Advertisement

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

Published:August 07, 2018DOI:https://doi.org/10.1016/j.ajem.2018.08.015

      Abstract

      Background

      In the ED, patients are treated empirically for suspected gonorrhea and/or chlamydia (GC). Limited studies have evaluated the treatment of sexually transmitted diseases (STDs) in conjunction with predictor variables. This study will allow providers to better identify patients with potential GC to streamline antibiotic treatment.

      Objectives

      The primary objective was to determine the incidence of positive assay in patients that underwent GC screening. The secondary objectives included the proportion of patients assayed that received empiric therapy and the predictive value of risk factors to identify positive assays.

      Methods

      This retrospective cohort study included adult patients who presented to the health-system EDs and underwent GC screening. Subjects were excluded if they were victims of sexual assault, left AMA or eloped.

      Results

      A total of 490 assayed patients were included, of which 84 (17%) were found to be positive for GC assay. Of the 278 patients treated empirically, 74% had a negative assay. Of the entire sample (n = 490), risk factors found to predict a positive assay (p < 0.05) included male, women <25 years of age, concomitant bacterial vaginosis, pelvic inflammatory disease or trichomonas, penile discharge, inconsistent condom use, previous/coexisting STDs, and uninsured.

      Conclusions

      Compared to previous reports, this study found a higher incidence of positive GC assays for patients with suspected infection. This is the first study to evaluate GC testing in both men and women in the ED, and risk factors not previously reported by the CDC were identified.

      Keywords

      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kirkcaldy R.D.
        • Harvey A.
        • Papp J.R.
        • et al.
        Neisseria gonorrhoeae antimicrobial susceptibility surveillance — the gonococcal isolate surveillance project, 27 sites, United States, 2014.
        Surveillance Summaries. July 15, 2016; 65: 1-19
        • Handsfield H.H.
        • Lipman TO
        • Harnisch J.P.
        • et al.
        Asymptomatic gonorrhea in men — diagnosis, natural course, prevalence and significance.
        N Engl J Med. 1974; 290: 117-123
        • Levitt M.A.
        • Johnson S.
        • Engelstad L.
        • et al.
        Clinical management of chlamydia and gonorrhea infection in a county teaching emergency department—concerns in overtreatment, undertreatment, and follow-up treatment success.
        J Emerg Med. 2003 Jul; 25: 7-11
      1. Antibiotic-resistant gonorrhea basic information. Centers for Disease Control and Prevention Website, March 28, 2018 (Updated March 28, 2018. Accessed July 13, 2018)
        • Upchurch D.M.
        • Brady W.E.
        • Reichart C.A.
        • et al.
        Behavioral contributions to acquisition of gonorrhea in patients attending an inner city sexually transmitted disease clinic.
        J Infect Dis. 1990 May; 161: 938-941
        • Dicker L.W.
        • Mosure D.J.
        • Berman S.M.
        • et al.
        Gonorrhea prevalence and coinfection with chlamydia in women in the United States, 2000.
        Sex Transm Dis. 2003 May; 30: 472-476
      2. Gonococcal infections. Centers for Disease Control and Prevention Website, June 4, 2015 (Updated July 27, 2016. Accessed July 13, 2018)
      3. Chlamydial infections. Centers for Disease Control and Prevention Website, June 4, 2016 (Updated June 4, 2015. Accessed August 25, 2017)
      4. STDs in men who have sex with men. Centers for Disease Control and Prevention Website, November 17, 2015 (Updated June 4, 2015. Accessed August 25, 2016)
        • Jenkins W.D.
        • Zahnd W.
        • Kovach R.
        • et al.
        Chlamydia and gonorrhea screening in United States emergency departments.
        J Emerg Med. 2013 Feb; 44: 558-567
      5. BD ProbeTec ET Chlamydia trachomatis and Neisseria gonorrhoeae amplified DNA assays [Package Insert]. Becton, Dickson, and Company, Sparks, MD2015
        • LeFevre M.L.
        USPSTF: screening for chlamydia and gonorrhea.
        Ann Intern Med. 2014; 161: 902-910
        • Schwebke J.R.
        • Sadler R.
        • Sutton J.M.
        • et al.
        Positive screening tests for gonorrhea and chlamydial infection fail to lead consistently to treatment of patients attending a sexually transmitted disease clinic.
        Sex Transm Dis. 1997 Apr; 24: 181-184
        • Simon E.L.
        • Dark C.
        • Kovacs M.
        Variation in hospital admission rates between a tertiary care and two freestanding emergency departments.
        Am J Emerg Med. 2017 Oct; 29
        • Simon E.L.
        • Griffin P.L.
        • Jouriles N.J.
        The impact of two freestanding emergency departments on a tertiary care center.
        J Emerg Med. 2012 Dec; 43: 1127-1131