Risk factors for infection with Chlamydia trachomatis and Neisseria gonorrhea in symptomatic emergency department patients

Objectives: The purpose of the current study was to indentify risk factors associated with a positive test for Neisseria gonorrheae (GC) or Chlamydia trachomatis (CT), or both in symptomatic emergency department (ED) patients.

Methods: Retrospective case-control study on ED patients tested for CG/CT during 2007. Cases were patients with a positive test for GC, CT, or both. Controls were randomly chosen from patients with negative test results. Descriptive statistics were utilized for demographic data. Associations were identified by univariate analysis (chi-square) and then further analyzed using multivariate logistic regression analysis.

Results: A total of 372 female cases and 60 male cases were compared to 482 female and 60 male controls. Factors associated with a positive test in a female included (Odds Ratio; 95% confidence intervals); age < 25 years (OR=3.00; 2.10, 4.29), history of fever (OR=2.16; 1.04, 4.47), African American (AA) Race (OR=1.85; 1.25, 2.73), unmarried (OR=3.47; 1.70, 7.06), Trichomonas (OR=1.89; 1.21, 3.00), no complaint of lower abdominal pain (OR=1.95; 1.15, 3.31), cervical motion tenderness (OR=1.75; 1.13, 2.71), and no ED visit in the last year (OR=1.59; 1.17, 2.15). The study was underpowered to identify all risk factors for males although penile discharge was a risk factor (OR=3.57; 1.10, 11.65).

Conclusions: There are several factors that increase the risk of a positive test for GC, CT, or both in symptomatic ED patients. However, the increased risk is relatively small and might not be clinically useful in deciding whom to treat empirically prior to receiving test results.