Feasibility of screening for Chlamydia trachomatis in young men attending an emergency department

Screening for asymptomatic chlamydia and gonorrhea in adolescent males in an urban pediatric emergency department

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.

Computerized self-interviews improve Chlamydia and gonorrhea testing among youth in the emergency department

STUDY OBJECTIVE

National guidelines recommend annual Chlamydia trachomatis and Neisseria gonorrhoeae screening for sexually active youth at risk for infection. These infections have serious sequelae in women if untreated, and methods to improve testing are needed. We hypothesize that an electronic method of identifying at-risk youth will significantly increase testing for these sexually transmitted infections during emergency department (ED) visits.

METHODS

We developed an audio-enhanced computer-assisted self-interview (ACASI) to obtain sexual histories from ED patients and an embedded decision tree to create a sexually transmitted infection testing recommendation. ED health care providers were prompted by the electronic medical record to review the participant answers and testing recommendations, and to offer testing to at-risk youth. Patients aged 15 to 21 years and visiting the St. Louis Children's Hospital ED, regardless of complaint, were eligible for participation.

RESULTS

Sexually transmitted infection testing among all 15- to 21-year-old ED patients increased from 9.3% in the 3 months before the ACASI to 17.8% during the 8-month period the ACASI was available and diminished to 12.4% in the 3 months after ACASI withdrawal (P<.001). During the ACASI period, we approached 51.4% of eligible patients and enrolled 59.8% (800/1,337) of those approached. Among ACASI participants, 52.4% (419/800) received a recommendation to receive sexually transmitted infection testing. Of these patients, 52.7% (221/419) received testing in the ED and 18.1% (40/221) of those tested had positive results for chlamydia or gonorrhea, 55% of whom (22/40) had chief complaints unrelated to sexually transmitted infections. Most participants (89%) rated the ACASI easy to use.

CONCLUSION

Sexually transmitted infection testing in the ED significantly increased during ACASI use and diminished after withdrawal. The ACASI was well accepted by youth and holds promise for enhancing sexually transmitted infection testing in the ED.

Chlamydia trachomatis in Tasmania 2001-2007: rising notification trends

OBJECTIVES

To investigate trends in notification rates of Chlamydia trachomatis in Tasmania, Australia, by population sub-groups, from 1 January 2001 to 31 December 2007.

METHODS

An enhanced surveillance dataset was used to supplement case notifications. Rates based on age group were analysed by sex, geographic region, indigenous status, sexual exposure, reason for testing and healthcare provider.

RESULTS

In all age groups, the notification rate increased steeply. The highest rates were seen in the ages 15-24 years; this age group represented 15% of the population but accounted for 74% of the chlamydial notifications. The increased rates in females aged 15-24 years and males 15-19 years in Tasmania were larger than the increases observed nationally. Rates were consistently higher in urban areas. Females were more likely to have been tested as a result of screening, and males were more likely to have been tested when presenting with symptoms or as a result of contact tracing. The majority of cases reported sexual exposure with opposite sex partners only.

CONCLUSIONS

This study highlights the increasing significance of chlamydial infection as a public health issue, the gender differences in health-seeking behaviour, and the discrepancies in testing patterns. These findings will assist with the design of health promotion programs.

Emergency department Chlamydia screening through partnership with the public health department

BACKGROUND

The emergency department (ED) serves a population that may benefit from numerous screening initiatives but screening in the ED is challenging due to crowding as well as resource and time constraints. One option may be to collect specimens in the ED and then partner with the public health department (PHD) to analyze the specimens off-site and arrange follow-up treatment.

OBJECTIVES

The objective was to explore the feasibility of chlamydia screening in females using a partnership model in which the ED is responsible for urine collection and the PHD is responsible for chlamydia testing, notification, and treatment.

METHODS

A collaborative partnership-based chlamydia screening project was initiated at a large (90,000 visits/yr), urban, teaching ED from April 2007 to April 2008. Study information sheets were handed out to a convenience sample of eligible female patients and visitors (15-24 yr of age). Those wishing to participate provided a urine sample and follow-up contact information. The information sheet also asked if they had either lower abdominal pain or vaginal discharge (affirmative answer for either was considered symptomatic). Specimens collected in the ED were retrieved by PHD staff for off-site testing. The PHD contacted those participants testing positive using the patient provided contact information and arranged for treatment.

RESULTS

Of the 633 women offered screening, 296 (47%) agreed to testing and provided samples. Of the 296 tested, 38 (12.8%) were positive for chlamydia infection, and 25 (66%) received follow-up and treatment; 13 could not be contacted through information they provided. A higher percentage of symptomatic subjects (23 of 115, or 20%) tested positive for chlamydia than asymptomatic subjects (15 of 181, or 8.3%; p < 0.01).

CONCLUSIONS

This study demonstrates the feasibility of an ED-PHD partnership for chlamydia screening in young women. This model can potentially be applied to other initiatives and may improve public health screening without creating significant additional burdens for crowded EDs.