Sexually Transmitted Infection Epidemiology and Care in Rural Areas: A Narrative Review

Abstract

Background: Although rural areas contain approximately 19% of the US population, little research has explored sexually transmitted infection (STI) risk and how urban-developed interventions may be suitable in more population-thin areas. Although STI rates vary across rural areas, these areas share diminishing access to screening and limited rural-specific testing of STI interventions.Methods: This narrative review uses a political ecology model of health and explores 4 domains influencing STI risk and screening: epidemiology, health services, political and economic, and social. Articles describing aspects of rural STI epidemiology, screening access and use, and intervention utility within these domains were found by a search of PubMed.

Area-based comparison of risk factors and testing rates to improve sexual health care access: cross-sectional population-based study in a Dutch multicultural area

“…These results correspond with the previous literature 22 23. In addition to physical accessibility, people living in less urbanised areas may also be less likely to seek sexual healthcare themselves because of barriers such as lack of anonymity, social stigma and privacy concerns 24 25. Also, healthcare providers in rural areas may contribute to lower testing rates because they are less likely to offer an STI test 26 27.…”

“… 22 23 In addition to physical accessibility, people living in less urbanised areas may also be less likely to seek sexual healthcare themselves because of barriers such as lack of anonymity, social stigma and privacy concerns. 24 25 Also, healthcare providers in rural areas may contribute to lower testing rates because they are less likely to offer an STI test. 26 27 Educational training, including information about STI testing guidelines and local STI testing practices, could motivate and increase STI test provision by the GP.…”

Racial, Ethnic, and Rural/Urban Disparities in HIV and Sexually Transmitted Infections in South Carolina

“…Addressing disparities in outcomes among rural and racial/ethnic minority populations will require interventions that address factors at multiple levels, and are scaled to work in rural environments especially those that are focused on the structural barriers these populations face in seeking services. [ 29 ] While primary prevention can reduce the burden of these diseases, there is currently an opportunity to improve access to and coordination of patient care among health departments and health care payors that supports the reduction of STIs. This is especially critical in rural areas where services overall are often limited.…”

“…Specifically, these data may undercount the true prevalence of STI rates as providers may be uncertain of diagnosis before further evaluation and testing. [ 29 ] Further, we could not estimate incidence rates, given the nature of our data. The data also had large counts of missing race/ethnicity data, limiting our race/ethnicity categories to just three.…”

State-Level Recommendations to Reduce Inequities in Sexually Transmitted Infections

“…Nationally, sexual health services are less available in rural areas (Jenkins, Williams, & Pearson, 2021). To entice more sexual health providers into rural and underserved areas, state legislatures and departments of health should develop adequate reimbursement models, residency training programs, and financial incentives (Centers for Medicare and Medicaid Services, 2019).…”