Sexually transmitted infection (STI) clinics typically offer their services at no or low cost to clients. Little is known about the effects of charging fees on clinic attendance and STI identification.

In December 2002, as a result of budget shortfalls, the Denver Metro Health (STI) Clinic (DMHC) began charging a clinic fee of $15 for Denver residents and up to $65 for nonresidents. In the current study, researchers evaluated the effects of the fees on clinic use and diagnoses of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infections.

The researchers examined DMHC's computerized medical records to compare clinic visits and CT/GC diagnoses between the first three quarters of 2002 and 2003. In addition, they compared CT and GC cases reported by DMHC with reports by other Denver health care providers during 2002 and 2003.

Their analysis showed that compared with 2002, there were 3,250 fewer visits (-28.5 percent) to DMHC in 2003, with no variance across quarters. CT diagnoses declined by 427 cases (-28.1 percent), disproportionately affecting women (-40 percent) and those under 20 (-42 percent). There were 332 fewer GC diagnoses (-38.1 percent) with no clear demographic preponderance. There were some decreases in non-DMHC reports of CT and GC, but the ratio of DMHC to non-DMHC reports declined from 0.42 percent to 0.33 percent (-21.4 percent) for CT and from 0.94 to 0.61 (-35.1 percent) for GC.

The researchers concluded, "Even a modest fee for service appears to have a major impact on the use of STI clinic services and may result in a significant effect on the ability to diagnose CT/GC infection, especially among those at highest risk."

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