Suspected gonorrhea and chlamydia: Incidence and utilization of empiric antibiotics in a health system emergency department

Garlock, Jenna; Lee, Leborah; Cucci, Michaelia; Frazee, Lawrence A; Mullen, Chanda

doi:10.1016/j.ajem.2018.08.015

Cited by 7 publications

(11 citation statements)

References 9 publications

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“…The data set used in our analysis did not include history and physical examination findings, which could have expanded our analysis. Our findings on vaginal wet preparation associated with C. trachomatis or N. gonorrhoeae or both, were an increased number of WBCs and the presence of T. vaginalis , which have been reported by some authors but not others (Garlock et al, 2019; Geisler, Yu, Venglarik, & Schwebke, 2004; Hafner & Schaefer, 2014; Lo, Schott, Visintainer, & Best, 2012; Wegner, Yen, & Witting, 2009; White, Sadalla, Springer, & Counselman, 2005; Wilkerson, 2011). Because not all women who received a vaginal wet preparation received a T. vaginalis NAAT, selection bias is likely for that association.…”

Section: Discussionsupporting

confidence: 78%

“…The incidence of C. trachomatis and N. gonorrhoeae infection is increasing in the country, especially among younger persons of races who are not Black (Centers for Disease Control and Prevention, 2019). Additional risk factors for C. trachomatis and N. gonorrhoeae infection in the United States include an increased number of sexual partners, unmarried status, inconsistent condom use, men having sex with men, a history of sexual abuse, and poverty (Centers for Disease Control and Prevention, 2019; Fichtenberg, Jennings, Glass, & Ellen, 2010; Garlock, Lee, Cucci, Frazee, & Mullen, 2019; Marshall et al, 2009).…”

mentioning

confidence: 99%

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

Sheele

Bragg

et al. 2022

Advanced Emergency Nursing Journal

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Demographic characteristics, risk factors, and clinical variables associated with gonorrhea and chlamydial infection in women being treated in emergency departments (EDs) in the United States are incompletely characterized. We used univariable and multivariable regression analyses on 17,411 encounters from women 18 years and older who presented to EDs in northeast Ohio and were tested for gonorrhea or chlamydial infection. There were 1,360 women (7.8%) who had Chlamydia trachomatis infection and 510 (2.9%) who had Neisseria gonorrhoeae infection. Those infected with C. trachomatis or N. gonorrhoeae were younger (23.8 vs. 29.2 years), unmarried (97.7% vs. 90.1%), Black (93.3% vs. 88.0%), infected with Trichomonas vaginalis (39.9% vs. 27.2%), diagnosed with urinary tract infection (15.7% vs. 10.6%), and treated for gonorrhea and chlamydial infection during the ED visit (31.6% vs. 17.4%) (all ps < .001). Women infected with C. trachomatis or N. gonorrhoeae had more urine white blood cells (WBCs) (23.9 vs. 16.4 cells per high-power field [HPF]) and leukocyte esterase (1.2+ vs. 0.8+) on urinalysis. They had more WBCs (18.5 vs. 12.4 cells/HPF) and odds of having T. vaginalis infection (12.8% vs. 8.2%) on vaginal wet preparation (all ps < .001). Women infected with C. trachomatis were more likely to be younger and not Black; they were less likely to be treated for gonorrhea and chlamydial infection in the ED and to have lower levels of urine WBCs, leukocyte esterase, and blood than those infected with N gonorrhoeae (all ps ≤ .05).

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Section: Discussionsupporting

confidence: 78%

mentioning

confidence: 99%

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

Sheele

Bragg

et al. 2022

Advanced Emergency Nursing Journal

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“…On univariate analysis there were multiple variables associated with ED providers empirically treating patients with antibiotics for NG and CT in the ED; however, none of these variables were associated with an increased risk for infection with NG or CT with the exception of TV on vaginal wet prep. Other studies have shown additional associated risk factors for STIs in the ED including male sex, women <25 years of age, being diagnosed with pelvic inflammatory disease, penile discharge, and patients without health insurance [9]. Clinicians significantly overtreated NG and CT in the ED.…”

Section: Discussionmentioning

confidence: 99%

“…Antibiotics may still be warranted for some genital tract infections such as pelvic inflammatory disease where NG and CT are present in <50% of cases [4]. Considering the pretest probability for an STI may affect the decision to empirically treat patients, as STI incidence rates of patient populations have demonstrated significant variation in hospitalbased EDs (22%) versus free-standing EDs (9%) [9].…”

Section: Discussionmentioning

confidence: 99%

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

Sheele

Smith

Niforatos

et al. 2019

Cureus

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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

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“…Emergency departments (EDs) play an important role in providing episodic care for high-risk populations presenting with sexually transmitted infections (STIs), particularly chlamydia and gonorrhea. 1 Increasingly, the ED is a venue where adolescents 2 among others are seeking STI care. As STI rates continue to rise in the U.S., 3 STI-related ED visits have increased at a rate greater than ED visits for other types of care, 39% compared to 2%, respectively.…”

Section: Introductionmentioning

confidence: 99%

Undertreatment of chlamydia and gonorrhea among pregnant women in the emergency department

et al. 2019

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The objective of this study is to evaluate whether pregnant women receive appropriate treatment, undertreatment, or overtreatment in the emergency department (ED) when they are tested for chlamydia and gonorrhea as compared to non-pregnant women. In a retrospective cohort study, we analyzed visits made to an urban ED from 1 July 2012 to 30 June 2014, with testing for chlamydia and gonorrhea (n = 3908). Using multiple logistic regression, we compared undertreatment and overtreatment in women controlling for pregnancy, age, race, and sexually transmitted infection International Statistical Classifications of Diseases (ICD)-9 coded diagnosis. Pregnant women were significantly more likely to be undertreated when positive for infection as compared to non-pregnant women (OR 2.94; 95% CI, 1.47–5.95) and significantly less likely to be overtreated when negative for infection (OR 0.40; 95% CI, 0.31–0.53) as compared to non-pregnant women. Pregnant women may not be receiving appropriate treatment when they present to the ED with chlamydia or gonorrhea. Attention should be paid to this group when administering chlamydia and gonorrhea treatment to ensure appropriate care and follow-up.

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Suspected gonorrhea and chlamydia: Incidence and utilization of empiric antibiotics in a health system emergency department

Cited by 7 publications

References 9 publications

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

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

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

Undertreatment of chlamydia and gonorrhea among pregnant women in the emergency department

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