Women's sexually transmitted infections in primary care: General practitioners' challenges and strategies - A qualitative study in Germany

Background The incidence of sexually transmitted infections (STI) is rising. Amongst women, STIs are often asymptomatic and thus likely underreported. STI care in Germany is fragmented. General Practitioners (GPs) could offer accessible care; however, to which extent GPs provide STI care and which challenges they face remains unclear. Objectives To increase understanding of how GPs provide STI care for women in German high-incidence settings and to identify challenges and opportunities for improved care. Methods Between 10/20 and 09/21, we contacted 75 practices using snowball and theoretical sampling. We conducted qualitative guide-assisted interviews with 19 GPs in their practices in Berlin, Germany. Data were analysed using thematic analysis with grounded theory components. Results Responsibilities and financing of STI care services were unclear. Most GPs perceived specialised doctors to be responsible for STI care in women; however, many non-STI specialised doctors were the first point of contact for patients and felt responsible to help. (LBTQI) Women were perceived to have less access to care. Stigmatising perceptions of women with STI-related needs were common. Doctors immediately referred patients to other providers, offered STI care for selected cases, or routinely offered primary STI care. GPs' referral strategies were often unsystematic. Those who offered primary STI care perceived patients' need for STI care, showed open attitudes to sexual health, and had undergone further training on STI care. Conclusion Training regarding STI care, remuneration, and referral pathways should be provided for GPs. Comprehensive STI care could be offered through the cooperation of GPs and specialists.