Association of Marital Status in the Testing and Treatment of Sexually Transmitted Infections in the Emergency Department

Abstract

IntroductionSexually transmitted infections (STIs) are frequently tested for and treated in the emergency department (ED). Age, race, and number of sexual partners are known risk factors for STIs. The objective of the current study was to examine marital status as it relates to testing and treating for STIs in the ED. MethodsA database of 75,000 ED patient encounters from a single healthcare system in northeast Ohio between April 18, 2014, and March 7, 2017, was examined. All patients in the dataset underwent a urinalysis and urine culture or received STI testing in the ED. We performed Chi-square and multivariable regression analysis to examine the relationships between the patient's marital status and testing and treatment for STIs performed in the ED. ResultsThere were 20,965 patient encounters where STI testing was performed and was analyzed. Patients were 9.1% (N=1,912) married, 86.6% (N=18,149) single, 4.0% (N=837) were neither married nor single, and 0.3% (N=67) with an unknown marital status. There were 7.1% (19/267) and 4.9% (12/267) of tested married men who were infected with gonorrhea and chlamydia, respectively, whereas only 0.4% (6/1,583) and 2.2% (35/1,588) of tested married women were infected with gonorrhea and chlamydia, respectively. Single men and women were both significantly more likely to have a positive test for gonorrhea and chlamydia compared to married men and women, respectively (P<0.001). Married men and women, compared to single men and women, respectively, were more likely to be given antibiotics for gonorrhea and chlamydia in the ED when the infection was present and not be given antibiotics for the infections when testing was negative (P<0.001). Single women (9.1%; 1,291/14,258) were more likely than married women (4.9%; 75/1,534) to have a positive test for trichomonas, but there were no significant differences between married (1.0%; 1/100) and single men (0.7%; 6/893). ConclusionEven when accounting for age and race, marital status can help predict infection with gonorrhea and chlamydia in the ED. The marital status could be considered by clinicians when risk stratifying patients regarding testing and treating for the diseases in the ED. Gonorrhea and chlamydia are much more common in single men and women and much less common in married persons. However, married men tested for gonorrhea and chlamydia were more than twice as likely to test positive for infection than married women. Married men and women were both more likely to be appropriately treated with antibiotics for gonorrhea and chlamydia in the ED (i.e., testing negative for infection and not receiving antibiotics or testing positive and receiving antibiotics) compared to non-married men and women. While trichomonas was more common in single women than married women, the infection was less common in men, and both married men and single men had similar rates of testing positive for the infection.

Patient and Provider Demographics and the Management of Genitourinary Tract Infections in the Emergency Department

“…Younger age, being single (compared to married/life partner), and having higher vaginal WBCs on the wet mount were significantly associated with receiving empiric antibiotics for gonorrhea and chlamydia, which have also been reported previously [ 24 , 27 , 29 , 37 , 38 ]. ED clinicians were more likely to empirically treat gonorrhea and chlamydia in the ED when trichomonas was identified during the ED encounter.…”

Prevalence of sexually transmissible infections in adolescents treated in a family planning outpatient clinic for adolescents in the western Amazon

“…Early sexarche appears to have a significant correlation with multiple sexual partners in the last 12 months, which in turn may put these adolescents at higher risk of contracting an STI [37]. It is believed that the type of partner influences the STI risk of women because the prevalence is higher in single subjects [38,39]. However, researchers generally restrict the type of partner to labels of "casual" versus "fixed" or "living in union" versus "single", which can mask the variability of risk [40].…”

Sexually transmitted infection (STI): A malady with skewed marital unfaithfulness, the Nigerian experience

“…The largely preventable burden of disease attributable to sexual transmission, together with increasing resistance of these infections to available antibiotics, argue for a strong public health response. The prevention and control of all these infections involve interventions to interrupt sexual transmission; however, the continued prevalence has been fueled by marital infidelity (Fox and Sheele, 2021).…”

“…Gonorrhea and chlamydia are more common in single men and women and less common among married persons; however, empirical evidence shows that married men tested for gonorrhea are more likely to test positive than women. Fox and Sheele (2021) reported that of 1360 women infected with chlamydia, only 2.57% were married, among 510/17388 women, 1.18% tested positive for gonorrhea. For men, in a population of 3105, 418 tested positive for gonorrhea with 94.74% being married.…”