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.
B. Cooper, None
S. Liang, None
H. Reno, None
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