The rate of sexually transmitted infections in ED patients with vaginal bleeding

Berwald, Nicole; Zehtabchi, Shahriar; Cheng, Susan; Augenbraun, Michael; Abu-Lawi, Khaled; McLaughlin, Tom; Lucchesi, Michael

doi:10.1016/j.ajem.2008.05.012

« Previous Next »American Journal of Emergency Medicine
Volume 27, Issue 5 , Pages 563-569, June 2009

The rate of sexually transmitted infections in ED patients with vaginal bleeding

Nicole Berwald, MD
- Department of Emergency Medicine, State University of New York, Downstate Medical Center/Kings County Hospital, Brooklyn, NY, USA
- Corresponding author. Department of Emergency Medicine, State University of New York, Downstate Medical Center, Box: 1228, Brooklyn, NY 11203, USA. Tel.: +1 718 245 4790; fax: +1 718 245 4799.
Shahriar Zehtabchi, MD
- Department of Emergency Medicine, State University of New York, Downstate Medical Center/Kings County Hospital, Brooklyn, NY, USA
Susan Cheng, MPH
- College of Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
Michael Augenbraun, MD
- Department of Internal Medicine, Division of Infectious Disease, State University of New York, Downstate Medical Center/Kings County Hospital, Brooklyn, NY, USA
Khaled Abu-Lawi, PhD
- Department of Microbiology, State University of New York, Downstate Medical Center/Kings County Hospital, Brooklyn, NY, USA
Tom McLaughlin, PA
- Department of Emergency Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
Michael Lucchesi, MD
- Department of Emergency Medicine, State University of New York, Downstate Medical Center/Kings County Hospital, Brooklyn, NY, USA

Received 16 April 2008; received in revised form 10 May 2008; accepted 13 May 2008.

Abstract

Background

Early diagnosis of sexually transmitted infections (STI) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoea (NG) is crucial in reducing complications. Vaginal bleeding (VB) has been suggested as a possible presentation of STI.

Objective

To identify the rate of STI in sexually active women presenting to the emergency department (ED) with VB.

Methods

Prospective observational study of females 18-55 years-old presenting to two affiliated urban EDs with VB (convenience sample). Patients with recent STI or antibiotic use (< 3 months) were excluded. To estimate the background rate of STI, we enrolled women with no genitourinary complaints as controls. Specimens for CT and NG were obtained during speculum exam from cases and by self administered vaginal swab in controls. All specimens were analyzed by polymerase chain reaction. Continuous data was presented as mean ± standard deviation and categorical data as percentages with 95% confidence intervals CI). Fisher's exact test was used to compare the rate of STI between the groups.

Results

From 09.06 to 08.07 a total 273 subjects were enrolled (174 VB and 99 controls, mean age: 33 ± 10). Groups were similar with regards to baseline characteristics. The majority of STI cases were due to CT: 5.8% in VB group (95% CI, 3.2%-10.4%) vs. 7.1% in controls (95% CI, 3.5%-14.0%). The STI rate was 6.3% (95% CI, 3.5%-11.1%) in VB patients and 8% (95% CI, 3.9%-15.3%) in controls.