Prevalence and Factors Associated With Gonorrhea and Chlamydial Infection in At-Risk Females Presenting to an Urban Emergency Department

Background Patients without a regular healthcare source are less likely to be tested, diagnosed, and treated effectively for sexually transmitted diseases (STDs). Emergency departments (EDs) are a major healthcare source for patients without health insurance or primary care providers. Goal This study evaluated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in women aged 15 to 35 years presenting to a metropolitan ED with genitourinary or pregnancy-related complaints and the frequency with which patients were effectively treated for these infections during routine ED care. Study Design Women completed an interviewer-administered questionnaire and submitted urine for ligase chain reaction (LCR) testing for C trachomatis and N gonorrhoeae. Results The combined prevalence of gonorrhea and chlamydia was 16.4% (n = 62), and factors associated with infection included younger age and greater numbers of sex partners over 30 days. Problem-oriented care failed to detect infection in most cases, and 58% of infected women left the ED without effective therapy. Through a close working relationship with the local health department, we documented that 92% had received effective follow-up therapy. Conclusion Continued efforts to refine and develop tools for the diagnosis and management of cervical infections for at-risk women seen in EDs are warranted.

[1]  C. Todd,et al.  Emergency department screening for asymptomatic sexually transmitted infections. , 2001, American journal of public health.

[2]  T. Quinn,et al.  Clinical aspects of diagnosis of gonorrhea and Chlamydia infection in an acute care setting. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[3]  J. Zenilman,et al.  Unsuspected Gonorrhea and Chlamydia in Patients of an Urban Adult Emergency Department: A Critical Population for STD Control Intervention , 2001, Sexually transmitted diseases.

[4]  K. Monroe,et al.  Opportunistic urine ligase chain reaction screening for sexually transmitted diseases in adolescents seeking care in an urban emergency department. , 2000, Annals of emergency medicine.

[5]  J. Schwebke,et al.  Patterns of Chlamydia trachomatis testing and follow-up at a University Hospital Medical Center. , 1999, Sexually transmitted diseases.

[6]  D. Levy,et al.  Surveillance for waterborne-disease outbreaks--United States, 1995-1996. , 1998, MMWR. CDC surveillance summaries : Morbidity and mortality weekly report. CDC surveillance summaries.

[7]  F. Ndowa,et al.  Syndromic approach to STD case management: where do we go from here? , 1998, Sexually transmitted infections.

[8]  K. Curtis,et al.  Visits to Emergency Departments for Gynecologic Disorders in the United States, 1992–1994 , 1998, Obstetrics and gynecology.

[9]  K. Holmes,et al.  Risk assessment, symptoms, and signs as predictors of vulvovaginal and cervical infections in an urban US STD clinic: implications for use of STD algorithms. , 1998, Sexually transmitted infections.

[10]  D. Brown,et al.  Role of type specific herpes simplex virus serology in the diagnosis and management of genital herpes. , 1998, Sexually transmitted infections.

[11]  T. Brennan,et al.  Insurance or a regular physician: which is the most powerful predictor of health care? , 1998, American journal of public health.

[12]  G. Kuhn,et al.  Diagnosis and follow-up of Chlamydia trachomatis infections in the ED. , 1998, The American journal of emergency medicine.

[13]  L. Chan,et al.  A retrospective review of positive chlamydial cultures in emergency department patients. , 1996, The American journal of emergency medicine.

[14]  W. Cates,et al.  Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility , 1993, American journal of obstetrics and gynecology.

[15]  T. Quinn,et al.  Comparative behavioral epidemiology of gonococcal and chlamydial infections among patients attending a Baltimore, Maryland, sexually transmitted disease clinic. , 1992, American journal of epidemiology.

[16]  J. Pfaff,et al.  Chlamydial antigen testing on female patients presenting to the emergency department. , 1991, Military medicine.