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Effect of provider type and sex on empiric treatment of STD infections in adolescent patients

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    1 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States.
    Erica Tavares
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    1 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States.
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    Michigan State University College of Human Medicine, Department of Emergency Medicine, United States

    Department of Emergency Medicine, Spectrum Health Hospitals, United States
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    2 15 Michigan St NE 736, Grand Rapids, MI 49503, United States.
    Lindsey Ouellette
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    2 15 Michigan St NE 736, Grand Rapids, MI 49503, United States.
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    Michigan State University College of Human Medicine, Department of Emergency Medicine, United States
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    1 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States.
    Junwen Law
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    1 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States.
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    Michigan State University College of Human Medicine, Department of Emergency Medicine, United States

    Department of Emergency Medicine, Spectrum Health Hospitals, United States
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    1 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States.
    Timothy Joseph
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    1 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States.
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    Michigan State University College of Human Medicine, Department of Emergency Medicine, United States

    Department of Emergency Medicine, Spectrum Health Hospitals, United States
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    1 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States.
    Jennifer Zhan
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    1 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States.
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    Michigan State University College of Human Medicine, Department of Emergency Medicine, United States

    Department of Emergency Medicine, Spectrum Health Hospitals, United States
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    1 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States.
    Christopher Ardary
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    1 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States.
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    Michigan State University College of Human Medicine, Department of Emergency Medicine, United States

    Department of Emergency Medicine, Spectrum Health Hospitals, United States
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    1 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States.
    Adam Nicholson
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    1 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States.
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    Department of Emergency Medicine, Helen DeVos Children's Hospital, United States
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  • Jeffrey Jones
    Correspondence
    Corresponding author at: 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States.
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    Michigan State University College of Human Medicine, Department of Emergency Medicine, United States

    Department of Emergency Medicine, Spectrum Health Hospitals, United States
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    1 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States.
    2 15 Michigan St NE 736, Grand Rapids, MI 49503, United States.
Published:March 02, 2018DOI:https://doi.org/10.1016/j.ajem.2018.03.003
      Teens and young adults have the highest rates of sexually transmitted infections (STIs) of any age group [
      • Workowski K.A.
      • Bolan G.A.
      Centers for disease control and prevention. Sexually transmitted diseases treatment guidelines, 2015.
      ]. Emergency departments (EDs) are a key point of access to care for many of these patients. When adolescents present with symptoms suggestive of an STI, the Centers for Disease Control and Prevention (CDC) recommends routine testing for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT), liberal antibiotic treatment, and close outpatient follow-up [
      • Workowski K.A.
      • Bolan G.A.
      Centers for disease control and prevention. Sexually transmitted diseases treatment guidelines, 2015.
      ]. Previous studies have shown the CDC's suggestions are not always put into action, and there are no specific guidelines for ED providers [
      • Wiest D.R.
      • Spear S.J.
      • Bartfield J.M.
      Empiric treatment of gonorrhea and chlamydia in the ED.
      ,
      • Anaene M.
      • Soyemi K.
      • Caskey R.
      Factors associated with the over-treatment and under-treatment of gonorrhea and chlamydia in adolescents presenting to a public hospital emergency department.
      ,
      • Krivochenitser R.
      • Bicker E.
      • Whalen D.
      • Norman C.
      • Jones J.S.
      Adolescent patients with sexually transmitted infections: who gets lost to follow-up?.
      ,
      • Breslin K.
      • Tuchman L.
      • Hayes K.L.
      • et al.
      Sensitivity and specificity of empiric treatment for sexually transmitted infections in a pediatric emergency department.
      ]. The unpredictable diagnostic and treatment patterns of practitioners can lead to underrecognized GC and CT infections, delay in treatment for patients, and lingering consequences of the STI infection itself. This study sought to quantify the frequency of these missed GC and CT cervical infections in adolescent females tested in the ED, to describe and compare the characteristics of those treated and not treated during their initial presentation, and to characterize the influence of ED provider type and gender on the empiric treatment of STIs.

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