Some Adolescents May be Inappropriately Treated for STIs in the ED

Recent research has found that a significant proportion of adolescents who presented to the emergency department (ED) of a large urban hospital were overtreated (OT) and an even higher proportion were undertreated (UT) for Neisseria gonorrhoeae and Chlamydia trachomatis (GC/CT).

Adolescents and young adults screened for sexually transmitted infections [STIs] have a high prevalence of GC/CT. A significant proportion of these patients end up over-treated and an even higher proportion are under-treated. … Adolescent females who are more likely to suffer from the sequelae of GC/CT are more likely to be under-treated," the authors, led by Mutimbwa Anaene, MD, MPH, a pediatrician in the Department of Pediatrics at the University of Illinois at Chicago, wrote in their study, published in the December 2016 issue of the International Journal of Infectious Diseases.

Because STI prevalence among patients in this ED is high, adolescents and young adults are screened for these infections regardless of the reason for their visit, although they can opt out of testing if they choose to.

The researchers investigated the prevalence of GC/CT, the rates of OT and UT, and factors associated with OT and UT for female and male adolescent and young adult patients.

They conducted a retrospective chart review of patients ages 13 through 24 treated at the Pediatric Emergency Department who were screened for GC/CT from July 2014 through June 2015.

Overall, 797 adolescents and young adults were screened for GC/CT and 171 of these patients (21.6%) tested positive for an STI (either GC, CT, or both): 152 patients (19.1%) were positive for CT, 44 patients (5.5%) were positive for GC, and 25 patients (3.1%) were co-infected with GC/CT. A total of 136 patients were overtreated for their infection and 74 of the patients who were positive for an STI were undertreated.

Female patients with OT were more likely to be between 18 and 19 years of age (risk ratio [RR] 2.13, 95% confidence interval (CI) 1.18 to 3.84), to present with STI exposure (RR 97.83, 95% CI 12.50 to 763.4), to have a history of STIs (RR 3.78, 95% CI 2.07 to 6.88), and to present with genito-urinary (GU) symptoms (RR 2.34, 95% CI 1.36 to 4.02).

Male patients with OT were more likely to present with STI exposure (RR 31.76, 95% CI 7.35 to 137.22) and to have GU symptoms (RR 8.07, 95% CI 3.26 to 19.95).

A patient was more likely to be UT if female (RR 3.28, 95% CI 1.34 to 8.05) and was less likely to be UT if presenting with STI exposure (RR 0.03, 95% CI 0.003 to 0.21), having a prior history of STIs (RR 0.13, 95% CI 0.05 to 0.33), and having GU symptoms (RR 0.26, 95% CI 0.12 to 0.57).

The authors call for more research into improving communication with patients to improve follow-up. They also recommend enrolling adolescents and young adults in health insurance plans so they can receive appropriate medical care. Recent research has shown that rapid diagnostic testing can go a long way in helping to appropriately diagnose GC/CT infections in the ED by providing timely detection of infectious organisms and allowing for targeted antibiotic therapy.

Lorraine L. Janeczko, MPH, is a medical science writer who creates news, continuing medical education and feature content in a wide range of specialties for clinicians, researchers and other readers. She has completed a Master of Public Health degree through the Department of Epidemiology of the Johns Hopkins Bloomberg School of Public Health and a Dana Postdoctoral Fellowship in Preventive Public Health Ophthalmology from the Wilmer Eye Institute, the Johns Hopkins University School of Medicine and the Bloomberg School.