1554. Treatment patterns for sexually transmitted infections among superusers of an urban emergency department
Session: Poster Abstract Session: Clinical Infectious Diseases: Sexually Transmitted Infections
Saturday, October 10, 2015
Room: Poster Hall
  • IDSA poster FINAL pdf.pdf (1.9 MB)
  • Background: Sexually-transmitted infections (STIs) remain prevalent in urban populations and are often diagnosed in emergency departments (ED). However, the burden of STI care for superusers on urban EDs has not been well-described.

    Methods: We conducted a retrospective study of patients seeking acute care for STI-related complaints at a large urban academic ED from July 2012 to June 2014. Demographic characteristics, ED utilization patterns, test positivity, and treatment data for patients undergoing Chlamydia trachomatis (Ct) and/or Neisseria gonorrhoeae (GC) nucleic acid amplification testing were examined.

    Results: Approximately 183,000 ED patient visits occurred during the study period. Of these, 6,518 visits (3.6%) resulted in STI testing for 5,431 patients. Overall prevalence was 6.6% for GC and 11.8% for Ct among patients tested. Patients tested more than once during the study period (superusers) comprised 14% of the cohort and were responsible for 28% of ED STI visits. Superusers were more likely to have a positive test for GC (p<0.001) and/or Ct (p<0.001), and had a GC prevalence more than twice that of single users (13.1% vs 5.7%, p<0.001).

    Superusers received adequate treatment for STIs at 55% of visits compared to 62% for those who were tested in the ED only once (single users) (χ² = 27.86, p < .001).  Superusers were overtreated at 40% of visits vs 32% of visits for single users (χ² = 36.09, p < .001) and undertreated at 5% of visits vs 6% of visits for single users (χ² = 1.34 p=.246).

    Analysis of treatment by disease status showed 75% of GC positive visits were adequately treated compared to only 52% of Ct positive visits.  GC positive visits were undertreated at half the rate (25%) of Ct positive visits (48%). These results were significant at the p < .01 level. Visits positive for both GC and Ct were adequately treated 55% of the time and undertreated 45% of the time.

    Conclusion: STIs, particularly GC, create significant burden in this urban ED setting. Superusers of the ED for STI testing had higher rates of positive tests for GC and/or Ct and higher rates of overtreatment for either infection than single users. GC was adequately treated at a rate 50% greater than Ct infection alone or dual GC/Ct infection. Better understanding of STI super users will improve management of STIs in the ED.

    Alex Dretler, MD1, Anne Trolard, MPH2, Benjamin Cooper, MPH2, Stephen Liang, MD3 and Hilary Reno, MD, PhD4, (1)Washington University in St. Louis, Saint Louis, MO, (2)Institute of Public Health, Washington University in St. Louis, Saint Louis, MO, (3)Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, (4)Division of Infectious Disease, Washington University in St. Louis, Saint Louis, MO


    A. Dretler, None

    A. Trolard, None

    B. Cooper, None

    S. Liang, None

    H. Reno, None

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