Sexually Transmitted Infection Symptom Reporting to AI-Based Virtual Triage and Care Referral
Main Article Content
Abstract
Objective: Evaluate the effectiveness of artificial intelligence-based virtual triage and care referral in describing, engaging and influencing care seeking behavior among patients with symptoms indicative of sexually transmitted infections.
Methods: Evaluated 4,487,191 virtual triage encounters among patients aged 12+ years over 36 months for sexually transmitted infections ranked as top three conditions. Demographics and type of care seeking before and following virtual triage were quantified and relationships assessed for statistical significance.
Results: A total 115,109 (2.6%) virtual triage encounters were consistent with a possible sexually transmitted infection. Most patients were female (64.5%) and 89.2% were aged 18–44. Over half of patients completed the virtual triage encounters in English or Spanish. Frequency of symptoms consistent with sexually transmitted infections reflected low detection rates due to the largely asymptomatic nature of these conditions. Of 5,717 patients completing pre- and post-triage care intent surveys, care seeking increased 6.1% post-triage (p<0.05); those uncertain about their care intent or planning no action decreased 20.0% (p<0.05). However, 46.3% of patients opted for contraindicated self-care measures post-triage, a 13.8% increase (p<0.05).
Conclusions: Virtual triage substantially influenced care seeking among individuals reporting symptoms suggestive of a sexually transmitted infection. Patients unsure how to address their symptoms or who planned inaction decreased significantly, while users intending to seek care increased. Virtual triage reduced indecision among patients by converting passive symptom acknowledgement into proactive intent to seek care. Increase in patients opting for self-care measures after virtual triage indicated a possible sexually transmitted infection, and despite a recommendation to seek care, suggests that certain barriers to care seeking for these infections may be too deeply rooted to be addressed by virtual triage technology alone.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
2. Centers for Disease Control and Prevention, Sexually transmitted disease surveillance 2019: National overview - Sexually Transmitted Disease Surveillance, 2019. April 13, 2021. Accessed 23 March 2025. https://stacks.cdc.gov/view/cdc/105137. Accessed 23 March 2025.
3. Centers for Disease Control and Prevention, Reported STDs reach all-time high for 6th consecutive year. https://archive.cdc.gov/www_cdc_gov/media/releases/2021/p0413-stds.html#:~:text=The%20newly%20released%202019%20STD,STDs%20between%202015%20and%202019. Accessed 23 March 2025.
4. Centers for Disease Control and Prevention. Sexually transmitted infections (STIs): National overview of STIs in 2023, https://www.cdc.gov/sti-statistics/annual/summary.html. Accessed 23 March 2025.
5. de Wit JBF, Adam PCG, den Daas C, Jonas K. Sexually transmitted infection prevention behaviours: Health impact, prevalence, correlates, and interventions. Psychol Hlth 2023;38(6):675-700.
DOI: 10.1080/08870446.2022.2090560
6. Dalby J, Stoner BP. Sexually transmitted infections: Updates from the 2021 CDC guidelines. Am Fam Phys 2022;105(5):514-520.
7. O'Byrne P, Orser L, Kroch A. Rates of sexually transmitted infections are rising. BMJ 2023:30;381:1492. DOI: 10.1136/bmj.p1492
8. Garcia PJ, Miranda AE, Gupta S, Garland SM, Escobar ME, Fortenberry JD. The role of sexually transmitted infections (STI) prevention and control programs in reducing gender, sexual and STI-related stigma. Eclin Med 2021 Feb 24;33:100764. DOI: 10.1016/j.eclinm.2021.100764
9. Lee ASD, Cody SL. The stigma of sexually transmitted infections. Nurs Clin North Amer 2020;55(3):295-305. DOI: 10.1016/j.cnur.2020.05.002
10. King AJ, Bilardi JE, Towns JM, Maddaford K, Fairley CK, Chow EPF, Phillips TR. User views on an online sexual health symptom checker tool: Qualitative research. JMIR Form Res 2024;4;8:e54565. DOI: 10.2196/54565
11. Karamouzian N, Knight R, Davis WM, Gilbert M, Shoveller J. Stigma associated with sexually transmissible infection testing in an online testing environment: Examining the perspectives of youth in Vancouver, Canada. Sex Hlth 2027;15:46-53. https://doi.org/10.1071/SH17089.
12. Low N, Broutet N, Adu-Sarkodie Y, Barton P, Hossain M, Hawkes S. Global control of sexually transmitted infections. Lancet 2006;2;368(9551):2001-16.
DOI: 10.1016/S0140-6736(06)69482-8
13. Malek AM, Chang CC, Clark DB, Cook RL. Delay in seeking care for sexually transmitted diseases in young men and women attending a public STD clinic. Open AIDS J 2013;14;7:7-13. DOI: 10.2174/1874613620130614002
14. Tilson EC, Sanchez V, Ford CL, et al. Barriers to asymptomatic screening and other STD services for adolescents and young adults: Focus group discussions. BMC Publ Hlth 2004;4:21. DOI: 10.1186/1471-2458-4-21
15. Leichliter JS, Copen C, Dittus PJ. Confidentiality issues and use of sexually transmitted disease services among sexually experienced persons aged 15-25 Years - United States, 2013-2015. MMWR 2017;66(9):237-241. DOI: 10.15585/mmwr.mm6609a1
16. Kenyon C, Herrmann B, Hughes G, de Vries HJC. Management of asymptomatic sexually transmitted infections in Europe: Towards a differentiated, evidence-based approach. Lancet Reg Hlth Eur 2023;34:100743. DOI: 10.1016/j.lanepe.2023.100743
17. Centers for Disease Control and Prevention. Sexually Transmitted infections prevalence, incidence, and cost estimates in the United States, https://www.cdc.gov/sti/php/communication-resources/prevalence-incidence-and-cost-estimates.html#:~:text=CDC%20estimates%20indicate%20about%2020,billion%20in%20healthcare%20costs%20alone. Accessed 23 March 2025.
18. Korenromp EL, Sudaryo MK, de Vlas SJ, Gray RH, Sewankambo NK, Serwadda D, Wawer MJ, Habbema JD. What proportion of episodes of gonorrhoea and chlamydia becomes symptomatic? Int J STD AIDS 2002;13(2):91-101. DOI: 10.1258/0956462021924712
19. Clifton S, Mercer CH, Sonnenberg P, Tanton C, Field N, Gravningen K, Hughes G, Mapp F, Johnson AM. STI Risk Perception in the British population and how it relates to sexual behaviour and STI healthcare use: Findings from a cross-sectional survey (Natsal-3). Eclin Med 2018;2-3:29-36 DOI: 10.1016/j.eclinm.2018.08.001
20. Gellert GA Garber L, Kabat-Karabon A et al. Using AI-based virtual triage to improve acuity-level alignment of patient care seeking in an ambulatory care setting. Intl J Hlthcr 2024;10. 41.10.5430/ ijh.v10n1p41.
DOI: https://doi.org/10.5430/ijh.v10n1p41
21. Gellert GA, Kabat-Karabon A, Gellert GL et al. The potential of virtual triage AI to improve early detection, care acuity alignment, and emergent care referral of life-threatening conditions. Front Publ Hlth 2024;12:1362246. DOI: 10.3389/fpubh.2024.1362246
22. World Health Organization, Sexually transmitted infections (STIs), May 21, 2024. https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis).
23. Kreisel KM, Spicknall IH, Gargano JW et al. Sexually transmitted infections among US women and men: Prevalence and incidence estimates, 2018. STDs 2021;48(4):208-214. DOI: 10.1097/OLQ.0000000000001355
24. Gellert GA, Orzechowski PM, Price T et al. A multinational survey of patient utilization of and value conveyed through virtual symptom triage and healthcare referral. Front Publ Hlth 2023. DOI: https://doi.org/10.3389/fpubh.2022.1047291