233625 Systematic review of chlamydia and gonorrhea screening in emergency departments

Tuesday, November 9, 2010

Wiley D. Jenkins, PhD, MPH , Family and Community Medicine, Southern Illinois University School of Medicine, Springfield, IL
Regina Kovach, MD , Emergency Medicine, Southern Illinois University School of Medicine, Springfield, IL
Whitney Zahnd, BA, MPH , Ceneter for Clincal Research, Southern Illinois University School of Medicine, Springfield, IL
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.

Learning Areas:
Clinical medicine applied in public health
Epidemiology

Learning Objectives:
1. Describe current methods for CT/GC screening, presumptive identification and empiric treatment used by EDs. 2. Describe the weaknesses of these methods and costs involved. 3. Discuss some of the barriers to effective CT/GC identification and care, and how screening barriers might be overcome.

Keywords: Infectious Diseases, Medical Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to study and report on the topic of sexually transmitted infections due to my education (MPH, PhD; both public health), work experience (13 years in a state public health department) and current experience (3 years in academics with >5 peer-reviewed publications and >30 presentations on the topic of STIs).
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.