Management of Patients with Sexually Transmitted Infections in the Emergency Department

Hilbert, SueLin; Reno, Hilary

doi:10.1016/j.emc.2018.06.007

Cited by 9 publications

(9 citation statements)

References 20 publications

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“…While it is generally understood that most STI testing originates in primary care clinics, STI clinics, or other outpatient care settings ( 5 ), few previous studies have examined the role of the emergency department in testing for and diagnosing STIs. Published reports have found 7% to 16% of patients seeking care for STIs utilized the ED ( 6 , 7 ), although certain factors such as low income ( 6 ), male gender, young age, non-White race, and public insurance ( 7 ) were associated with greater likelihood of ED care seeking.…”

Section: Discussionmentioning

confidence: 99%

“…With such a large proportion of positive STI testing originating in the ED, programs and partnerships are needed to ensure patient follow up for timely treatment, counseling, and HIV prevention education ( 14 ). A major barrier to ED STI testing is concern about informing patients of positive test results after discharge from the ED ( 5 ), as STI tests can take up to 48 h to return a result. In order to address this, the study site maintains a partnership between the ED and a Sexual Wellness Clinic ( 15 ) run by Infectious Disease physicians.…”

Section: Discussionmentioning

confidence: 99%

“…Gonorrhea and chlamydia are frequently underrecognized and undertreated in pregnant women visiting the ED ( 20 ). Furthermore, previous studies have demonstrated that a only a small fraction of patients tested for gonorrhea or chlamydia in the ED are also tested for HIV and syphilis ( 21 ), and all pregnant women should be screened for HIV and syphilis to prevent devastating fetal complications ( 5 ). If pregnant women are preferentially seeking care for their STIs in the ED, then efforts should be made to ensure comprehensive screening takes place, including HIV and syphilis testing.…”

Section: Discussionmentioning

confidence: 99%

“…Residents in areas of high economic hardship may disproportionately visit the ED for all health care ( 2 ), and Medicaid beneficiaries have been found to utilize the ED at twice the rate of those with private insurance ( 3 ), believing ED care to be more accessible, more affordable, and higher quality ( 4 ). Despite this preference, previous studies have suggested that the minority of STI care is provided through the ED ( 5 – 7 ).…”

Section: Introductionmentioning

confidence: 99%

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Trends in STI testing and diagnosis rates during the COVID-19 pandemic at a large urban tertiary care center, and the role of the emergency department in STI care

Stanford

Mason

Friedman

2023

Front. Reprod. Health

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IntroductionThe COVID-19 pandemic has had profound effects on access to care, including outpatient sexually transmitted infection (STI) testing and treatment. Many vulnerable populations already relied on the emergency department (ED) for much of their care prior to the pandemic. This study examines trends in STI testing and positivity before and during the pandemic at a large urban medical center and evaluates the role of the ED in providing STI care.MethodsThis is a retrospective review of all gonorrhea, chlamydia, and trichomonas tests from November 1, 2018, through July 31, 2021. Demographic information and location and results of STI testing were extracted from the electronic medical record. Trends in STI testing and positivity were examined for 16 month periods before and after the COVID-19 pandemic started (March 15, 2020), with the latter divided into the early pandemic period (EPP: March 15 -July 31, 2020) and late pandemic period (LPP: August 1, 2020 - July 31, 2021).ResultsTests per month decreased by 42.4% during the EPP, but rebounded by July 2020. During the EPP, the proportion of all STI testing originating in the ED increased from 21.4% pre-pandemic to 29.3%, and among pregnant women from 45.2% to 51.5%. Overall STI positivity rate increased from 4.4% pre-pandemic to 6.2% in the EPP. Parallel trends were observed for gonorrhea and chlamydia individually. The ED represented 50.5% of overall positive tests, and as much as 63.1% of positive testing during the EPP. The ED was the source of 73.4% of positive tests among pregnant women, which increased to 82.1% during the EPP.ConclusionsSTI trends from this large urban medical center paralleled national trends, with an early decrease in positive cases followed by a rebound by the end of May 2020. The ED represented an important source of testing for all patients, and especially for pregnant patients, throughout the study period, but even more so early in the pandemic. This suggests that more resources should be directed towards STI testing, education, and prevention in the ED, as well as to support linkage to outpatient primary and obstetric care during the ED visit.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Trends in STI testing and diagnosis rates during the COVID-19 pandemic at a large urban tertiary care center, and the role of the emergency department in STI care

Stanford

Mason

Friedman

2023

Front. Reprod. Health

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“…Some STD pathogens are cured using appropriate antibiotic treatment. However, most STD pathogens have atypical symptoms, are difficult to diagnose (Hilbert and Reno, 2018). Therefore, the development of fast and low-cost laboratory STD diagnostic screening methods will contribute to reducing STD-induced reproductive tract damage and improve women's health worldwide.…”

Section: Introductionmentioning

confidence: 99%

Design and Evaluation of a Novel Multiplex Real-Time PCR Melting Curve Assay for the Simultaneous Detection of Nine Sexually Transmitted Disease Pathogens in Genitourinary Secretions

Jiang

et al. 2019

Front. Cell. Infect. Microbiol.

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Background: Sexually transmitted diseases (STD) are a major cause of infertility, long-term disability, ectopic pregnancy, and premature birth. Therefore, the development of fast and low-cost laboratory STD diagnostic screening methods will contribute to reducing STD-induced reproductive tract damage and improve women's health worldwide. In this study, we evaluated a novel multiplex real-time PCR melting curve assay method for the simultaneous detection of 9 STD pathogens, including Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum, and herpes simplex virus.Methods: The analytical performance of the method, including its limit of detection (LOD), specificity, repeatability, and effect on different DNA extraction kits were evaluated. Additionally, we obtained 1,328 clinical specimens from 3 hospitals to detect the 9 STD pathogens using multiplex real-time PCR melting curve and Sanger sequencing, to evaluate the sensitivity, specificity, and consistency of the assay method.Results: The results showed that the analytical sensitivity of the novel multiplex real-time PCR melting curve assay is very excellent, with LOD of DNA corresponding to <200 copies/μL for the DNA of the 9 STDs and 1.00 × 104 color change unit /ml for those of UU and UP. Additionally, this assay demonstrated excellent analytical specificity, excellent repeatability, and its results had no effect of different DNA extraction kits. The performance, in terms of sensitivity (91.06–100%) and specificity (99.14–100%), was remarkable, since the consistency between it and Sanger sequencing was more than 0.85 in the clinic.Conclusion: The novel multiplex real-time PCR melting curve assay method has high sensitivity and specificity, relatively low cost, and simple to use for the simultaneous detection of 9 STD pathogens in genitourinary secretions.

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STI therapy compliance pre and post 2021 CDC treatment guideline update

Baack

Gomez

Nichols

et al. 2022

The American Journal of Emergency Medicine

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Management of Patients with Sexually Transmitted Infections in the Emergency Department

Cited by 9 publications

References 20 publications

Trends in STI testing and diagnosis rates during the COVID-19 pandemic at a large urban tertiary care center, and the role of the emergency department in STI care

Trends in STI testing and diagnosis rates during the COVID-19 pandemic at a large urban tertiary care center, and the role of the emergency department in STI care

Design and Evaluation of a Novel Multiplex Real-Time PCR Melting Curve Assay for the Simultaneous Detection of Nine Sexually Transmitted Disease Pathogens in Genitourinary Secretions

STI therapy compliance pre and post 2021 CDC treatment guideline update

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