Online Program

Oral and genital screening of emergency department patients for chlamydia and gonorrhea

Wednesday, November 6, 2013

Wiley D. Jenkins, PhD, MPH, Population Health Science Program, Southern Illinois University School of Medicine, Springfield, IL
Laurette Nessa, MPH/MPA, Center for Clincal Research, Southern Illinois University School of Medicine, Springfield, IL
Ted Clark, MD, Division of Emergency Medicine, Southern Illinois University School of Medicine, Springfield, IL
Background – Emergency department (ED) patients are at increased risk chlamydia (CT) and gonorrhea (GC) infection. Though CT/GC prevalence frequently exceeds 8%/4%, clinical symptoms are ambiguous. EDs may be important screening sites if cost-effective screening algorithms can be identified.

Objective – To determine if ED patient survey responses predict CT/GC infection.

Methods – Participating ED patients aged 15-34 completed a sexual history survey and provided urine samples (GEN) and oralpharyngeal swabs (ORAL) for CT/GC testing. Surveys were analyzed for associations between specific answers and infection status.

Results (preliminary; will end at 300 each females/males) – Of 395 participants, mean age was 25.1 years, 65.6% were female, 192 aged 15-24 (younger) and 203 aged 25-34 (older). 31 (7.8%) individuals were infected, including 11 males (8.1%)/20 females (7.7%), with those younger more likely infected (OR=3.317; CI=1.446-7.611). For males, oral infection was associated with giving another male oral sex (p=0.013) and receptive anal sex (p=0.025) and genital infection with receptive and insertive anal sex (p=0.027 and p=0.024). Females thinking their partners had other partners were more likely for any infection (OR=4.540; CI=1.700-12.122). Regarding algorithms, screening only sexually active males not in a relationship for 6+ months identifies 9 (81.8%) of those infected while reducing tests by 58.1%.

Conclusions – Infection rates are sufficient to warrant screening, and patient data-based algorithms may increase cost-effectiveness. Oral testing should be considered as genital sample-only testing would have resulted in 2 missed individuals (oral infection only) and 1improperly treated (CT genital/GC oral); representing 9.7% of all infected.

Learning Areas:

Clinical medicine applied in public health
Provision of health care to the public
Public health biology
Public health or related research

Learning Objectives:
Describe the prevalence or oral and genital chlamydia and gonorrhea infections in emergency department patients Describe how patient responses to sexual hisotry questions are associated with infection status. Discuss how patient responses and infection status may be used to devise screening algorithms.

Keyword(s): STD, Epidemiology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have spent 13 years at the state health department laboratory and 6 years since as an academic STD researcher. My MPH and PhD are in public health and I have been funded and published in the area of STD research.
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.