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

Background Sexually transmitted infections (STIs) remain a major global public health concern, disproportionately affecting uninsured and underserved populations. Student-run free clinics (SRFCs) play a vital role in addressing disparities in STI screening and treatment; however, data describing infection patterns and symptom-based testing outcomes in these settings are limited. Methods This IRB-approved retrospective review analyzed 296 patient records from a SRFC between October 2019 and November 2023. Patients who underwent testing for Chlamydia trachomatis , Neisseria gonorrhoeae , Treponema pallidum , Human Immunodeficiency Virus (HIV) , and Human Papilloma Virus (HPV) were included. Patients were categorized as symptomatic or asymptomatic at the time of testing. Demographic data were collected when available. Results Positivity rates were 19.6% for HPV, 7.1% for chlamydia, 7.1% for syphilis, 4.1% for gonorrhea, and 0.5% for HIV. Roughly half of gonorrhea and chlamydia infections occurred in asymptomatic patients. Symptomatic presentation was not significantly associated with positive and negative results. Assigned male at birth (AMAB) patients and younger individuals had higher odds of gonorrhea, while older AMAB patients had higher odds of syphilis. Conclusions A substantial proportion of STIs, particularly gonorrhea and chlamydia, occurred in asymptomatic individuals, underscoring the limitations of symptom-based screening. Expanding access to asymptomatic STI testing in SRFCs is essential to reduce missed diagnoses, improve equity, and mitigate long-term sequelae among underserved populations.