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

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.