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

Abstract

Failure to screen sexually active adolescents and adults for gonorrhea and chlamydia at the time of acute care visits to urban emergency departments (ED) results in missed treatment opportunities for 38% to 82% of infected persons. The prevalence of gonorrhea and chlamydia infections among ED patients presenting with genitourinary or pregnancy-related complaints or providing urine specimens as part of routine medical care ranges from 4.3% to 16.4%. Notably, prevalence among general ED patients is similar (9.7%-14.3%). Due to the asymptomatic or nonspecific presentation of these infections, expanded screening is recommended to increase detection, treatment, and partner notification. A lower threshold of empiric treatment in the ED setting is recommended due to the difficulty and incompleteness of follow-up subsequent to ED discharge. Specific recommendations to improve the quality of ED care for sexually transmitted infections and to expand detection are provided.

Emergency Department Management of Adolescents with Urinary Complaints: Missed Opportunities

“…Most research on UTIs in adolescents focuses on females; however, the association of urinary complaints and STIs in sexually active males may also be missed in pediatric settings. For these reasons, clinical practice recommendations for the evaluation of adolescents with urinary complaints advise taking a sexual history and testing all sexually active patients for STIs [2,3,[5][6][7].The evaluation and diagnosis of STIs can be challenging in the emergency department (ED) environment; 38% to 82% of gonorrhea and Chlamydia cases were unrecognized in one review [8]. This study examines adherence to clinical practice recommendations regarding adolescents presenting with urinary complaints in a pediatric emergency department.…”

“…The evaluation and diagnosis of STIs can be challenging in the emergency department (ED) environment; 38% to 82% of gonorrhea and Chlamydia cases were unrecognized in one review [8]. This study examines adherence to clinical practice recommendations regarding adolescents presenting with urinary complaints in a pediatric emergency department.…”

Sexual History Taking in the Emergency Department – More Specificity Required

“…The answer is equally complex and will likely need to be determined for each institution. From a societal perspective, routine screening and treatment services may be beneficial, as multiple studies have shown that the ED patient population has an increased prevalence of STI and that clinical presentation and examination is insufficiently sensitive for identification (12,13,20). Although the majority of CT/GCinfected individuals will remain asymptomatic and many infections will spontaneously clear, CT infection/ repeat infection itself remains one of the most significant causes of infertility and other morbidities (27).…”

“…ED clinicians serve a population at increased risk of STI, with overall prevalence rates in excess of 0.9-8.1% for CT and 0.9-3.9% for GC (12,13). Such rates are frequently observed even among those presenting without any STI symptoms (e.g., CT and GC at 6.3% and 0.8%, respectively) (14).…”

Differences in Treatment of Chlamydia trachomatis by Ambulatory Care Setting

“…Past work has shown that many people seek treatment for STIs in the emergency department setting [7,8] and that people seeking care in the emergency department are at a greater risk of having STIs [9]. Furthermore, several studies have indicated that adherence to treatment guidelines for STIs are different depending on practice setting [10][11][12].…”