Identifying a need for more focused treatment of chlamydia and gonorrhoea in the emergency department. Int J STD AIDS 2016 Oct;27(11):993-7
Date
09/24/2015Pubmed ID
26394998DOI
10.1177/0956462415604769Scopus ID
2-s2.0-84988424300 (requires institutional sign-in at Scopus site) 7 CitationsAbstract
The indolent nature of chlamydia and gonorrhoea, along with the time delay associated with current diagnostic testing, makes definitive diagnosis while in the emergency department impossible. We therefore sought to determine the proportion of patients who receive accurate, presumptive antimicrobial treatment for these infections. A retrospective chart review was performed on all patient encounters that underwent chlamydia and gonorrhoea testing at an urban emergency department during a single month in 2012. Each encounter was reviewed for nucleic acid amplification test results and whether presumptive antibiotics were given during the initial visit. A total of 639 patient encounters were reviewed; 87.2% were female and the mean age was 26.7 years. Chlamydia was present in 11.1%, with women and men having similar infection rates: 10.6% vs. 14.6% (p = 0.277). Gonorrhoea was present in 5.0%, with a lower prevalence among women than men: 3.2% vs. 17.1% (p < 0.001). Women received presumptive treatment less often than men: 37.7% vs. 82.9% (p < 0.001). Presumptive treatment was less accurate in women than men: 7.9% vs. 25.6% (p < 0.001). After combining genders, 10.2% received accurate presumptive treatment; 33.3% were overtreated and 4.4% missed treatment. Presumptive treatment for chlamydia and gonorrhoea was more frequent and more accurate in men than in women. Overall, one-third of patients received unnecessary antibiotics, yet nearly 5% missed treatment. Better methods are needed for identifying patients who need treatment.
Author List
Wilson SP, Knych M, Iordanova R, Mahan M, Vohra TAuthor
Mckenna Knych MD Assistant Professor in the Emergency Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAnti-Bacterial Agents
Chlamydia Infections
Chlamydia trachomatis
Emergency Service, Hospital
Female
Gonorrhea
Humans
Male
Middle Aged
Neisseria gonorrhoeae
Nucleic Acid Amplification Techniques
Point-of-Care Systems
Prevalence
Retrospective Studies
Sex Distribution
Urban Population
