract: Various iron-bearing primary phases and rocks have been weathered experimentally to simulate possible present and past weathering processes occurring on Mars. We used magnetite, monoclinic and hexagonal pyrrhotites, and metallic iron as it is suggested that meteoritic input to the martian surface may account for an important source of reduced iron. The phases were weathered in two different atmospheres: one composed of CO2 +H2O, to model the present and primary martian atmosphere, and a CO2 +H2O+H2O2 atmosphere to simulate the effect of strong oxidizing agents. Experiments were conducted at room temperature and a pressure of 0.75atm. Magnetite is the only stable phase in the experiments and is thus likely to be released on the surface of Mars from primary rocks during weathering processes. Siderite, elemental sulfur, ferrous sulfates and ferric (oxy)hydroxides (goethite and lepidocrocite) are the main products in a water-bearing atmosphere, depending on the substrate. In the peroxide atmosphere, weathering products are dominated by ferric sulfates and goethite. A kinetic model was then developed for iron weathering in a water atmosphere, using the shrinking core model (SCM). This model includes competition between chemical reaction and diffusion of reactants through porous layers of secondary products. The results indicate that for short time scales, the mechanism is dominated by a chemical reaction with second order kinetics (k =7.75×10−5 g−1/h), whereas for longer time scales, the mechanism is diffusion-controlled (DeA =2.71×10−10 m2/h). The results indicate that a primary CO2- and H2O-rich atmosphere should favour sulfur, ferrous phases such as siderite or Fe2+-sulfates, associated with ferric (oxy)hydroxides (goethite and lepidocrocite). Further evolution to more oxidizing conditions may have forced these precursors to evolve into ferric sulfates and goethite/hematite. [Copyright &y& Elsevier]

Background: Emergency departments (EDs) play an essential role in the timely initiation of HIV post-exposure prophylaxis (PEP) for sexual assault victims., Methods: Retrospective analysis of sexual assault victims evaluated and offered HIV PEP in an urban academic ED between January 1, 2005 and January 1, 2018. Data on demographics, comorbidities, nature of sexual assault, initial ED care, subsequent healthcare utilization within 28 days of initial ED visit, and evidence of seroconversion within 6 months of the initial ED visit were obtained. Predictors of subsequent ED visit and follow-up in the infectious diseases clinic were evaluated using logistic regression analysis., Results: Four hundred twenty-three ED visits met criteria for inclusion in this study. Median age at ED presentation was 25 years (IQR 21-34 years), with the majority of victims being female (95.5%), Black (63.4%), unemployed (66.3%) and uninsured (53.9%); psychiatric comorbidities (38.8%) and substance abuse (23.6%) were common. About 87% of the patients accepted HIV PEP (368 of 423 ED visits). Age (OR 0.97, 95% CI 0.94-0.99, p = 0.025) and sexual assault involving >1 assailant (OR 0.48, 95% CI 0.26-0.88, p = 0.018) were associated with lower likelihood of HIV PEP acceptance. Ten patients (2.7%) followed up with the infectious disease clinic within 28 days of starting HIV PEP; 70 patients (19%) returned to the ED for care during the same time period. Psychiatric comorbidity (OR 2.48, 95% CI 1.43-4.30, p = 0.001) and anal penetration (OR 2.02, 95% CI 1.10-3.70, p = 0.024) were associated with greater likelihood of repeat ED visit; female gender (OR 0.30, 95% CI 0.11-0.85, p = 0.023) was associated with lower likelihood of repeat visit. Completion of HIV PEP was documented for 14 (3.3%) individuals., Conclusions: While ED patient acceptance of HIV PEP after sexual assault was high, infectious disease clinic follow-up and documented completion of PEP remained low. Innovative care models bridging EDs to outpatient clinics and community support services are needed to optimize transitions of care for sexual assault victims, including those receiving HIV PEP., Competing Interests: Declaration of Competing Interest JNC, EG, SM, BF, AT, CM, SH, EC, HR, and SYL have no conflicts of interest to report. SYL received support through the Foundation for Barnes-Jewish Hospital and the Washington University Institute of Clinical and Translational Sciences which is, in part, supported by the NIH/National Center for Advancing Translational Sciences (NCATS), Clinical and Translational Science Award (CTSA) program (UL1TR002345)., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: Firearm injuries are a public health epidemic in the United States, yet a comprehensive national database for patients with firearm injuries does not exist. Here we describe the methods for a study to develop and query a new regional database of all patients who present to a St. Louis level I trauma hospital with a violent injury, the St. Louis Hospital-Based Violence Intervention Program Data Repository (STL-HVIP-DR). We hypothesize that the STL-HVIP-DR will facilitate identification of patients at risk for violent injury and serve as a comparison population for participants enrolled in clinical trials., Methods: The STL-HVIP-DR includes all visits made for violent injury to four level I trauma hospitals in St. Louis, Missouri between January 1, 2010 and December 31, 2019. Two health systems representing the four participating hospitals executed a data sharing agreement to aggregate clinical data on firearm injuries, stabbings, and blunt assaults. Dataset variables include demographic hospital and timestamp, medical, and insurance information., Results: A preliminary cross-sectional query of the STL-HVIP-DR reveals 121,955 patient visits among the four partner level I trauma hospitals for a violent injury between 2010 and 2019. This includes over 18,000 patient visits for firearm injury., Discussion: The STL-HVIP-DR repository fills a critical gap regarding identification and outcomes among individuals who are violently injured, especially those with non-lethal firearm injuries. It is our hope that the methods presented in this paper will serve as a primer to develop repositories to help target violence prevention services in other regions., (© 2020 Published by Elsevier Inc.)

Background: Emergency Departments (EDs) are a care source for patients with sexually transmitted diseases (STDs). St. Louis, MO reports among the highest rates of gonorrhea and chlamydia infection. We examined STD treatment in a high-volume urban ED, in St. Louis MO, to identify factors that may influence treatment., Methods: A retrospective chart review and analysis was conducted on visits to a high volume, academic ED in St. Louis, MO where patients received a gonorrhea/chlamydia nucleic acid amplification test (NAAT) with a valid matching test result over two years. Using multiple logistic regression, we examined available predictors for under and overtreatment., Results: NAATs were performed on 3.3% of all ED patients during the study period. Overall prevalence was 6.9% for gonorrhea (95% CI: 6.2, 7.7) and 11.6% for chlamydia (95% CI: 10.6, 12.5). Race was not a statistically significant predictor for undertreatment but Black patients were significantly more likely to be overtreated compared to White patients. (OR 1.83, 95% CI: 1.5, 2.2). Females were more likely to be undertreated when positive for infection compared to males (OR 7.34, 95% CI: 4.8, 11.2) and less likely to be overtreated when negative for infection (OR 0.27, 95% CI: 0.2, 0.3)., Conclusion: The burden of STDs in a high-volume academic ED was significant and treatment varied across groups. Attention should be paid to particular groups, specifically women and patients reporting Black as their race, to ensure appropriate treatment is administered. Patients would benefit from targeted STD management protocols and training in the ED., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Chlamydia and gonorrhea infection rates are rising in the United States, and the emergency department (ED) is increasingly a site where individuals seek care for these infections, sometimes more than once. This article investigates how individuals who use the ED more than once and receive chlamydia and gonorrhea care differ from individuals who are single users of the ED, as well as characteristics associated with being a repeat user of the ED., Methods: We analyzed 46,964 visits made by individuals who attended 1 of 4 EDs from January 1, 2010, to May 31, 2016, and received a test for chlamydia and gonorrhea infection. We used negative binomial regression to test the ability of age, sex, race, infection status, and insurance status to predict number of visits., Results: Individuals who used the ED more than once and received chlamydia and gonorrhea care were at their first visit more likely to be younger (incident rate ratio [IRR], 0.98; 95% confidence interval [CI], 0.97-0.98 per year) nonpregnant female (IRR, 1.23; 95% CI, 1.06-1.42), black (IRR, 1.27; 95% CI, 1.04-1.57), and have no or public insurance compared with single users of the ED., Discussions: Individuals likely to make multiple visits to the ED and receive chlamydia and gonorrhea care may be identifiable on their first visit and potentially directed elsewhere during subsequent visits for more comprehensive and potentially less expensive sexually transmitted disease care.

Objective: The Surgical Council on Resident Education (SCORE) web portal provides a uniform, comprehensive, competency-based curriculum for general surgery residents. One of SCORE's principal founding goals was to provide equal opportunity for access of educational resources at programs across the United States which reported having a range of resources. We aimed to determine if there was a difference in portal usage by trainees in independent versus university programs, and across geographic areas., Methods: Using analytic software, we measured SCORE usage by trainees in 246 subscribing programs from August 2015 to March 2017. The primary outcome was the average duration of SCORE use per login. Secondary outcomes were the geographic region of each program, and university versus independent designation. Encounters lasting >8 hours (comprising 7% of the data set) were excluded to eliminate the likelihood of failure to log off the portal., Results: Over the study period, there were 669,501 SCORE sessions with 22% of these lasting 1 to 5 minutes, 33% lasting 6 to 30 minutes, and 28% lasting 31 to 120 minutes. Between the university (64.4% of encounters) and independent (35.6% of encounters) program types, there was no significant difference in average visit length overall, or in the normally-distributed designated time categories (t test -1.0, p = 0.3). When mean encounter length per program was compared by geographic regions, there was also no difference in the three time categories (ANOVA p = 0.9, 0.2, and 0.5, respectively)., Conclusions: Most (50%) of SCORE encounters lasted 30 minutes of less, confirming prior work that shows trainees use the portal in relatively short bursts of activity. While there were more encounters from university program trainees (proportional with their greater numbers), the mean duration of an individual encounter did not significantly differ by program type as a whole or by region. These results suggest that SCORE is an equally accessible educational resource and is used by surgical trainees, regardless of program type or geographic region., (Copyright © 2019 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Rates of sexually transmitted diseases (STDs) including chlamydia and gonorrhea are increasing in the United States while public health funding for STD services is decreasing. Individuals seek care in various locations including the emergency department (ED). The objective of this study is to investigate whether there are more physically proximal clinic-based STD care locations available to individuals who present to the ED in a major metropolitan area., Methods: Addresses of EDs, clinics, and patients 13 years or older in St. Louis City or County given a nucleic acid amplification test and assigned an STD diagnosis (n = 6100) were geocoded. R was used to analyze clinics within 5 radii from the patients' home address and assess missed clinic opportunities (open, no charge, with walk-in availability) for those living in an urban versus suburban area., Results: In urban areas, 99.1% of individuals lived closer to a clinic than the ED where they sought STD services; in suburban areas, 82.2% lived closer to a clinic than the ED where they presented. In the region, 50.6% lived closer to the health department-based STD care location than the hospital where they presented. Up to a third of ED patient visits for STD care could have occurred at a clinic that was closer to the patient's home address, open, no charge, and available for walk-in appointments., Conclusions: Clinic availability is present for most of the individuals in our study. Clinics providing STD services can increase advertising efforts to increase public awareness of the services which they provide.