Abstract
Background
Emergency Departments (EDs) are a care source for patients with sexually transmitted
diseases (STDs). St. Louis, MO reports among the highest rates of gonorrhea and chlamydia
infection. We examined STD treatment in a high-volume urban ED, in St. Louis MO, to
identify factors that may influence treatment.
Methods
A retrospective chart review and analysis was conducted on visits to a high volume,
academic ED in St. Louis, MO where patients received a gonorrhea/chlamydia nucleic
acid amplification test (NAAT) with a valid matching test result over two years. Using
multiple logistic regression, we examined available predictors for under and overtreatment.
Results
NAATs were performed on 3.3% of all ED patients during the study period. Overall prevalence
was 6.9% for gonorrhea (95% CI: 6.2, 7.7) and 11.6% for chlamydia (95% CI: 10.6, 12.5).
Race was not a statistically significant predictor for undertreatment but Black patients
were significantly more likely to be overtreated compared to White patients. (OR 1.83,
95% CI: 1.5, 2.2). Females were more likely to be undertreated when positive for infection
compared to males (OR 7.34, 95% CI: 4.8, 11.2) and less likely to be overtreated when
negative for infection (OR 0.27, 95% CI: 0.2, 0.3).
Conclusion
The burden of STDs in a high-volume academic ED was significant and treatment varied
across groups. Attention should be paid to particular groups, specifically women and
patients reporting Black as their race, to ensure appropriate treatment is administered.
Patients would benefit from targeted STD management protocols and training in the
ED.
Keywords
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Article Info
Publication History
Published online: May 30, 2019
Accepted:
May 29,
2019
Received in revised form:
May 24,
2019
Received:
January 4,
2019
Footnotes
â?†Authors report no conflicts of interest or external sources of support.
â?†Summary: A study of patients attending an urban emergency department (ED) in St. Louis, MO revealed a significant burden of STD-related diagnoses, as well as significant levels of overtreatment and undertreatment.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
