Final year of medical school includes preparing for residency and celebrating research publications

Gabriel Lee, a fourth-year medical student at The Ohio State University College of Medicine, has two different successes to celebrate as he moves through his final year – he’s prepared to apply for medical residency programs in internal medicine and to continue working in advocacy and community research to bridge gaps in healthcare for uninsured and underserved populations.

Lee received a fellowship from The New York Academy of Medicine for his research analyzing sexually transmitted infections (STIs) and vaginitis testing outcomes at student-run free clinics (SRFCs), which play a vital role in addressing disparities in STI screening and treatment. Because data describing infection patterns and symptom-based testing outcomes in these settings is limited, his findings have been shared at regional and international conferences, and some were recently published in articles that appeared in two medical journals.

In “No Symptoms, No Problem? An Analysis of Asymptomatic and Symptomatic Sexually Transmitted Infections and the Impact on Clinical Outcomes in a Student-run Free Clinic” in the journal Infection, he shares the analysis of 296 patient records from a SRFC that tested them for Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, human immunodeficiency virus (HIV) and human papillomavirus (HPV) over a five-year period. At the time of testing, patients were categorized as symptomatic or asymptomatic and findings showed:

• Positivity rates were 19.6% for HPV, 7.1% for chlamydia, 7.1% for syphilis, 4.1% for gonorrhea and 0.5% for HIV.
• 50% of gonorrhea and chlamydia infections occurred in asymptomatic patients, showing that symptomatic presentation was not significantly associated with positive and negative results, underscoring its limitations.

“Vaginitis Testing Outcomes by Documented Symptom Status in a Student-run Free Clinic: A Retrospective Study,” recently published in the Journal of Obstetrics and Gynaecology, showed that documented symptom status did not consistently correspond with organism-specific test results. Lee also revealed that findings among patients without documented symptoms should be interpreted cautiously because testing was frequently bundled, and symptom status was determined retrospectively. The findings analyzed:

• How bacterial vaginosis, yeast infection and trichomoniasis cause similar symptoms, and that laboratory testing is needed to help identify the likely specific cause.
• Vaginitis testing performed at a SRFC included testing on patients with documented vaginitis symptoms and patients without.
• Bacterial vaginosis, yeast infection and trichomoniasis can cause similar symptoms, and the relationship symptoms and test results differed by condition. Some tests were ordered together as part of the same panel, and the absence of a documented symptom did not necessarily mean that the patient had no symptoms.
• How the findings show the importance of considering the reason for testing, the patient’s clinical presentation and the limitations of laboratory results.

Lee’s findings show that more research is needed to develop practical and accurate testing approaches for clinics serving patients with limited access to care. And expanding access to asymptomatic STI testing is essential in order to reduce missed diagnoses, improve equity and mitigate long-term sequelae among underserved populations.