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Salas-Marquez C, Bosch García R, Rivas Ruiz F, De Troya Martín M. Impact of a Training Directed to the Emergency Health Professionals on the Managements of Sexual Transmission Infection Patients. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T353-T355. [PMID: 36806632 DOI: 10.1016/j.ad.2022.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/07/2022] [Indexed: 02/19/2023] Open
Affiliation(s)
- C Salas-Marquez
- Departamento de Dermatología y Venereología, Hospital Costa del Sol, Marbella, Málaga, España; Programa de Doctorado de Biomedicina, Universidad de Málaga, Málaga, España.
| | - R Bosch García
- Programa de Doctorado de Biomedicina, Universidad de Málaga, Málaga, España; Departamento de Dermatología y Venereología, Facultad de Medicina, Universidad de Málaga, España; Departamento de Dermatología y Venereología, Hospital Clínico Virgen de la Victoria, Málaga, España
| | - F Rivas Ruiz
- Departamento de investigación, Hospital Costa del Sol, Marbella, Málaga, España
| | - M De Troya Martín
- Departamento de Dermatología y Venereología, Hospital Costa del Sol, Marbella, Málaga, España
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Viottini E, Albanesi B, Casabona E, Onorati R, Campagna S, Borraccino A. Ten-Year Trend in Emergency Department Visits for Sexually Transmitted Infections among Adolescents: A Retrospective Cross-Sectional Study in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14207. [PMID: 36361087 PMCID: PMC9656796 DOI: 10.3390/ijerph192114207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED Sexually transmitted infections (STIs) are frequently underdiagnosed, representing a serious public health concern, especially during adolescence and in more vulnerable communities. AIM to describe the last ten years of emergency department (ED) visits for STIs among adolescents. METHODS a retrospective cross-sectional observation was carried out in the Piedmont region in Italy. Data were retrieved through the Italian National Information System database. ED visits related to specific ICD-9-CM codes carried out on 11 to 19-year-old youths between 2011 and 2020 were investigated. Age-specific, crude, and standardized rates and admission ratios, with 95% confidence intervals (CIs), were calculated to estimate the STI trend. RESULTS from a total of 1,219,075 ED visits, 339 were related to STIs, representing an increasing ratio of 28 per 100,000 visits, primarily in females. Most infections occurred in girls (83.5%) and among 17 to 19-year-olds (71.5%). A drop in both ED visits and STI cases was observed in 2020. Genital Herpes and Genital Warts were more frequent in girls while Gonorrhea was more frequent in boys. CONCLUSIONS the increasing trend of ED visits for STIs, particularly in girls, represents an emerging relevant public health issue that needs to be urgently tackled.
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Affiliation(s)
- Elena Viottini
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy
| | - Beatrice Albanesi
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy
| | - Elena Casabona
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy
| | - Roberta Onorati
- Epidemiology Unit, Local Health Unit TO3, 10095 Grugliasco, Italy
| | - Sara Campagna
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy
| | - Alberto Borraccino
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy
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3
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Salas-Marquez C, Bosch García R, Rivas Ruiz F, De Troya Martín M. Impact of a Training Directed to the Emergency Health Professionals on the Managements of Sexual Transmission Infection Patients. ACTAS DERMO-SIFILIOGRAFICAS 2022; 114:353-355. [PMID: 36309043 DOI: 10.1016/j.ad.2022.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/09/2021] [Accepted: 01/07/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- C Salas-Marquez
- Departamento de Dermatología y Venereología, Hospital Costa del Sol, Marbella (Málaga), Spain; Programa de Doctorado de Biomedicina, Universidad de Málaga, Spain.
| | - R Bosch García
- Programa de Doctorado de Biomedicina, Universidad de Málaga, Spain; Universidad de Medicina de Málaga, Departamento de Dermatología y Venereología, Universidad de Málaga, Spain; Departamento de Dermatología y Venereología, Hospital Clínico Virgen de la Victoria, Málaga, Spain
| | - F Rivas Ruiz
- Departamento de Investigación, Hospital Costa del Sol, Marbella (Málaga), Spain
| | - M De Troya Martín
- Departamento de Dermatología y Venereología, Hospital Costa del Sol, Marbella (Málaga), Spain
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4
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Impact of Rapid Testing for Gonorrhea and Chlamydia in an Urban Pediatric Emergency Department. J Adolesc Health 2022; 70:910-914. [PMID: 35256240 DOI: 10.1016/j.jadohealth.2022.01.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/02/2021] [Accepted: 01/14/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine the impact of rapid testing for gonorrhea (NG) and chlamydia (CT) on accuracy of treatment in adolescents in the pediatric emergency department (ED). METHODS Retrospective study of adolescents tested for NG and CT in the pediatric ED before and after implementation of rapid testing. Treatment during initial visit, availability of test results prior to discharge, and number of follow-up phone calls made with test results were compared. Appropriate treatment was defined per Centers for Disease Control and Prevention 2015 guidelines as monotherapy for CT and dual therapy for NG. Descriptive statistics were used to compare groups. RESULTS Rapid testing improved treatment accuracy with 522 (79.3%) patients treated appropriately in the rapid testing group compared to 478 (64.7%) patients in the batched testing group (p < .001). Inaccurate treatment was more common in the batch testing group among those who tested negative (p < .001). Among those who tested positive for NG and/or CT, phone calls were made to 54 (47.8%) patients in the rapid testing group and 129 (84.3%) patients in the batched testing group to discuss positive test results (p < .001). CONCLUSION Compared to batched testing, rapid testing is associated with improved accuracy of treatment of NG and CT in the pediatric ED setting. Additionally, rapid testing is associated with decreased number of phone calls to discuss positive test results.
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Robertson C, Thomas A, Koyama A, Middlebrooks L, Kandaswamy S, Orenstein E, Gooding H. Missed Opportunities for Sexual History Documentation and Sexually Transmitted Infection Testing in the Pediatric Emergency Department. J Adolesc Health 2022; 70:429-434. [PMID: 34836803 DOI: 10.1016/j.jadohealth.2021.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Sexually transmitted infections (STIs) are disproportionally prevalent in adolescents, and adolescents often present to the pediatric emergency department (PED) for STI care. Prior studies have found low rates of sexual history documentation and STI testing in the PED. However, these studies have had limited sample sizes because of the burden of manual chart review. We aimed to estimate the rate of sexual history documentation and identify factors associated with STI testing in a large cohort of adolescents using natural language processing (NLP). METHODS We applied a validated NLP algorithm to all adolescent visits over a three-year period to the PED at a single large children's health care organization with a chief complaint potentially related to an STI. We utilized NLP to determine the prevalence of sexual history documentation in these patients. We applied logistic regression models to determine associations between sexual history documentation, patient demographic factors, and STI testing. RESULTS Of the 1,987 patient encounters included, only 56% had a sexual history documented, and only 40% of all patients were tested for STIs. Patients were more likely to have a sexual history documented and to be tested for STIs if they were of non-Hispanic black race/ethnicity, were >15 years of age, and had nonprivate insurance. Patients with a sexual history documented were seven times more likely to have STI testing ordered. Of patients tested (n = 728), 25% were positive for an STI. CONCLUSIONS Despite presenting to the PED with symptoms potentially related to an STI, many adolescents are not receiving recommended sexual health care. Rates of sexual history documentation and STI testing varied by demographic factors including race, age, and insurance status. Utilizing NLP technology allowed us to examine a larger sample size than previously documented in the adolescent sexual history and PED literature. This study highlights critical opportunities to improve sexual health provision and equity of care provided in the PED.
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Affiliation(s)
- Caryn Robertson
- Division of Pediatric Emergency Medicine, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia.
| | - Amanda Thomas
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Atsuko Koyama
- Division of Emergency Medicine, Department of Child Health, University of Arizona, College of Medicine Phoenix, Phoenix, Arizona
| | - Lauren Middlebrooks
- Division of Pediatric Emergency Medicine, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | - Evan Orenstein
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia; Division of Hospitalist Medicine, Atlanta, Georgia
| | - Holly Gooding
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia; Division of General Pediatrics and Adolescent Medicine, Atlanta, Georgia
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Marks LR, Reno H, Liang SY, Schwarz ES, Liss DB, Jiang L, Nolan NS, Durkin MJ. Value of Packaged Testing for Sexually Transmitted Infections for Persons who Inject Drugs Hospitalized With Serious Injection-Related Infections. Open Forum Infect Dis 2021; 8:ofab489. [PMID: 34926711 PMCID: PMC8675536 DOI: 10.1093/ofid/ofab489] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/23/2021] [Indexed: 11/14/2022] Open
Abstract
Background Persons who inject drugs (PWID) are frequently admitted for serious injection-related
infections (SIRIs). PWID are also at risk for sexually transmitted infections (STIs). Methods We conducted a multicenter quality improvement project at 3 hospitals in Missouri. PWID with
SIRI who received an infectious diseases consultation were prospectively identified and placed
into an electronic database as part of a Centers for Disease Control and
Prevention–funded quality improvement project. Baseline data were collected from
8/1/2019 to 1/30/2020. During the intervention period (2/1/2020–2/28/2021), infectious
diseases physicians caring for patients received 2 interventions: (1) email reminders of best
practice screening for HIV, viral hepatitis, and STIs; (2) access to a customized EPIC
SmartPhrase that included checkboxes of orders to include in assessment and plan of
consultation notes. STI screening rates were compared before and after the intervention. We
then calculated odds ratios to evaluate for risk factors for STIs in the cohort. Results Three hundred ninety-four unique patients were included in the cohort. Initial screening
rates were highest for hepatitis C (88%), followed by HIV (86%). The bundled intervention
improved screening rates for all conditions and substantially improved screening rates for
gonorrhea, chlamydia, and syphilis (30% vs 51%, 30% vs 51%, and 39 vs 60%, respectively;
P < .001). Of patients who underwent screening, 16.9% were
positive for at least 1 STI. In general, demographics were not strongly associated with
STIs. Conclusions PWID admitted for SIRI frequently have unrecognized STIs. Our bundled intervention improved
STI screening rates, but additional interventions are needed to optimize screening.
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Affiliation(s)
- Laura R Marks
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Hilary Reno
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Stephen Y Liang
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.,Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Evan S Schwarz
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.,Division of Medical Toxicology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - David B Liss
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.,Division of Medical Toxicology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Linda Jiang
- Division of Medical Education, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nathanial S Nolan
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Michael J Durkin
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Shamash Z, Catallozzi M, Dayan PS, Chernick LS. Preferences for Expedited Partner Therapy Among Adolescents in an Urban Pediatric Emergency Department: A Mixed-Methods Study. Pediatr Emerg Care 2021; 37:e91-e96. [PMID: 30883535 PMCID: PMC6744998 DOI: 10.1097/pec.0000000000001746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Expedited partner therapy (EPT) refers to treating sexual partners of patients with sexually transmitted infections by providing prescriptions or medications to give to their partners. Expedited partner therapy is not routinely prescribed in the emergency department (ED). Our objective was to explore adolescent preferences for EPT use in the ED. METHODS We conducted a mixed-methods study using surveys and semistructured interviews in one urban ED. Sexually active patients aged 15 to 19 years completed an anonymous survey eliciting (1) sexual history and risky sexual behaviors, (2) preferences for partner notification when hypothetically testing positive for an STI, and (3) preferences for EPT. A subsample of survey respondents participated in the interviews, which were conducted until no new perspectives emerged. Investigators analyzed interviews using thematic analysis. RESULTS A total of 247 participants completed surveys; the majority were female (183/247, 74%), Hispanic (209/243, 86%), and did not use a condom at last intercourse (129/243, 53%). Two thirds of participants (152/236, 64%) did not prefer EPT for partner notification. Preference for EPT was not associated with sex, age, ethnicity, condom use, a steady sexual partner, or STI history. Qualitative data from both surveys and interviews revealed the following reasons for not preferring EPT: concern for partner safety, importance of determining partner STI status, perceived benefit of clinical interaction, and partner accountability. Reasons for preferring EPT included increased treatment accessibility and convenience. CONCLUSIONS The majority of adolescent patients in a pediatric ED did not prefer EPT. Emergency department practitioners should address common concerns regarding EPT to increase EPT adherence if prescribed.
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Affiliation(s)
- Zohar Shamash
- Zohar Shamash, MD, Division of Pediatric Emergency
Medicine, Department of Pediatrics, 3959 Broadway, CHN 1-116, Columbia University
Medical Center, NY, NY, United States;
| | - Marina Catallozzi
- Marina Catallozzi, MD, MSCE, Population and Family Health
and Pediatrics at the Columbia University Medical Center, 622 W 168
Street, PH-520, NY, NY, United States;
| | - Peter S Dayan
- Peter S Dayan, MD MSc, Division of Pediatric Emergency
Medicine, Department of Pediatrics, 3959 Broadway, CHN 1-116, Columbia University
Medical Center, NY, NY, United States;
| | - Lauren S Chernick
- Lauren Chernick MD MSc, Division of Pediatric Emergency
Medicine, Department of Pediatrics, 3959 Broadway, CHN 1-116, Columbia University
Medical Center, NY, NY, United States; ,
212-305-9825 (phone), 212-305-0682 (fax)
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Eckman MH, Reed JL, Trent M, Goyal MK. Cost-effectiveness of Sexually Transmitted Infection Screening for Adolescents and Young Adults in the Pediatric Emergency Department. JAMA Pediatr 2021; 175:81-89. [PMID: 33136149 PMCID: PMC7607492 DOI: 10.1001/jamapediatrics.2020.3571] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Adolescents and young adults compose almost 50% of all diagnosed sexually transmitted infection (STI) cases annually in the US. Given that these individuals frequently access health care through the emergency department (ED), the ED could be a strategic venue for examining the identification and treatment of STIs. OBJECTIVE To examine the cost-effectiveness of screening strategies for Chlamydia trachomatis and Neisseria gonorrhoeae (chlamydia and gonorrhea) in adolescents and young adults who seek acute care at pediatric EDs. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation is a component of an ongoing, larger multicenter clinical trial at the Pediatric Emergency Care Applied Research Network. A decision analytic model, created using literature-based estimates for the key parameters, was developed to simulate the events and outcomes associated with 3 strategies for screening and testing chlamydial and gonococcal infections in individuals aged 15 to 21 years who sought acute care at pediatric EDs. Data sources included published (from January 1, 1997, to December 31, 2019) English-language articles indexed in MEDLINE, bibliographies in relevant articles, insurance claims data in the MarketScan database, and reimbursement payments from the Centers for Medicare and Medicaid Services. Because the events and outcomes were simulated, a hypothetical population of 10 000 ED visits by adolescents and young adults was used. INTERVENTIONS The 3 screening strategies were (1) no screening, (2) targeted screening, and (3) universally offered screening. Targeted screening involved the completion of a sexual health survey, which yielded an estimated STI risk (at risk, high risk, or low risk). MAIN OUTCOMES AND MEASURES Outcome metrics included cost (measured in 2019 US dollars) and the detection and successful treatment of STIs. The incremental cost-effectiveness ratio (ICER) of each strategy was calculated in a base case analysis. The ICER reflects the cost per case detected and successfully treated. RESULTS A 3.6% prevalence of chlamydia and gonorrhea was applied to a hypothetical population of 10 000 ED visits by adolescents and young adults. Targeted screening resulted in the detection and successful treatment of 95 of 360 STI cases (26.4%) at a cost of $313 063, and universally offered screening identified and treated 112 of 360 STI cases (31.1%) at a cost of $515 503. The ICER for targeted screening vs no screening was $6444, and the ICER for universally offered screening vs targeted screening was $12 139. CONCLUSIONS AND RELEVANCE This economic evaluation found that targeted screening and universally offered screening compared with no screening appeared to be cost-effective strategies for identifying and treating chlamydial and gonococcal infections in adolescents and young adults who used the ED for acute care. Universally offered screening was associated with detecting and successfully treating a higher proportion of STIs in this population.
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Affiliation(s)
- Mark H. Eckman
- Division of General Internal Medicine and the Center for Clinical Effectiveness, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Jennifer L. Reed
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Department of Pediatrics, The University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Maria Trent
- Department of Pediatrics, Johns Hopkins Medical Center, Baltimore, Maryland
| | - Monika K. Goyal
- Department of Pediatrics, Children's National Hospital, The George Washington University, Washington, DC
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Pediatric Emergency Provider Sexually Transmitted Infection Screening Practices in Adolescents With Oropharyngeal or Anorectal Chief Complaints. Pediatr Emerg Care 2020; 36:e614-e619. [PMID: 29406475 PMCID: PMC6077108 DOI: 10.1097/pec.0000000000001414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Sexually transmitted infections (STIs) may present with oropharyngeal or anorectal symptoms. Little is known about the evaluation of adolescents with these complaints in the pediatric emergency department (PED). This study aimed to determine the frequency of and factors associated with STI consideration and testing in this population. METHODS Retrospective chart review of patients aged 13 to 18 years who presented to an urban PED with oropharyngeal or anorectal chief complaints between June 2014 and May 2015. Sexually transmitted infection consideration was defined as sexual history documentation, documentation of STI in differential diagnosis, and/or diagnostic testing. Multivariate logistic regression models were used to identify factors associated with consideration. RESULTS Of 767 visits for oropharyngeal (89.4%), anorectal (10.4%), or both complaints, 153 (19.9%) had STI consideration. Of the 35 visits (4.6%) that included gonorrhea and/or chlamydia testing, 12 (34.3%) included testing at the anatomic site of complaint. Of those 12 tests, 50.0% were the incorrect test. Patients with older age (adjusted odds ratio [aOR] = 1.5, 95% confidence interval [CI] = 1.3-1.7), female sex (aOR = 1.6, 95% CI = 1.03-2.5), or anorectal complaints (aOR = 2.4, 95% CI = 1.3-4.3) were more likely to have STI consideration. CONCLUSIONS In an urban PED, only 20% of visits for adolescents with oropharyngeal or anorectal symptoms included STI consideration. Testing was performed in only 5% of cases and often at an inappropriate anatomic site or with the incorrect test. Interventions to increase awareness of appropriate STI consideration and testing for individuals presenting with possible extragenital complaints may help reduce STIs among adolescents.
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Hsieh YH, Lewis MK, Viertel VG, Myer D, Rothman RE, Gaydos CA. Performance evaluation and acceptability of point-of-care Trichomonas vaginalis testing in adult female emergency department patients. Int J STD AIDS 2020; 31:1364-1372. [PMID: 32998638 DOI: 10.1177/0956462420956532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated the accuracy and perception of a patient self-administered, tablet-facilitated rapid Trichomonas vaginalis (TV) point-of-care (POC) test in adult female emergency department (ED) patients.ED patients undergoing gynecologic examination were eligible. Each consented participant self-collected a vaginal swab, performed a tablet-facilitated TV rapid test using the OSOM® Trichomonas Rapid Test, and completed pre- and post-test self-surveys. After the self-test, the clinician collected one standard-of-care (SOC) vaginal swab for wet-mount testing and two for research. The research coordinator performed the TV rapid test using the clinician-collected swab, and reported the results to the clinician and patient. If the self- and coordinator-performed results were discordant, a TV nucleic acid amplification test (NAAT) was performed in a clinical laboratory. A survey was later administered to providers to assess their perceptions of the utility of the POC TV test.Of the 136 participants, 134 (98.5%) completed self-testing; two had invalid results. Comparing coordinator-performed TV rapid test adjudicated with NAAT, the sensitivity and specificity of self-administered test was 96.0% and 100%, respectively. The wet mount had a sensitivity of 52.0% and specificity of 100%. TV detection increased from 9.6% with wet mount to 18.4% with the TV rapid test. Most women (82.0%) stated self-testing was "not at all hard" (versus 66.2% before testing, p < 0.001). Clinicians indicated the TV rapid test affected their clinical management in 48.5% of cases, including 82.6% of positive cases and 41.6% of negative cases.ED patients were able to reliably collect, perform, and interpret their own POC TV test using tablet instructions. Both participants and providers reported high levels of acceptability of POC TV testing, which nearly doubled rates of TV detection.
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Affiliation(s)
- Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mitra K Lewis
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valentina G Viertel
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Deanna Myer
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard E Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charlotte A Gaydos
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Abstract
OBJECTIVES The objective of this study was to determine whether adolescents in emergency departments (EDs) who report engaging in high-risk sexual behaviors are less likely to identify a primary care provider (PCP) and more likely to access the ED than their sexually inexperienced peers. METHODS This was a secondary analysis of adolescents presenting to a pediatric ED with non-sexually transmitted infection (STI)-related complaints who completed surveys to assess sexual behavior risk and health care access. We measured differences in self-reported PCP identification, preferential use of the ED, and number of ED visits over a 12-month period by sexual experience. Secondary outcomes included clinician documented sexual histories and STI testing. RESULTS Of 758 patients meeting inclusion criteria, 341 (44.9%) were sexually experienced, and of those, 129 (37.8%) reported engaging in high-risk behavior. Participants disclosing high-risk behavior were less likely to identify a PCP (adjusted odds ratio, 0.5; 95% confidence interval [CI], 0.3-0.9), more likely to prefer the ED for acute care issues (adjusted odds ratio, 1.6; 95% CI, 1.0-2.6), and had a higher rate of ED visits (adjusted relative risk, 1.2; 95% CI, 1.0-1.3) compared with sexually inexperienced peers. Among patients disclosing high-risk behavior, 10.9% had clinician-documented sexual histories and 2.6% underwent STI testing. CONCLUSION Adolescents who reported engaging in high-risk sexual behaviors were less likely to identify a PCP, as well as more likely to prefer ED-based care and make more ED visits. However, ED clinicians infrequently obtained sexual histories and performed STI testing in asymptomatic youth, thereby missing opportunities to screen high-risk adolescents who may lack access to preventive care.
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12
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Chernick LS, Siden JY, Bell DL, Dayan PS. A Qualitative Assessment to Understand the Barriers and Enablers Affecting Contraceptive Use Among Adolescent Male Emergency Department Patients. Am J Mens Health 2020; 13:1557988319825919. [PMID: 30819063 PMCID: PMC6440070 DOI: 10.1177/1557988319825919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Early fatherhood is common in the United States (U.S.). The emergency department (ED) plays a disproportionate role in serving patients with unmet reproductive and sexual health needs. With 8 million adolescent males visiting U.S. EDs annually, the ED is a potential site to implement interventions to minimize early fatherhood and unintended teenage pregnancy. Little is known about how adolescent male ED patients perceive and behave in sexual relationships and how they influence contraceptive decision making. The objective of this study was to identify the barriers and enablers affecting contraceptive and condom use among adolescent male ED patients. Semistructured interviews were conducted with males aged 14–19 in one urban ED. Enrollment continued until saturation of key themes. Interviews were recorded, transcribed, and coded based on thematic analysis using NVivo 10. The Social Ecological Model was used to organize and understand themes. Participants (n = 24) were predominantly 18–19 years (63%) and Hispanic (92%). Most (71%) had sex ≤3 months prior but infrequently used a condom at last intercourse (42%). The primary barrier influencing contraceptive use was lack of knowledge of effective contraceptives. Other barriers consisted of perceived gender roles, poor partner communication, and little relationship with a primary provider. Enablers included intention not to get a partner pregnant, school-based sexual health education, normalcy to use condoms, and a trustworthy confidante. The identified barriers and enablers influencing adolescent males’ perspectives toward contraceptives should be addressed if designing future ED-based pregnancy prevention interventions targeting teen males.
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Affiliation(s)
- Lauren S Chernick
- 1 Division of Pediatric Emergency Medicine, Department of Emergency Medicine and Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Jonathan Y Siden
- 1 Division of Pediatric Emergency Medicine, Department of Emergency Medicine and Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - David L Bell
- 2 Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA.,3 Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Peter S Dayan
- 1 Division of Pediatric Emergency Medicine, Department of Emergency Medicine and Pediatrics, Columbia University Medical Center, New York, NY, USA
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Chernick LS, Chun TH, Richards R, Bromberg JR, Ahmad FA, McAninch B, Mull C, Shenoi R, Suffoletto B, Casper C, Linakis J, Spirito A. Sex Without Contraceptives in a Multicenter Study of Adolescent Emergency Department Patients. Acad Emerg Med 2020; 27:283-290. [PMID: 31596987 DOI: 10.1111/acem.13867] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/15/2019] [Accepted: 10/06/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES In the United States, rates of teenage pregnancy and sexually transmitted infections (STIs) remain exceptionally high, and racial and ethnic disparities persist. Emergency departments (EDs) care for over 19 million adolescents each year, the majority being minority and low socioeconomic status. Single-center studies demonstrate infrequent use of contraceptives among adolescent ED patients and an association between risky sex and behaviors such as alcohol and drug use; however, no multicenter ED data exist. The objectives of this study were to 1) determine the prevalence of sex without contraceptives in a large multicenter adolescent ED study and 2) assess patient demographic and risky behaviors associated with sex without contraceptives. METHODS Participants aged 14 to 17 years (n = 3,247) in 16 pediatric EDs across the United States completed an electronic survey. Questions focused on validated measures of risky sex; use of alcohol, tobacco, marijuana, and other drugs; and depression and violence. In this secondary analysis, we constructed univariable and multivariable models to identify demographic and behavioral factors associated with sex without contraceptives (our primary outcome), separately for adolescent males and females. RESULTS In the prior year, 17.4% (236/1,356) of males and 15.8% (299/1,891) of females had sex without contraceptives. In the multivariable model, sex without contraceptives for both genders was more likely among teens who were black, with conduct problems and participated in casual sex, binge drinking, or cannabis use. Sex without contraceptives was also more likely among Hispanic and cigarette-smoking males, as well as depressed females. CONCLUSIONS Adolescent ED patients across the United States are participating in risky sexual behaviors that increase their likelihood of pregnancy and STI acquisition. These adolescents report a number of problem behaviors, including substance use, which are strongly correlated with unprotected sex. The ED visit may be an opportunity to identify at-risk adolescent patients, address risky behaviors, and intervene to improve adolescent health.
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Affiliation(s)
- Lauren S. Chernick
- Division of Pediatric Emergency Medicine Department of Emergency Medicine Columbia University Medical Center New York NY
| | - Thomas H. Chun
- Department of Pediatrics and Emergency Medicine The Warren Alpert Medical School of Brown UniversityRhode Island Hospital ProvidenceRI
| | - Rachel Richards
- Division of Pediatric Critical Care Department of Pediatrics University of Utah Health Sciences Center Salt Lake City UT
| | - Julie R. Bromberg
- Department of Emergency Medicine The Warren Alpert Medical School of Brown UniversityRhode Island Hospital ProvidenceRI
| | - Fahd A. Ahmad
- Department of Pediatrics Washington University School of Medicine St. Louis MO
| | - Brett McAninch
- Division of Pediatric Emergency Medicine Department of Pediatrics University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh PittsburghPA
| | - Colette Mull
- Division of Pediatric Emergency Medicine Department of Pediatrics Nemours/Alfred I. duPont Hospital for Children Wilmington DE
| | - Rohit Shenoi
- Section of Emergency Medicine Department of Pediatrics Baylor College of Medicine Houston TX
| | - Brian Suffoletto
- Department of Emergency Medicine University of Pittsburgh Pittsburgh PA
| | - Charlie Casper
- Division of Pediatric Critical Care Department of Pediatrics University of Utah Health Sciences Center Salt Lake City UT
| | - James Linakis
- Department of Pediatrics and Emergency Medicine The Warren Alpert Medical School of Brown UniversityRhode Island Hospital ProvidenceRI
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior Alpert Medical School of Brown University Providence RI
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Lieberman A, Badolato GM, Tran J, Goyal MK. Frequency of Prescription Filling Among Adolescents Prescribed Treatment for Sexually Transmitted Infections in the Emergency Department. JAMA Pediatr 2019; 173:695-697. [PMID: 31135829 PMCID: PMC6547101 DOI: 10.1001/jamapediatrics.2019.1263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This study investigates prescription filling for the treatment of sexually transmitted infections among adolescents in the emergency department setting.
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Affiliation(s)
- Alexandra Lieberman
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Gia M. Badolato
- Department of Pediatrics, Children’s National Health System, Washington, DC
| | - Jennifer Tran
- Department of Pediatrics, Children’s National Health System, Washington, DC
| | - Monika K. Goyal
- George Washington University School of Medicine and Health Sciences, Washington, DC,Department of Pediatrics, Children’s National Health System, Washington, DC
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Diagnosis and Treatment of Sexually Transmitted Infections in the Emergency Department. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2019. [DOI: 10.1016/j.cpem.2019.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Physician Adherence to Centers for Disease Control and Prevention Guidelines for Sexually Active Adolescents in the Pediatric Emergency Setting. Pediatr Emerg Care 2018; 34:767-773. [PMID: 27749798 PMCID: PMC5378669 DOI: 10.1097/pec.0000000000000873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES There is limited literature about physicians' adherence to 2010 Centers for Disease Control and Prevention (CDC) Sexually Transmitted Diseases Treatment Guidelines specific to specimen collection testing methods in adolescent females in the emergency setting is limited. The objectives are to (1) determine physician adherence to CDC guidelines for specimen collection/testing for chlamydia and gonorrhea, (2) determine physician characteristics associated with guideline adherence, and (3) describe physicians' knowledge of expedited partner therapy (EPT) laws. METHODS This is a cross-sectional, anonymous, Internet-based survey of physician members of the American Academy of Pediatrics Section of Emergency Medicine. Questions addressed practice patterns and knowledge through clinical scenarios of adolescent girls. Descriptive statistics are used to report frequency. Fisher exact and χ analyses are used to compare physician subgroups: gender, years in practice, practice setting, and geographical region. RESULTS Overall, 257 physicians responded and 231 were analyzed; 62.4% females; 46.0% in practice for ≤ 7 years; 86.2% in academic medicine. Specimen collection/testing in an asymptomatic patient were consistent with guidelines for 85.6% of respondents, but decreased to 37.4% for a symptomatic patient. Guideline adherence was not different between physician subgroups. Only 30.4% of physicians reported state EPT law knowledge. CONCLUSIONS Adherence with the CDC guidelines for chlamydia/gonorrhea specimen collection/testing for adolescents in the emergency setting is inadequate, and EPT knowledge is poor. With increased emergency department use by adolescents, it is critical that physicians know and implement the current recommendations to improve adolescent health outcomes.
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Hilbert SM, Reno HEL. Management of Patients with Sexually Transmitted Infections in the Emergency Department. Emerg Med Clin North Am 2018; 36:767-776. [PMID: 30297003 DOI: 10.1016/j.emc.2018.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sexually transmitted infections (STI) are very common infections in the United States. Most patients with STIs are evaluated and treated in primary care settings; however, many also present to the Emergency Department (ED) for initial care. Management of STIs in the ED includes appropriate testing and treatment per CDC Sexually Transmitted Diseases Treatment Guidelines. Although most patients with STIs are asymptomatic or may only exhibit mild symptoms, serious complications from untreated infection are possible. Pregnant women with STIs are particularly vulnerable to serious complications; therefore, empiric ED treatment combined with close follow-up care and referral to obstetrics are paramount.
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Affiliation(s)
- SueLin M Hilbert
- Department of Emergency Medicine, Washington University in St. Louis, 660 S. Euclid Campus Box 8072, St. Louis, MO 63110, USA
| | - Hilary E L Reno
- Division of Infectious Disease, Washington University in St. Louis, Campus Box 8051, 4523 Clayton Avenue, St Louis, MO 63110, USA.
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Breslin K, Tuchman L, Hayes KL, Badolato G, Goyal MK. Sensitivity and Specificity of Empiric Treatment for Sexually Transmitted Infections in a Pediatric Emergency Department. J Pediatr 2017. [PMID: 28629687 PMCID: PMC5614813 DOI: 10.1016/j.jpeds.2017.05.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine test characteristics of provider judgment for empiric antibiotic provision to patients undergoing testing for a sexually transmitted infection. STUDY DESIGN We conducted a retrospective cross-sectional electronic health record review of all patients aged 13-19 years who had Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) testing sent from an urban, academic pediatric emergency department in 2012. We abstracted data, including patient demographics, chief complaint, sexually transmitted infection test results, and treatment. We calculated test characteristics comparing clinician judgment for presumptive treatment for a sexually transmitted infection with the reference standard of the actual results of testing for a sexually transmitted infection. RESULTS Of 1223 patient visits meeting inclusion criteria, 284 (23.2%) had a positive GC and/or CT test result. Empiric treatment was provided in 615 encounters (50.3%). Provider judgment for presumptive treatment had an overall sensitivity of 67.6% (95% CI, 61.8-73.0) and a specificity of 55% (95% CI, 51.7-58.2) for accurate GC and/or CT detection. CONCLUSIONS Many adolescents tested for GC and CT receive empiric treatment at the initial emergency department visit. Provider judgment may lack sufficient sensitivity and specificity for identifying infected patients, resulting in the potential for undertreatment of true disease, overtreatment of uninfected patients, or both.
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Affiliation(s)
- Kristen Breslin
- Division of Emergency Medicine, Children's National Medical Center, Washington, DC.
| | - Lisa Tuchman
- Adolescent Medicine, Children's National Medical Center, Washington, DC, United States (Tuchman)
| | - Katie L Hayes
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States (Hayes)
| | - Gia Badolato
- Division of Emergency Medicine, Children's National Medical Center, Washington, DC, United States
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Medical Center, Washington, DC, United States
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Maraynes ME, Chao JH, Agoritsas K, Sinert R, Zehtabchi S. Screening for asymptomatic chlamydia and gonorrhea in adolescent males in an urban pediatric emergency department. World J Clin Pediatr 2017; 6:154-160. [PMID: 28828298 PMCID: PMC5547427 DOI: 10.5409/wjcp.v6.i3.154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/16/2017] [Accepted: 06/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhea (GC) in young men seeking care in the emergency department (ED) for non-sexually transmitted infection (STI) related symptoms.
METHODS This was a prospective, cross-sectional study in an urban ED. The main outcome was the rate of positive CT and GC on urine nucleic acid amplification testing in males aged 16-21 presenting with non-STI related complaints.
RESULTS Two hundred and eighty-four patients were enrolled, 271 were included in the final data analysis [age range 16-21, median: 18 (quartiles 16-18, 19-21)]. Overall, 17 (6.3%, 95%CI: 4%-10%) tested positive for CT and 0% (95%CI: 0%-2%) were found to have GC. The proportion of sexually active subjects was 71% (95%CI: 65%-76%) and 2% (95%CI: 0.6%-4%) reported sex with men. Previous STI testing was reported in 46% (95%CI: 43%-54%) and 13% (95%CI: 8%-20%) of those patients previously tested had a history of STI. Of the patients who tested positive for CT in the ED, 88% (95%CI: 64%-98%) were successfully followed up.
CONCLUSION The prevalence of CT infection found by screening was 6.3%. Screening and follow-up from the ED was successful. The findings justify routine STI screening in male adolescents presenting to the ED with non-STI related complaints.
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Goyal MK, Fein JA, Badolato GM, Shea JA, Trent ME, Teach SJ, Zaoutis TE, Chamberlain JM. A Computerized Sexual Health Survey Improves Testing for Sexually Transmitted Infection in a Pediatric Emergency Department. J Pediatr 2017; 183:147-152.e1. [PMID: 28081888 PMCID: PMC5440080 DOI: 10.1016/j.jpeds.2016.12.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/27/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess whether clinical decision support, using computerized sexually transmitted infection (STI) risk assessments, results in increased STI testing of adolescents at high risk for STI. STUDY DESIGN In a 2-arm, randomized, controlled trial conducted at a single, urban, pediatric emergency department, adolescents completed a computerized sexual health survey. For patients assigned to the intervention arm, attending physicians received decision support to guide STI testing based on the sexual health survey-derived STI risk; in the usual care arm, decision support was not provided. We compared STI testing rates between the intervention and usual care groups, adjusting for potential confounding using multivariable logistic regression. RESULTS Of the 728 enrolled patients, 635 (87.2%) had evaluable data (323 intervention arm; 312 usual care arm). STI testing frequency was higher in the intervention group compared with the usual care group (52.3% vs 42%; aOR 2 [95% CI 1.1, 3.8]). This effect was even more pronounced among the patients who presented asymptomatic for STI (28.6 vs 8.2%; aOR 4.7 [95% CI 1.4-15.5]). CONCLUSIONS Providing sexual health survey-derived decision support to emergency department clinicians led to increased testing rates for STI in adolescents at high risk for infection, particularly in those presenting asymptomatic for infection. Studies to understand potential barriers to decision support adherence should be undertaken to inform larger, multicenter studies that could determine the generalizability of these findings and whether this process leads to increased STI detection. TRIAL REGISTRATION ClinicalTrials.gov: NCT02509572.
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Affiliation(s)
- Monika K Goyal
- Department of Pediatrics & Emergency Medicine, Children's National Health System, Washington, DC.
| | - Joel A Fein
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Gia M Badolato
- Department of Pediatrics & Emergency Medicine, Children's National Health System, Washington, DC
| | - Judy A Shea
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Maria E Trent
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Stephen J Teach
- Department of Pediatrics & Emergency Medicine, Children's National Health System, Washington, DC
| | - Theoklis E Zaoutis
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - James M Chamberlain
- Department of Pediatrics & Emergency Medicine, Children's National Health System, Washington, DC
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Screening for Asymptomatic Gonorrhea and Chlamydia in the Pediatric Emergency Department. Sex Transm Dis 2016; 43:209-15. [PMID: 26967296 DOI: 10.1097/olq.0000000000000424] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Because adolescents rely heavily on emergency services for health care, a pediatric emergency department (PED) visit may be their only opportunity for sexually transmitted infection (STI) screening. The primary objectives of this study were to determine the proportion of Neisseria gonorrheae (GC) and Chlamydia trachomatis (CT) infections in asymptomatic PED adolescents and patient-perceived barriers to STI screening. METHODS A convenience sample of patients aged 14 to 21 years presenting to an urban PED with nongenitourinary complaints was offered screening for GC and CT. Regardless of declining or accepting screening, all were asked to complete a questionnaire designed to identify barriers to screening. RESULTS Sixty-eight percent of those approached participated (n = 719). Those who agreed to STI screening were more likely to be nonwhite (61.4% vs. 38.6%, P = 0.001) and publically insured (63.3%) versus privately insured (29.3%) or no insurance (7.58%). Four hundred three (56%) participants provided urine samples, and of those, 40 (9.9%) were positive for an STI. Controlling for other demographics, race was a significant predictor, with the odds of testing positive for nonwhite participants 5.90 times that of white participants. Patients who refused testing were more likely to report not engaging in sexual activity (54.3% vs. 42.4%, P = 0.009) and less likely to perceive that they were at risk for STIs. CONCLUSIONS There are high proportions of GC and CT among asymptomatic adolescents visiting an academic urban PED. A universal PED STI screening program may be an important component of STI reduction initiatives, especially among adolescents who do not perceive that they are at risk and may not receive testing elsewhere.
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Anaene M, Soyemi K, Caskey R. Factors associated with the over-treatment and under-treatment of gonorrhea and chlamydia in adolescents presenting to a public hospital emergency department. Int J Infect Dis 2016; 53:34-38. [PMID: 27771470 DOI: 10.1016/j.ijid.2016.10.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/16/2016] [Accepted: 10/14/2016] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The purpose of this study was to measure the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) and the rates and factors associated with their over-treatment (OT) and under-treatment (UT). METHODS A retrospective chart review was performed of patients aged 13-24 years who were screened for GC/CT in the emergency department (ED) of a public hospital. Descriptive statistics were obtained for all variables, and multivariate log binomial regression was performed to ascertain the factors associated with OT and UT. RESULTS Seven hundred and ninety-seven adolescents and young adults were screened for GC/CT. The overall sexually transmitted infection (STI) positivity rate was 21.6%; 136 (21.6%) subjects were over-treated and 74 (43.4%) subjects were under-treated. Patients presenting with STI exposure or genito-urinary symptoms were more likely to be OT. Additionally, females aged 18-19 years or with a prior history of STIs were more likely to be OT. Females (83.6%) were more likely to be UT, while STI exposure, genito-urinary symptoms, and a prior history of STI were protective of UT . CONCLUSION Adolescents and young adults screened for STIs have a high prevalence of GC/CT. A significant proportion of these patients end up over-treated and an even higher proportion are under-treated.
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Affiliation(s)
- Mutimbwa Anaene
- Department of Pediatrics (MC 856), The University of Illinois at Chicago, 840 S. Wood Street, Chicago, IL 60612, USA.
| | - Kenneth Soyemi
- Pediatric Emergency Room, John H. Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Rachel Caskey
- Department of Internal Medicine, The University of Illinois at Chicago, Chicago, Illinois, USA
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Goyal MK, Shea JA, Hayes KL, Badolato G, Chamberlain JM, Zaoutis T, Fein J. Development of a Sexual Health Screening Tool for Adolescent Emergency Department Patients. Acad Emerg Med 2016. [DOI: https:/doi:10.1111/acem.12994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Monika K. Goyal
- Children's National Health System; The George Washington University; Washington DC
| | - Judy A. Shea
- The University of Pennsylvania; Perelman School of Medicine; Philadelphia PA
| | | | - Gia Badolato
- Children's National Health System; The George Washington University; Washington DC
| | - James M. Chamberlain
- Children's National Health System; The George Washington University; Washington DC
| | - Theoklis Zaoutis
- The University of Pennsylvania; Perelman School of Medicine; Philadelphia PA
- Children's Hospital of Philadelphia; Philadelphia PA
| | - Joel Fein
- The University of Pennsylvania; Perelman School of Medicine; Philadelphia PA
- Children's Hospital of Philadelphia; Philadelphia PA
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Goyal MK, Shea JA, Hayes KL, Badolato G, Chamberlain JM, Zaoutis T, Fein J. Development of a Sexual Health Screening Tool for Adolescent Emergency Department Patients. Acad Emerg Med 2016; 23:809-15. [PMID: 27126128 DOI: 10.1111/acem.12994] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/15/2016] [Accepted: 03/24/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective was to develop a content-valid audio computer-assisted self-interview (ACASI) sexual health survey (SHS) that is understandable and acceptable to adolescents and can be feasibly implemented in a pediatric emergency department (ED) for sexually transmitted infection (STI) risk assessment. METHODS Multistep iterative qualitative study utilizing a Delphi panel of key informants for survey development and content validity, cognitive interviews with end-users to evaluate understanding, and pilot testing with end-users to evaluate acceptability and feasibility. RESULTS We developed a 20-item questionnaire through an iterative modified Delphi process with experts in adolescent and pediatric emergency medicine. All items were assessed as understandable by >90% of adolescents during the cognitive interviews. All respondents found the SHS easy to use. A total of 76.5% preferred answering questions related to sexual health through the SHS compared to face-to-face interviews. Mean (±SD) length of survey completion was 17.5 (±6.7) minutes and 88.6% of participants found survey length to be "just right." With respect to feasibility testing, there was no statistically significant difference in median ED LOS between those who piloted the SHS and those who did not (230.0 minutes vs. 219.0 minutes; p = 0.7). CONCLUSIONS We developed a content-valid ACASI for the identification of adolescents at risk for STIs that was understandable, acceptable, and easy to use by adolescent patients and feasible for implementation in the pediatric ED. Future planned steps include the evaluation of the SHS in providing clinical decision support for targeted STI screening in the ED.
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Affiliation(s)
- Monika K. Goyal
- Children's National Health System; The George Washington University; Washington DC
| | - Judy A. Shea
- The University of Pennsylvania; Perelman School of Medicine; Philadelphia PA
| | | | - Gia Badolato
- Children's National Health System; The George Washington University; Washington DC
| | - James M. Chamberlain
- Children's National Health System; The George Washington University; Washington DC
| | - Theoklis Zaoutis
- The University of Pennsylvania; Perelman School of Medicine; Philadelphia PA
- Children's Hospital of Philadelphia; Philadelphia PA
| | - Joel Fein
- The University of Pennsylvania; Perelman School of Medicine; Philadelphia PA
- Children's Hospital of Philadelphia; Philadelphia PA
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Kosambiya JK, Baria HG, Parmar R, Mhaskar R, Emmanuel P, Kumar A. Diagnostic accuracy of self-reported symptomatic assessment versus per speculum/per vaginal examination for the diagnosis of vaginal/cervical discharge and lower abdominal pain syndromes among female sex workers. Indian J Sex Transm Dis AIDS 2016; 37:12-6. [PMID: 27190406 DOI: 10.4103/0253-7184.180294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND National AIDS Control Organization guidelines on enhanced syndromic case management of sexually transmitted infections (STIs) and reproductive tract infections (RTIs) require per speculum (P/S) and per vaginal (P/V) examinations for diagnosis of STIs. However, it is not known if the addition of P/S and P/V examinations to self-reported symptomatic assessment adds any value for the diagnosis of STI/RTI. OBJECTIVE To assess the diagnostic accuracy of P/S and P/V examinations compared with self-reported symptomatic assessment in a cohort of female sex workers (FSWs). METHODS We performed a cross-sectional study from August 2009 to June 2010, among 519 FSWs in Surat city, Gujarat, India. Symptomatic assessment for the presence or absence of vaginal/cervical discharge (VCD) or lower abdominal pain (LAP) was done using a self-administered questionnaire. After completion of the questionnaire, all participants underwent P/S and P/V examinations. Summary diagnostic accuracy measures were calculated. RESULTS Five hundred and nineteen FSWs between the ages of 18-49 years participated in the study. The median age of participants was 31 years. The prevalence of VCD and LAP syndromes based on vaginal discharge, LAP, or both was 56%, 5,-10%, respectively. The sensitivity of P/S and P/V examinations depending on symptomatic assessment ranged from 47% to 76%. The specificity ranged from 73% to 93%. The positive predictive value ranged from 25% to 83%, and the negative predictive value ranged from 56% to 98%. CONCLUSION Symptomatic assessment alone is not adequate for the diagnosis of VCD and LAP syndromes and can lead to a significant number of missed cases (36%). A P/S and P/V examinations is critical for assessment of VCD and LAP syndromes and subsequent treatment.
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Affiliation(s)
| | - H G Baria
- Department of Community Medicine, GMERS Medical College, Valsad, Gujarat, India
| | - Rohit Parmar
- Department of Community Medicine, GMERS Medical College, Vadodara, Gujarat, India
| | - Rahul Mhaskar
- USF Health Program for Comprative Effectiveness Research, Morsani Medical College, University of South Florida, Tampa, Florida, USA
| | - Patricia Emmanuel
- Department of Pediatrics, Morsani Medical College, University of South Florida, Tampa, Florida, USA
| | - Ambuj Kumar
- USF Health Program for Comprative Effectiveness Research, Morsani Medical College, University of South Florida, Tampa, Florida, USA
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Goyal MK, Teach SJ, Badolato GM, Trent M, Chamberlain JM. Universal Screening for Sexually Transmitted Infections among Asymptomatic Adolescents in an Urban Emergency Department: High Acceptance but Low Prevalence of Infection. J Pediatr 2016; 171:128-32. [PMID: 26846572 PMCID: PMC4808598 DOI: 10.1016/j.jpeds.2016.01.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 11/25/2015] [Accepted: 01/06/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate acceptance of sexually transmitted infection (STI) screening and measure STI prevalence in an asymptomatic adolescent emergency department (ED) population. STUDY DESIGN This was a prospectively enrolled cross-sectional study of 14- to 21-year-old patients who sought care at an urban pediatric ED with non-STI related complaints. Participants completed a computer-assisted questionnaire to collect demographic and behavioral data and were asked to provide a urine sample to screen for Chlamydia trachomatis and Neisseria gonorrhoeae infection. We calculated STI screening acceptance and STI prevalence. We used logistic regression to identify factors associated with screening acceptance and presence of infection. RESULTS Of 553 enrolled patients, 326 (59.0%) agreed to be screened for STIs. STI screening acceptability was associated with having public health insurance (aOR 1.7; 1.1, 2.5) and being sexually active (sexually active but denying high risk activity [aOR 1.7; 1.1, 2.5]; sexually active and reporting high risk activity [aOR 2.6; 1.5, 4.6]). Sixteen patients (4.9%; 95% CI 2.6, 7.3) had an asymptomatic STI. High-risk sexual behavior (aOR 7.2; 1.4, 37.7) and preferential use of the ED rather than primary care for acute medical needs (aOR 4.0; 1.3, 12.3) were associated with STI. CONCLUSIONS STI screening is acceptable to adolescents in the ED, especially among those who declare sexual experience. Overall, there was a low prevalence of asymptomatic STI. Risk of STI was higher among youth engaging in high-risk sexual behavior and those relying on the ED for acute health care access. Targeted screening interventions may be more efficient than universal screening for STI detection in the ED.
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Affiliation(s)
- Monika K Goyal
- Children's National Health System, Washington, DC; Departments of Pediatrics and Emergency Medicine, the George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Stephen J Teach
- Children's National Health System, Washington, DC; Departments of Pediatrics and Emergency Medicine, the George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | - Maria Trent
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - James M Chamberlain
- Children's National Health System, Washington, DC; Departments of Pediatrics and Emergency Medicine, the George Washington University School of Medicine and Health Sciences, Washington, DC
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Communicating With the Adolescent: Consent and Confidentiality Issues. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2015. [DOI: 10.1016/j.cpem.2015.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Miller MK, Dowd MD, Harrison CJ, Mollen CJ, Selvarangan R, Humiston SG. Prevalence of 3 sexually transmitted infections in a pediatric emergency department. Pediatr Emerg Care 2015; 31:107-12. [PMID: 25654676 PMCID: PMC5004729 DOI: 10.1097/pec.0000000000000284] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to determine the prevalence of Chlamydia trachomatis, Neisseria gonorrheae, and Trichomonas vaginalis and to describe factors associated with sexually transmitted infection (STI) in a pediatric emergency department (ED). METHODS Adolescents aged 14 to 19 years presenting to a Midwestern pediatric ED were asked to provide urine for STI testing and complete a survey about previous sexual activity (PSA), high-risk behaviors, demographics, and visit reason (reproductive: genitourinary complaints, abdominal pain, or a female with vomiting). Comparisons between subgroups were analyzed using Χ test. RESULTS Among 200 subjects (64% of approached), mean age was 15.6 years; 63% were female. Eleven subjects (6%; 95% confidence interval, 2.3-8.7) tested positive for 1 or more STIs: 10 for C. trachomatis (one denied PSA), 3 for T. vaginalis (all coinfected with C. trachomatis), and 1 for N. gonorrheae. Half reported PSA; of these, 71% reported 1 or more high-risk behaviors, most commonly first sex before the age of 15 years (51%) and no condom at last sex (42%). Among those with PSA and nonreproductive visit (n = 73), 11.0% had 1 or more STIs (95% confidence interval, 3.4-18.1). Two factors were associated with greater likelihood of positive STI test result, namely, reporting PSA versus no PSA (10% vs 1%, P = 0.005) and last sex within 1 month or less versus more than 1 month (20% vs 0%, P = 0.001). In this sample, none of the following characteristics were associated with STI: insurance, race, high-risk behaviors, age, or ED visit reason. CONCLUSIONS Approximately 1 in 10 sexually active adolescent ED patients without reproductive complaints had 1 or more STIs. This suggests the need for strategies to increase STI testing for this population.
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Affiliation(s)
- Melissa K. Miller
- Division of Emergency and Urgent Care, Department of Pediatrics, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - M. Denise Dowd
- Division of Emergency and Urgent Care, Department of Pediatrics, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - Christopher J Harrison
- Division of Infectious Disease, Department of Pediatrics, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - Cynthia J. Mollen
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - Sharon G. Humiston
- Division of Emergency and Urgent Care, Department of Pediatrics, Children’s Mercy Hospitals and Clinics, Kansas City, MO
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Reed JL, Huppert JS, Taylor RG, Gillespie GL, Byczkowski TL, Kahn JA, Alessandrini EA. Improving sexually transmitted infection results notification via mobile phone technology. J Adolesc Health 2014; 55:690-7. [PMID: 24962503 PMCID: PMC4209334 DOI: 10.1016/j.jadohealth.2014.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/08/2014] [Accepted: 05/09/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE To improve adolescent notification of positive sexually transmitted infection (STI) tests using mobile phone technology and STI information cards. METHODS A randomized intervention among 14- to 21-year olds in a pediatric emergency department (PED). A 2 × 3 factorial design with replication was used to evaluate the effectiveness of six combinations of two factors on the proportion of STI-positive adolescents notified within 7 days of testing. Independent factors included method of notification (call, text message, or call + text message) and provision of an STI information card with or without a phone number to obtain results. Covariates for logistic regression included age, empiric STI treatment, days until first attempted notification, and documentation of confidential phone number. RESULTS Approximately half of the 383 females and 201 males enrolled were ≥18 years of age. Texting only or type of card was not significantly associated with patient notification rates, and there was no significant interaction between card and notification method. For females, successful notification was significantly greater for call + text message (odds ratio, 3.2; 95% confidence interval, 1.4-6.9), and documenting a confidential phone number was independently associated with successful notification (odds ratio, 3.6; 95% confidence interval, 1.7-7.5). We found no significant predictors of successful notification for males. Of patients with a documented confidential phone number who received a call + text message, 94% of females and 83% of males were successfully notified. CONCLUSIONS Obtaining a confidential phone number and using call + text message improved STI notification rates among female but not male adolescents in a pediatric emergency department.
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Affiliation(s)
- Jennifer L Reed
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Jill S Huppert
- Division of Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Regina G Taylor
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Terri L Byczkowski
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jessica A Kahn
- Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Evaline A Alessandrini
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; The Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Jenkins WD, LeVault KR. Sexual history taking in the emergency department - more specificity required. J Emerg Med 2014; 48:143-51. [PMID: 25282115 DOI: 10.1016/j.jemermed.2014.06.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/16/2014] [Accepted: 06/30/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are the most reported diseases in the United States, and emergency departments (ED) serve a population presenting with increased infection risk. However, identifying patients for whom sexually transmitted infection (STI) screening is appropriate requires accurate sexual history reporting. STUDY OBJECTIVES To examine the consistency with which ED patients answer general and specific sexual activity questions, and how responses relate to perceived STI risk. METHODS Urban ED patients aged 15-34 years completed a sexual history survey containing sexual activity and perceived infection risk questions and provided urine and pharyngeal specimens for CT/GC analysis. RESULTS Participants included 192 males and 301 females with a mean age of 25.2 years and were 65.7% white and 33.3% black. Thirty-eight (7.7%) were infected with CT or GC. In patients denying sexual activity in the past year (general question), 40.7% of such males and 45.0% of females also reported some form of specific sexual activity (activity misclassification). Among self-identified heterosexuals, 7.2% males and 7.5% females reported some form of homosexual activity (orientation misclassification; OM). OM individuals were more likely to perceive themselves at risk of infection both orally (odds ratio 2.92, confidence interval 1.12-7.63) and genitally (odds ratio 3.36, confidence interval 1.55-7.30). CONCLUSIONS Given that reported sexual activity and age are the only criteria for routine female screening, and that homosexual activity is one of the few screening criteria for males, our results show that a substantial proportion of ED patients eligible for screening may not be identified by reliance upon general sexual history questions.
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Affiliation(s)
- Wiley D Jenkins
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois; Family and Community Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Kelsey R LeVault
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois
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Krivochenitser R, Bicker E, Whalen D, Gardiner C, Jones JS. Adolescent women with sexually transmitted infections: who gets lost to follow-up? J Emerg Med 2014; 47:507-12. [PMID: 25154560 DOI: 10.1016/j.jemermed.2014.06.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 03/27/2014] [Accepted: 06/30/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Adolescent patients comprise the highest rate of Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) in the United States. These patients often initially present to the emergency department (ED) with vague symptoms. OBJECTIVES 1) Quantify the frequency of underrecognized GC and CT cervical infections in adolescent women tested in the ED; 2) describe and compare the characteristics of those treated and not treated during the initial visit; and 3) quantify the delay interval until treatment was provided. METHODS This was a retrospective, cohort analysis of consecutive females (ages 13-19 years) seen at four academic medical centers over a 36-month period with positive results for GC/CT. Our key outcome measures were the proportion of adolescent females being untreated in the ED, the time to subsequent treatment, and the proportion lost to follow-up. RESULTS During the study period, 382 female adolescents had positive polymerase chain reaction studies for GC or CT or both; 266 (70%) were not treated in the ED. Untreated patients were significantly more likely to have a discharge diagnosis of urinary tract infection (23% vs. 11%, p < 0.008), new pregnancy (29% vs. 8%, p < 0.001), and vaginitis (24.8% vs. 5%, p < 0.001). Subsequently, only 11.7% (31/266) of the untreated patients fit the Centers for Disease Control and Prevention guidelines for empiric treatment of pelvic inflammatory disease. After telephone, mail, and public health follow-up, treatment could be documented for only 59% of the patients. CONCLUSION The majority of adolescent women found to have GC or CT or both in the ED were not treated at presentation.
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Affiliation(s)
| | - Erica Bicker
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - David Whalen
- Department of Emergency Medicine, Saint Mary's Health Care, Grand Rapids, Michigan
| | - Cynthia Gardiner
- Department of Emergency Medicine, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Jeffrey S Jones
- Michigan State University Program in Emergency Medicine, Spectrum Health Hospital-Butterworth Campus, Grand Rapids, Michigan
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