Systematic review of chlamydia and gonorrhea screening in emergency departments

Background – Reported cases of chlamydia and gonorrhea are increasing. Screening higher-risk individuals is the most cost-effective intervention, and emergency departments (ED) serve a reportedly high-prevalence population. However, most do not perform screening as a standard of care, but rely upon clinical presentations, patient history, and empiric treatment algorithms. These methods are all poorly sensitive to infection, and rates of both over- and under-treatment are high.

Objective – To perform a systematic literature review to determine the best screening strategy for EDs.

Methods – We systematically searched the literature for articles describing CT and/or GC infection in EDs. We identified a total of 34 articles published since 1995.

Results – CT and GC rates in the general patient population ranged from 6.3-9.1% and 2.6-7.0%. Clinician sensitivity to infection is poor, and many clinical presentations (e.g. dysuria, abdominal pain) do not predict infection. Poor on-the-spot diagnoses and lack of adequate on-site testing contribute to undertreatment (12-81%) and overtreatment (21-82%). Close collaborations with health departments improve both testing and patient follow-up. Nucleic acid testing is the preferred analysis method, but off-site analyses result in reporting delays. Other barriers to ED screening include lack of time, reimbursement and ignorance of local disease prevalence.

Conclusions – EDs serve high-risk populations and should be effective venues for CT/GC screening. However, clinical presentation and empiric treatment are inefficient and inadequate to determine infected patients during an ED visit. The data suggest that EDs collaborate with health departments to perform screening and patient follow-up, and investigate methods for swift, on-site sample analysis.