History, Physical Examination, and Laboratory Findings Associated with Infection and the Empiric Treatment of Gonorrhea and Chlamydia of Women in the Emergency Department

Abstract

Background Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), and Trichomonas vaginalis (TV) are common sexually transmitted infections (STIs) treated in the emergency department (ED). Objectives To assess the history, physical examination, and laboratory findings associated with NG and CT infection and the decision to administer empiric antibiotic treatment for the diseases in the ED. Methods A retrospective review of 566 clinical encounters of adult female patients tested for STIs between January 1, 2013 and December 31, 2014. An analysis of patient-and provider-level variables was assessed to determine the characteristics associated with empiric antibiotic treatment in the ED and post-discharge laboratory confirmed NG or CT. Results Younger age and the presence of TV on vaginal wet prep had a higher association with being infected with NG or CT (p < 0.05). Subjective exam findings, such as vaginal discharge, abdominal pain, urinary urgency, urinary frequency, dysuria, objective vaginal discharge, cervical motion tenderness, adnexal tenderness, vaginal bleeding, as well as positive leukocyte esterase and nitrites on urinalysis were all not associated with NG or CT infection (p > 0.05). ED providers were more likely to treat subjects in the ED for NG and CT when there was subjective and objective vaginal discharge, cervical motion tenderness, adnexal tenderness, and vaginal bleeding, TV on wet prep, and leukocyte esterase on urinalysis (p < 0.05). Conclusions Only younger age women and the presence of TV on vaginal wet prep were associated with NG 1 2 3 4 5 1 5

Descriptive Epidemiology of Women in the Emergency Department With Gonorrhea and Chlamydial Infection in the United States

“…Infection was also significantly associated with fewer urine bacteria, increased odds of having positive nitrites, and being diagnosed with a UTI. Women at risk for STIs and with urinary concerns in the ED cannot be easily evaluated if they have a UTI or an STI (Sheele et al, 2019; Wilbanks et al, 2014). In addition, the history and physical examination findings may not reliably identify those with STI (Brown et al, 2011; Jenkins & LeVault, 2015; Niforatos et al, 2019; Tucker & Evans, 2019).…”

“…NAAT results are typically not available to clinicians during the ED visit and thus ED clinicians must decide whether to treat the patient empirically with antibiotics (Sheele et al, 2019).…”

A Model for Syphilis Screening in the Emergency Department

“…The epidemiological trend of increased incidence of syphilis infections among marginalized populations who use the ED for care, including cities such as Cleveleand, 33,34 suggests that this clinical environment may benefit from co-testing of syphilis along with other sexually transmitted infections. 35,36 Syphilis testing is more complicated than HIV screening because of the The CNPC also serves the role of following up on positive cultures (blood, urine, cerebrospinal fluid) and polymerase chain reaction results after patient discharge and notifying physicians to ensure them that the patient has received disposition and/or antibiotic treatment.…”

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

“…Clinicians may need to provide empiric treatment for STIs in the emergency department (ED) because definitive STI testing results may not be available during the clinical encounter. Both overtreatment and undertreatment of STIs in the ED are common, and more accurate risk stratification for STIs in the ED could lead to better antibiotic stewardship 1 1 [2][3][4][5].…”