As an emergency doctor at Roper St. Francis, John Walters sees patients with sexually transmitted infections multiple times a day.
The symptoms are not comfortable, he said, so few will want to wait to find treatment. But many also come in to the emergency department knowing full well they won't pay for the care they receive, Walters said, adding he doesn't have time to handle the infections.
"We’ve got better things to do than treat STDs," he said.
Still, the number of cases of sexually transmitted infections, or STIs, that emergency doctors like Walters have been treating has been increasing.
A study released this spring by the Centers for Disease Control and Prevention found there was an increase in STIs seen in American emergency departments. The trend held true especially among Medicaid recipients.
William Pearson, a CDC researcher educated in South Carolina, said treating STIs in the emergency room is less than ideal.
Walters said he can rarely treat STIs effectively in an emergency setting. Lab tests require days to confirm the diagnosis, so he is often left with no option but to treat without a positive test or send the patient home empty-handed.
Pearson and his colleagues at the CDC found there was a 2 percent increase between 2008 and 2013 in the total number of emergency visits, and a 39 percent increase, specifically, in STI-related visits. They found patients receiving STI care in emergency departments were typically not white and usually were covered by public insurance programs, like Medicaid. They included in their research cases of chlamydia, gonorrhea and "unspecified venereal disease," the most common STIs.
South Carolina hasn't escaped the national trend. Between 2010 and 2014, there was nearly a 30 percent increase in the number of people showing up to South Carolina emergency departments with STIs, according to data from the Agency for Healthcare Research and Quality. Although syphilis was not included in the CDC study because it is less common, that particular sexually transmitted disease has also long been on the rise in South Carolina.
The closure of clinics set up to specifically treat STDs has likely resulted in some people turning to emergency departments, the CDC researchers wrote. But the underlying reasons many people go to emergency departments for routine medical care instead of primary care doctors are more complex, experts said.
"They know if they go to the emergency department, they’ll get care," Pearson said.
Adam Weaver, prevention program manager for Lowcountry AIDS, said many of the people the nonprofit helps don't have a primary care doctor. Some prefer the anonymity of the emergency room, too, he said.
"The ER feels more like a confidential and unbiased place," Weaver said.
Not only are emergency departments not the best places to be treated for an STI, the trend could be contributing to a major public health risk: antibiotic resistance.
Resistance to the medications that treat gonorrhea is building. South Carolina has the fourth-worst rate of gonorrhea in the country, according to the CDC.
The World Health Organization reported in July a strain of gonorrhea has emerged that resists all known treatments. WHO researchers reported three such cases in the world. At the time, WHO experts warned it was "only a matter of time" before the antibiotics used to treat gonorrhea are useless, according to Reuters.
"We are on the verge of having this bug become untreatable," Pearson said.
He said doctors have a tendency to overtreat gonorrhea and chlamydia. About half receive the right treatment when they come to an emergency department with symptoms, the CDC researchers wrote.
For HIV, too, emergency departments are not ideal places to be tested or treated, said Kim Butler Willis, program director of The Ryan White Wellness Center.
Willis said there is not nearly enough screening for HIV and AIDS in emergency departments.
"You just can’t rely on the self-reporting of patients," Willis said. "They may not know."
STIs sometimes don't show symptoms, particularly in men, Willis said. In HIV/AIDS, the virus can lie dormant for years. When symptoms do emerge, they often resemble symptoms associated with the flu. Screening is paramount in South Carolina, where the risk of getting an HIV diagnosis is among the highest in the country.
Doctors would also ideally reach out to the patient's partner for treatment — another reason STIs aren't ideally treated in emergency departments.
"It takes at least two people," Pearson said.