Follow‐up Program for Emergency Department Patients with Gonorrhea or Chlamydia

Abstract

Abstract. Objectives: To study the performance of a centralized regional follow-up program organized by a municipal department of health (DH) for female patients presenting to the emergency department (ED) with Neisseria gonorrhoeae and/or Chlamydia trachomatis, who are not diagnosed or treated at the time of presentation. Methods: This was a retrospective observational study of female patients seen in the ED with positive cervical specimens, and their subsequent treatment and follow-up by the DH. Medical records were reviewed to determine the female patients seen in the ED who had positive specimens for N. gonorrhoeae or C. trachomatis. The DH followed up those not treated in the ED. Analysis of how long it took for these patients to be treated and the proportion lost to follow-up was performed. Results: Of 2,121 specimens, 342 were positive for N. gonorrhoeae or C. trachomatis. Of the 342, 154 (45%) were recognized and appropriately treated in the ED. One hundred fifty-nine of the 342 (46.5%) patients were discharged from the ED without treatment but were contacted by the DH and appropriate treatment was provided. The DH could not locate 23 (6.7%) patients, and four (1.2%) refused treatment. One died before treatment. Only 21 of the 159 were treated within nine days. Median time to treatment was 36 days. Conclusions: Centralized laboratory analysis and follow-up by the DH for N. gonorrhoeae and C. trachomatis identified many female patients undiagnosed and untreated in the ED. The DH follow-up program provided appropriate treatment to most female patients.

The Utility of Wet Prep in Predicting Neisseria gonorrhoeae and Chlamydia trachomatis

“…Two previous studies have shown that approximately 50% of female ED patients who ultimately test positive for NG or CT were not initially treated, often with significant delays in contacting those patients (7,8). Another study showed that only 24% of patients (both males and females) who tested positive for NG or CT were treated initially in the ED (9).…”

Impact of Post-visit Contact on Emergency Department Utilization for Adolescent Women with a Sexually Transmitted Infection

“…11,12 However, others have emphasized the importance of systematic and efficient follow-up with positive results of all female patients after ED release. 5,13 Recently, we showed that we can improve our ability to contact women with their STI test results, and reduced our lost to follow-up rate from 40% to 24%. 3 Thus, timely followup of positive STI results is a necessary public health intervention for adolescent women utilizing the ED.…”

Gonorrhea and chlamydia in emergency departments: Screening, diagnosis, and treatment

“…However, studies demonstrate improved quality of care is possible, including proper follow-up and compliance with CDC treatment guidelines through implementation of specific system changes and actions [29••], and successful partnership with health departments [27]. Specific recommendations to improve ED STI diagnosis and management are summarized in Table 1.…”

“…Kelly et al [27] reviewed results of this program. Of 342 women testing positive for GC or CT, 154 (45%) were treated at the initial ED visit.…”