By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Background: Expedited partner therapy (EPT), the practice of prescribing antibiotics for sexual partners of patients, is underutilized in Georgia. This qualitative study in a large urban institution aimed to (1) characterize the clinical specialties that predominantly treat sexually transmitted infections (STIs), (2) identify perceived barriers to EPT, and (3) describe strategies to advance routine EPT use.Methods: Providers in obstetrics/gynecology (OB/GYN), infectious disease (ID), and emergency medicine (EM) were interviewed using a structured discussion guide. Transcripts were double-coded and iteratively analyzed using qualitative content analysis. Barriers and strategies were summarized and supported with quotes from providers (n = 23).Results: Perceived EPT barriers overlapped across OB/GYN, ID, and EM, yet the settings were diverse in their patient populations, resources, and concerns. Providers in OB/GYN were the only ones practicing EPT, yet there was a lack of standardization. Providers in ID noted that an EPT prescription from an ID provider could inadvertently disclose the HIV status of a patient to a sexual partner, posing an ethical dilemma. Providers in EM exhibited readiness for EPT, although routine empiric treatment for index patients in EM (estimated at 90%) gave some providers pause in prescribing for partners: "I do not know what I'm treating." Point-of-care testing could increase providers' confidence in prescribing EPT, yet some worried it could contribute to overutilization of the emergency department as a sexually transmitted infection clinic. All settings prioritized setting-specific training and protocols.Conclusions: Providers in OB/GYN, ID, and EM report unique hurdles, specific to their settings and patient populations; tailored EPT implementation strategies, particularly provider training, are urgently needed to improve patient/partner outcomes.C hlamydia trachomatis (CT) is the most frequently reported sexually transmitted infection (STI), with nearly 2 million reported cases each year. 1 Millions of cases of CT remain undiagnosed, as up to 75% of females and 50% of males exhibit no From the

Background:The Centers of Disease Control and Prevention guidelines recommend that all patients be retested 3 months after a positive chlamydia (CT) or gonorrhea (GC) result. However, retest rates are generally low, and only a quarter of patients return to clinic for retesting. This analysis explored retesting patterns in a high sexually transmitted infection (STI)/human immunodeficiency virus (HIV)-risk setting to illuminate gaps in adherence to guideline recommendations. Methods:Retrospective chart data from a large urban safety-net institution were analyzed descriptively. Patients who received a positive CT/GC test from January to February 2017 were followed up for at least 4 months to assess if retesting occurred within approximately 3 months.Results: Our sample of 207 patients was primarily non-Hispanic Black (92.8%), younger than 25 years (63.3%) and women (60.4%). Over half had been initially diagnosed with CT, one-third with GC, and one-tenth with both CT and GC. Eighty-nine (43.0%) patients were retested during the observed period; mean time between tests was 2.7 months. Retesting was most common in infectious diseases/HIV primary care (73.6%) and obstetrics/gynecology (44.9%). Patients who were first diagnosed in emergency medicine were significantly less likely to be retested. Retested patients included a large number of HIV-positive men (31 of 89 total) and pregnant women (23 of 54 women).Conclusions: Forty-three percent of patients were retested within approximately 3 months of their initial positive CT/GC diagnosis, exceeding previously published rates. Nonetheless, in light of the growing STI epidemic, health care systems should prioritize retesting across high-volume testing specialties, rethink retesting models, and facilitate referrals to ensure that patients receive guideline-recommended, comprehensive STI care.

Background: Sexually transmitted infections (STIs) in the United States continue to increase at an alarming rate. Since 2015, reported cases of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC), the 2 most prevalent reportable STIs, have increased by 19% and 56%, respectively. Characterizing testing patterns could elucidate how CT/GC care and positivity have evolved over time in a high-risk urban setting and illustrate how patients use the health care system for their STI needs.Methods: Using electronic medical record data from a large safety net hospital in Georgia, patient demographics and clinical characteristics were extracted for all nucleic acid amplification tests ordered from 2014 to 2017 (n = 124,793). Descriptive statistics were performed to understand testing patterns and assess positivity rates.Results: Annual nucleic acid amplification test volume grew by 12.0% from 2014 to 2017. Obstetrics/gynecology consistently accounted for half of all tests ordered; volume in emergency medicine grew by 45.2% (n = 4108 in 2014 to n = 5963 in 2017), whereas primary care volume fell by −4.3% (n = 4186 in 2014 to n = 4005 in 2017). The largest number of positive results was detected among 15-to 24-year-olds. The positivity of CTwas higher among females, and GC among males. The percent positivity of CT remained stable (range, 6.4%-7.0%). The percent positivity of GC increased from 2.7% to 4.3% over time. Conclusions:Testing volume in emergency medicine has increased at a faster rate than other specialties; point-of-care testing could ensure more accurate treatment and improve antibiotic stewardship. The rates of CT/GC were high among adolescents and young adults. Tailored approaches are needed to lower barriers to care for this vulnerable population.S exually transmitted infections (STIs) present a widespread and costly public health problem in the United States. The Centers for Disease Control and Prevention (CDC) estimates that in 2018, 1 in 5 persons aged 15 to 24 years in the United States had an STI, accounting for almost half of all new STI diagnoses.

Audience: Emergency medicine residents and medical students on emergency medicine rotations.Introduction: Though the incidence of tricyclic antidepressant (TCA) overdoses has decreased due to increasing prescriptions of selective-serotonin reuptake inhibitors (SSRI's), tricyclic antidepressants remain in the top 25 causes of poisoning deaths. 1 Patients who attempt suicide with a TCA have a fatality rate of 70% if they do not reach a healthcare facility; however, that rate is lowered to 3% if the patient reaches a facility for treatment. 2 Women are at higher risk of toxicity than men, particularly in the age range of 20-29. 2 Emergency medicine physicians should be skilled in the electrocardiogram (ECG) interpretation of acute TCA overdose, and need to be comfortable in the emergent management of patients who are unable, or unwilling, to verbalize the medication they ingested. This oral boards case tests the learners' approach to a patient with undifferentiated altered mental status, while attempting to focus the learner on intentional overdose as the likely diagnosis. Upon completing this oral board case, learners should be able to recognize the classic pattern of a widened QRS complex, rightaxis deviation, and large terminal R-wave (>3mm) in TCA overdose, and treat accordingly with high doses of sodium bicarbonate until the ECG improves. Though a toxicologist's support is an important adjunct, emergency physicians should be confident in managing this case from presentation to appropriate intensive care unit admission.Objectives: At the end of this oral boards session, learners will be able to: 1) discuss the appropriate laboratory testing and workup for a patient with undifferentiated altered mental status, 2) discuss the importance of obtaining an ECG in a timely manner in order to investigate the broad differential of altered mental status, 3) identify the classic ECG findings of a patient with TCA overdose, 4) review the treatment of TCA overdose, 5) discuss the appropriate disposition of a patient with TCA overdose. Method: Oral boards case.