Screening Adolescents for Sexually Transmitted Infections in the Pediatric Emergency Department

Uppal, Anjana; Chou, Katherine

doi:10.1097/pec.0000000000000322

Cited by 17 publications

(19 citation statements)

References 25 publications

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“…Although there are a few prior studies that have evaluated adolescent STI prevalence in EDs,(20–22) this study offered screening to patients regardless of reported sexual activity and included an asymptomatic population solely. We chose these selection criteria to more precisely estimate the prevalence of STI in a cohort of patients who would be approached for screening if a universal STI screening protocol were instituted.…”

Section: Discussionmentioning

confidence: 99%

“…Our detected prevalence is similar to prevalence of N gonorrhoeae and C trachomatis infections found in other studies that did not select populations based on sexual activity, although these studies did not exclude symptomatic patients. (21, 22) However, rates of STI were associated with greater engagement in high risk sexual behavior and preferential use of the ED versus primary care, suggesting that a targeted screening strategy may offer the best balance between efficiency and benefit to patients.…”

Section: Discussionmentioning

confidence: 99%

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Universal Screening for Sexually Transmitted Infections among Asymptomatic Adolescents in an Urban Emergency Department: High Acceptance but Low Prevalence of Infection

Goyal

Teach

Badolato

et al. 2016

The Journal of Pediatrics

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Objectives To evaluate acceptance of sexually transmitted infection (STI) screening and measure STI prevalence in an asymptomatic adolescent ED population. Study design This was a prospectively enrolled cross-sectional study of 14–21 year old patients who sought care at an urban pediatric ED with non-STI related complaints. Participants completed a computer-assisted questionnaire to collect demographic and behavioral data and were asked to provide a urine sample to screen for Chlamydia trachomatis and Neisseria gonorrhoeae infection. We calculated STI screening acceptance and STI prevalence. We used logistic regression to identify factors associated with screening acceptance and presence of infection. Results Of 553 enrolled patients, 326 (59.0%) agreed to be screened for STIs. STI screening acceptability was associated with having public health insurance (aOR 1.7; 1.1, 2.5) and being sexually active (sexually active but denying high risk activity [aOR 1.7; 1.1, 2.5]; sexually active and reporting high risk activity [aOR 2.6; 1.5, 4.6]). Sixteen patients (4.9%; 95% CI 2.6, 7.3) had an asymptomatic STI. High-risk sexual behavior (aOR 7.2; 1.4, 37.7) and preferential use of the ED rather than primary care for acute medical needs (aOR 4.0; 1.3, 12.3) were associated with STI. Conclusions STI screening is acceptable to adolescents in the ED, especially among those who declare sexual experience. Overall, there was a low prevalence of asymptomatic STI. Risk of STI was higher among youth engaging in high-risk sexual behavior and those relying on the ED for acute health care access. Targeted screening interventions may be more efficient than universal screening for STI detection in the ED.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Universal Screening for Sexually Transmitted Infections among Asymptomatic Adolescents in an Urban Emergency Department: High Acceptance but Low Prevalence of Infection

Goyal

Teach

Badolato

et al. 2016

The Journal of Pediatrics

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“…14 Prior studies have shown a higher prevalence of GC/CT in patients of non-Hispanic black race/ethnicity, although it is not clear if this data reflects differences in exposure or more limited access to healthcare for screening and treatment. 1–2,5 Given the high prevalence of GC/CT in adolescents and the barriers to follow up, providers should strongly consider treatment for patients who have clinical indications for testing, regardless of race/ethnicity.…”

Section: Discussionmentioning

confidence: 99%

Sensitivity and Specificity of Empiric Treatment for Sexually Transmitted Infections in a Pediatric Emergency Department

Breslin

Tuchman

Hayes

et al. 2017

The Journal of Pediatrics

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Objective To determine test characteristics of provider judgment for empiric antibiotic provision to patients undergoing STI testing. Study design We conducted a retrospective cross-sectional electronic health record review of all patients aged 13–19 years who had GC and CT testing sent from an urban, academic pediatric ED in 2012. We abstracted data including patient demographics, chief complaint, STI test results, and treatment. We calculated test characteristics comparing clinician judgment for presumptive STI treatment with the reference standard of the actual results of STI testing. Results Of 1223 patient visits meeting inclusion criteria, 284 (23.2%) had a positive GC and/or CT test result. Empiric treatment was provided in 615 encounters (50.3%). Provider judgment for presumptive treatment had an overall sensitivity of 67.6% (95%CI 61.8, 73.0) and a specificity of 55% (95%CI 51.7, 58.2) for accurate GC and/or CT detection. Conclusions Many adolescents tested for GC and CT receive empiric treatment at the initial ED visit. Provider judgment may lack sufficient sensitivity and specificity for identifying infected patients, resulting in the potential for under-treatment of true disease, overtreatment of uninfected patients, or both.

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“…Our detected prevalence is similar to prevalence of N gonorrhoeae and C trachomatis infections found in other studies that did not select populations based on sexual activity, although these studies did not exclude symptomatic patients. (21,22) However, rates of STI were associated with greater engagement in high risk sexual behavior and preferential use of the ED versus primary care, suggesting that a targeted screening strategy may offer the best balance between efficiency and benefit to patients. CDC, USPSTF, and AAP recommend annual screening.…”

Section: Discussionmentioning

confidence: 99%

“…Although there are a few prior studies that have evaluated adolescent STI prevalence in EDs, (20)(21)(22) this study offered screening to patients regardless of reported sexual activity and included an asymptomatic population solely. We chose these selection criteria to more precisely estimate the prevalence of STI in a cohort of patients who would be approached for screening if a universal STI screening protocol were instituted.…”

Section: Discussionmentioning

confidence: 99%

Universal Screening for Sexually Transmitted Infections among Asymptomatic Adolescents in an Urban Emergency Department: High Acceptance but Low Prevalence of Infection

Goyal

Teach

Badolato

et al. 2016

Journal of Adolescent Health

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Screening Adolescents for Sexually Transmitted Infections in the Pediatric Emergency Department

Cited by 17 publications

References 25 publications

Universal Screening for Sexually Transmitted Infections among Asymptomatic Adolescents in an Urban Emergency Department: High Acceptance but Low Prevalence of Infection

Universal Screening for Sexually Transmitted Infections among Asymptomatic Adolescents in an Urban Emergency Department: High Acceptance but Low Prevalence of Infection

Sensitivity and Specificity of Empiric Treatment for Sexually Transmitted Infections in a Pediatric Emergency Department

Universal Screening for Sexually Transmitted Infections among Asymptomatic Adolescents in an Urban Emergency Department: High Acceptance but Low Prevalence of Infection

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