The role of local health departments in providing sexually transmitted disease services and surveillance in rural communities.

Local health departments (LHDs) are an important source for screening and treating sexually transmitted diseases (STDs) in rural communities. Yet, they oftentimes lack the resources needed to adequately assess and monitor these conditions. The purpose of this study was to (1) explore how rural LHDs assess and monitor STDs; (2) identify barriers to effective surveillance; (3) examine STD patterns in their communities; and (4) provide recommendations for improving surveillance. Data were collected from questionnaires, LHD site visits, client management system records, and state reports. One of the greatest challenges to adequately monitoring STDs was the lack of standardized data collection methods among LHDs. In addition, race/ethnicity information, which is critical to monitoring disparities, was lacking in most records. Among records where recorded, racial/ethnic minorities were most affected. STD patterns indicated adolescents lead all age groups in STDs. LHDs should consider regionalized or statewide approaches to assessing and monitoring STDs and develop standardized STD interview/intake forms, paying particular attention to race, ethnicity, and income data. Demographic and coding variables should be included and standardized across all forms for consistency. STD interventions and campaigns targeting adolescents and racial/ethnic minorities in rural counties should also be considered. Due to limited time and resources, little can be done by rural LHDs in regards to prevention and education, yet, state and federal agencies should consider how additional resources and enhanced support could be provided to assist them in fulfilling their public health role in STD surveillance.