Last Friday, I spent four hours at the Specialty Clinic on Barrett Ave. I try to go in for regular sexually transmitted infection tests (STI/STDs: HIV, syphilis, gonorrhea, etc.) about once a year, but this is my first attempt in Louisville. As you can imagine, this may be TMI for many of you, so proceed at your own risk.
Louisville Metro Public Health & Wellness only has one testing center in Louisville. I looked up the hours on the website and realized I would have to take off work in order to go in. Fortunately I have enough paid time off that it was worth using half a day of “personal time” to go to the Specialty Clinic.
A few months ago, I had found a primary care physician within walking distance of my office downtown. I moved to Louisville from Nashville in August 2009, so I wanted to find a local GP. I was off health insurance until a year ago, so I took my chances of having nothing but emergency care to turn to at the time. Other than occasional knee problems (I’ve had cartilage repair surgery 3 times since I was 16), I’ve been in good health. I asked around for doc recommendations, but none of them were close to downtown. My insurer through work, Blue Cross, listed Dr. Rajesh Sheth on Broadway, so I made an appointment.
I paid my $30 copay, and got my otherwise free general exam with Dr. Sheth. I asked him to take blood for the whole range of STI tests, but he said that it wouldn’t be worth the lab expenses if I didn’t have any symptoms. I always use condoms, but that’s not foolproof protection against STIs. Dr. Sheth again urged me not to get tested… Really? Are doctors trained to tell people not to get regularly tested for STI’s? I know it would probably cost over $100 ($2000 deductible & STI tests not covered under insurance) to do the lab work for several diseases, but the doctor didn’t even bother to go any further than a basic, “No, not if you don’t have symptoms.” I failed to mention HIV specifically – I wonder if he would have said no to that, as well. I’m now looking for a different GP.
This is why I decided to look into public health testing. It’s $20 to get tested, so I figured i’d save a little money by doing it this way. I used to go to the Nashville clinic to get tested and I never had to wait more than an hour or two. Not the case in Louisville. I scheduled half a day off two weeks ago and showed up at 8:15 (they open @ 8). They had already filled up their max of 10 patients for the day as there was only one person administering tests. Since I had the time off work anyway, I asked if there was anywhere else I could go and the receptionist recommended the Immediate Care Center on Dixie Highway.
I was also aware of Volunteers of America’s STOP Program which does HIV/syphilis-only tests for free. They’re on the same floor as the Specialty Clinic, but rarely have anyone in the office. I was able to catch a kind woman in the hallway named Jamila who offered to set up an appointment the following Tuesday, although she is only authorized to do the HIV swab test, not syphilis. This test has immediate results compared to the 1-2 week blood test that the Specialty Center uses. Unfortunately, Jamila didn’t know of anyone at STOP offering a test that morning, so I went back to the Specialty Clinic and they informed me I could do their own short-wait HIV/syphilis blood test even though the nurse was booked for main appointments. I was not aware that I had this option until that moment! It was about 9:30, so I decided to take a drive to the Immediate Care Center (IC) to see if they could do the whole gamut of tests for me that day.
The IC was a little further away than I expected, but after another $30 copay, I was able to see a doctor within 20 minutes. I happened to be having one of my yearly cold sore outbreaks. (Since I was about 10 yrs old, I get a barely-noticeable herpes outbreak near one of my nostrils, approximately once every year or two.) The doctor was able to visually confirm that it is HSV1, which I had always assumed, but never remember being told exactly what it was. One doctor in the past suggested I take L-Lysine daily to minimize the outbreaks, but that never seemed to make much of a difference. Otherwise, the doctor at the IC also said that I would have to pay $60 or $70 for each sti test if I opted to do that there (she did not have the exact costs). They also did not offer the HIV-swab, only a blood test. She did recommend a couple of GPs for me, so along with the HPV1 diagnosis, the IC visit wasn’t a complete waste of a trip.
I had a little time to spare before needing to get back to work at noon, so I decided to return to the Specialty Center and at least get the HIV bloodwork done. One of the nurses explained that I did not need to pay $20 if I only did the HIV test, so that was helpful underhand advice. I still don’t quite understand if I’m normally required to pay that or not. Anyway, I ended up waiting another 30 minutes before they could take my blood and send me on my way. Afterward, I was handed a sheet of paper with an ID and phone # to call in about a week to see if the results were ready. I would then have to come in since they don’t reveal HIV status over the phone.
I’ve been typing the majority of this blog entry at the Specialty Clinic waiting room two weeks later. I arrived here at 7:45 this morning and there were already nine people in front of me waiting for the doors to open. In hindsight, I should have shot for 7:30. I asked the receptionist a few minutes ago if Fridays are always this busy and she mentioned that they usually only have one person working Mondays and Fridays… so avoid those days!
The office here is fairly small. There are 24 black padded chairs, a television (playing a 1991 video about STIs called A Million Teenagers) and a few magazines and newsletters scattered about the room. The carpet is at least ten years old. The receptionists are buried in papers behind two receiving windows. It’s comfortably cool and odor free, even with a room full of people. There are six or seven rooms in the back, mostly for exams, consultation and a lab of some sort where I had my blood taken at 9:30.
Just to get my HIV results from my previous visit I had to wait 25 minutes. For the record, it came out negative. I didn’t realize (or maybe had just forgotten) that this HIV antibody test is only accurate 6 weeks to 6 months previous to the test date. In other words, if I’ve slept with anyone in the past 6-24 months whose HIV status I don’t know, I could still be infected without the test showing positive.
Back in the waiting room, after my 9:30 blood work, I asked the receptionist if I would have time to leave for about 45 minutes, to which she replied yes. I drove four blocks away to my regular barber shop (Woody’s) and got a haircut. By the time I had returned to the clinic, my only worry was that I may not get to see the nurse by noon. I waited for close to another hour. Still holding my little piece of paper with the number 10, I had accepted the plight of waiting for public services and was actually enjoying typing this all out on my tiny cell phone memo pad – and joking around a little with my fellow patients (what an appropriate name for people in a doctors office waiting room). I felt like I was friends with the nurses and secretaries since I had clocked about six hours in that office over the past two weeks. Earlier, as I was leaving for my haircut, one of the ladies peered out from behind the piles of papers and jested, “Would you mind grabbing me some Arby’s while you’re out, hon?”
A little after 11:30, they called my number and I was in and out in less than ten minutes. The nurse was kind and knowledgeable and I was somehow able to hold a normal conversation with her while my pants were down and I endured the quick but painful urethra swab. She also informed me that as far as online resources go, she trusts the WebMD.com and CDC.gov sites the most. To be honest, though, I’m a little confused about the HPV vaccine, which they do not offer at the clinic there. I believe she said that it’s something most people are vaccinated against when they’re young, so I need to check my medical records to make sure I’m covered there.
And that was it. I picked up my $265 receipt ($245 assumed by the health department) on the way out and made it to work by 12:10, just in time to have lunch with everyone at work.
Why did I bother going through all of this? Other than the yearly cold sore that appears on my nose for a few days, I’ve never had any other STI symptoms. I think most people (even Dr. Sheth) would take this as a sign that I’m clean. With 19 million new infections yearly in the United States, this is clearly a risky assumption. So even if I’m practicing safe sex, I will continue to get tested once or twice a year, just as I go to the dentist and the doctor regularly. However, the situation in Louisville is pretty ridiculous. How can a clinic taking 10 patients a day support a city of half a million people? It may be worth a few trips a year to Nashville to use their services instead.
UPDATE, Jul29: Went in to get my results this morning and there were only three people in line! Go figure…. It still took them 15 minutes to hand me my sheet of paper. All negative 🙂