Sexually transmitted infection presentation in a large urban academic emergency department

introduction: STIs remain prevalent in urban populations and are commonly diagnosed and treated in emergency departments (ED). However, the burden of STI-care on urban EDs is not well understood. 

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. All ED patients evaluated for Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae(GC) infection by nucleic acid amplification testing were examined and patient demographics, testing rates, and STI prevalence were characterized.

results: During the study period, there were approximately 183,000 ED patient visits. Of these, 7,179 visits (3.9%) resulted in STI testing for 5,431 patients. For tested patients, 23% were male, 79% African-American, and median age (interquartile range) was 26.3(22.1-34.5). Overall prevalence was 6.6% for GC and 11.8% for Ct among patients tested. 863 patients had a positive test. Among patients positive for GC, Ct or both, 55.04-74.5% were female and 60.5-72.2% were ≤24 years. 22% of patients were tested more than once in the ED during the study period and defined as “superusers”. Unadjusted Chi-square test suggests superusers who are tested in the ED are more likely to have a positive test than non-superusers who are tested [GC (X²=102.5, p<.001) and for Ct (X²=103.5, p<.001)]. However, when we restrict the analysis to only positive patients (n=863), the superusers more likely to have GC than non-superusers who test positive [GC (X²=9.1, p=.003) but not for (Ct) (X²=.08, p=.782)].

discussion: Our study revealed a significant burden of STI-related diagnosis and treatment in the urban emergency department setting. The majority of patients tested for STIs were female, African American, and under age 24. Interestingly, we found a high rate of “superusers” of the ED for STI-related care. Superusers were more likely to have a positive test than those who were tested only once, and more likely to have a test that was positive for GC. Additional research is needed to understand the unique patient population presenting to urban EDs for STI care and inform tailored intervention strategies.