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Adolescents who present to ED should be tested for STIs
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DENVER, Colo. – Adolescents who present to the emergency department with lower abdominal pain or genitourinary symptoms often have a sexually transmitted infection, according to a data presented here at the Pediatric Academic Societies’ 2011 Annual Meeting.
Monika K. Goyal, MD, instructor of pediatrics and attending physician in the department of pediatrics and of the division of emergency medicine at Children’s Hospital of Philadelphia, University of Pennsylvania, said that STI testing should be considered in all adolescent females presenting to the ED with lower abdominal and/or genitourinary (GU) symptoms.
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The prospective prevalence study included a consecutive sample of female patients aged 14-19 years who presented to a pediatric ED with symptoms of lower abdominal, pelvic, or flank pain and/or GU complaints. Patients were tested for Neisseria gonorrhoeae and Chlamydia trachomatis utilizing a urine PCR test and for Trichomonas vaginalis utilizing a vaginal rapid antigen test.
Among 276 patients who met inclusion criteria, 236 underwent STI testing. The prevalence of any STI was 26.3% (95% CI, 20.6-31.9) among patients who had STI testing performed.
“Assuming all eligible patients who did not undergo STI testing were not infected with any STIs, sensitivity analysis still revealed an STI prevalence of nearly 23% Goyal said during her presentation.
Among patients who underwent STI testing, Chlamydia was the most frequently detected infection (19.7%; 95 CI, 14.5-24.9), followed by trichomoniasis (9.9%; 95% CI, 5.7-14.0) and gonorrhea (3.5%; 95% CI, 1.1-5.9). Nineteen percent of patients infected with C. trachomatis were also positive for T. vaginalis and 6.7% with C. trachomatis were co-infected with N. gonorrhoeae. Logistic regression revealed that there was no significant association between STI and patient age or chief complaint.
However, the researchers noted that there was a significant association between STI and black race (OR 15.2; 95% CI, 3.6-64) and lack of private insurance (3.14; 95% CI, 1.53-6.43).
Goyal said that because EDs are often the primary point of care of adolescents, testing for STIs should be considered in this population. She plans to do a follow-up study of STIs in asymptomatic adolescent patients who present to the ED at Children’s Hospital of Philadelphia.
Given the high prevalence of STIs in this population and the potential morbidity associated with infection, Goyal and colleagues conducted this study to determine the prevalence of STIs in adolescent females presenting to a pediatric ED with chief complaints suggestive of an STI.
“Further study is needed,” Goyal said. “Adolescents make up 16% of all ED visits in the US, which equates to 16 million visits,” Goyal said.
Disclosure: Dr. Goyal reports no relevant financial disclosures.
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Results of Dr. Goyal's study are consistent with findings from our study that was also presented during the PAS meeting. Both of us found that it is important to test for STIs. We have to test our patients as they come in. If we don't, we are doing a disservice to our patients.
Testing for gonorrhea, chlamydia and trichomonas can help prevent pelvic inflammatory disease (PID) and tubo-ovarian abscesses (TOA) that can both lead to increased risk for ectopic pregnancy, overall problems with fertility as adults, and chronic abdominal/pelvic pain due to scaring and adhesions.
With testing for chlamydia, gonorrhea and trichomonas - followed by appropriate treatment with antibiotics - we can potentially prevent the occurrance of PID and its long-term consequences.
Carolyn Holland, MD, MEd
Cincinnati Children's Hospital Medical Center and University of Cincinnati
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