953. Comprehensive Screening for Sexually Transmitted Disease Pathogens Improves Patient and Financial Outcomes
Session: Poster Abstract Session: Sexually Transmitted Infections
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 953_IDWposter.pdf (1.0 MB)
  • Background:

     

    The silent epidemic of sexually transmitted diseases (STD) impacts patients, partners, infants and  community. Important organisms are part of an ecological pool sharing one risk factor:  sex.  The STD pool is not exclusive to Gonorrhea (GC) and Chlamydia (CTA), but inclusive for GC, CTA, Herpes (HSV) and Trichomonas (Tric).  Asymptomatic shedding accounts for significant transmission.  Routine screening for all important agents will reduce infection by identifying those who need treated.

    Methods:

     

    20 symptomatic emergency department (ED) patients and 329 women's health centers (HC) patients were tested for GC, CTA, HSV, and Tric using target enriched multiplex PCR (Tem-PCR) STD5 Diatherix proprietary assay.  The assay is a nested PCR assay, with tagged, target specific primers providing initial target identification, and common flanking Super Primers providing bulk amplification.  A cell control confirms specimen adequacy.   

    Results:

     

    Utilization of Tem-PCR STD 5 panel resulted in increased diagnosis of STD in 69 of 349 patients.  Of the 20 ED patients, 19/20 had GC/CTA ordered; 1/20 was a GC screen only which was positive for CTA.   6/20 patients were positive for HSV 2, one for HSV 1 with coexisting oral lesions.  7/19 patients were positive for CTA and 3/19 for GC.  One patient had both GC and HSV 2.  5/20 patients were positive for Tric.  Of the 329 HC patients, 50 were positive, a detection rate of 15%.   9/50 were positive for CTA, 5/50 for GC, and 4/50 had both GC and CTA.  Other markers were HSV (6), and Tric (38).  One patient was coinfected with HSV1 and HSV2.  Of the 38 Tric, only 9 were detected by wet mount. 

    Conclusion:

    The data suggest multiple cases of HSV and Tric are missed when patients are tested for GC/CTA only.  Our patients with HSV had no visible lesions and were often misdiagnosed as urinary tract infection due to dysuria and pyuria.  Four ED patients had multiple prior visits with repeated pelvic and gall bladder ultrasound, and abdominal CAT scans.  Wet mount for Tric was unreliable.  The burden of Tric and the substantial evidence linking it to adverse health outcomes, including pelvic inflammatory disease, preterm delivery, cervical cancer, and increased susceptibility to HIV, speaks to the appropriateness of its inclusion in routine screening.

     

    Carol Quinter, PhD, Microbiology, Kettering Medical Center, Kettering, OH, Catherine D. Bacheller, MD, Medicine, Kettering Medical Center/Wright State University, Kettering, OH and Susan Troutman, MT (ASCP), Kettering Health Network, Kettering, OH

    Disclosures:

    C. Quinter, Diatherix Laboratory: Consultant and Speaker's Bureau, Consulting fee

    C. D. Bacheller, Diatherix Laboratories: Consultant and Speaker's Bureau, Consulting fee

    S. Troutman, None

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