Screening in the ED Identifies Men With Chlamydia and Gonorrhea

Barbara Boughton

October 31, 2010

October 31, 2010 (San Francisco, California) — A new study suggests that screening men for Chlamydia trachomatis and Neisseria gonorrhoeae in an emergency department setting may be an effective way to test men who might otherwise go untreated, and may help prevent the infection of others, according to research presented here at the American Society for Clinical Pathology 2010 Annual Meeting.

Researchers from Louisiana State University Health Sciences Center analyzed the rates of positive test results for both chlamydia and gonorrhea among men and women in inpatient, outpatient, and emergency department settings in 2002 and 2008. Although most women who tested positive for chlamydia or gonorrhea were most likely to present as outpatients, men who tested positive were more likely to be seen in the emergency department, said presenting author Delecia LaFrance, MD, from Louisiana State University Health Sciences Center in Shreveport.

"Shreveport is a hot spot for sexually transmitted disease [STD]," Dr. LaFrance said. "Although we knew we were identifying females who were positive for gonorrhea and chlamydia, we wondered about men who were positive. What we found is that because men don't come in for healthcare as often as females, we were more likely to identify males in the emergency room," she said. "Our study indicates that screening males for STDs in an [emergency department] setting might be a way to catch those who are positive and proactively treat them," she said.

The US Preventive Services Task Force has recommended routine screening for chlamydia and gonorrhea in young women aged 15 to 24 years but does not recommend screening men because of lack of evidence supporting the benefits of such screening. Yet in Shreveport, where the patient population is heavily indigent, the emergency department is one of the primary means of healthcare access. So screening men for chlamydia and gonorrhea in an emergency department setting could be a possible means for identifying and treating infected patients, Dr. LaFrance said.

The researchers found that 153 (8.5%) of 1793 screened men were positive for chlamydia or gonorrhea in 2002. Fifty-two percent of the positive specimens in men were obtained in the emergency department. By 2008, the rate of chlamydia and gonorrhea among men had increased to 11%, or 200 of 1821 screened men. Of those men who tested positive in 2008, 62% presented to the emergency department. In contrast, most women who tested positive for chlamydia or gonorrhea were primarily seen as outpatients in obstetric or gynecology clinics, and the rate for positive test results stayed fairly stable between 2002 and 2008, Dr. LaFrance said.

Although testing men in the emergency department was effective in finding those who were positive for chlamydia or gonorrhea, analyzing and processing test results took 24 hours or more, Dr. LaFrance said. Patients then had to return for treatment — causing a delay that might cause some to be lost to follow-up, Dr. LaFrance added. She noted that the next step in the research is to assess outcomes in male patients who tested positive for STDs in the emergency department, and the effectiveness of later follow-up and treatment.

"Chlamydia and gonorrhea can have a serious impact on young women, because these infections are often asymptomatic and can affect fertility. And while the impact on males from these STDs is less than for women, males can still act as vectors of transmission," said Mark Stoler, MD, professor of pathology and gynecology and associate director of surgical pathology and cytopathology at the University of Virginia Health System in Charlottesville. Dr. Stoler is president of the American Society for Clinical Pathology.

Screening men in an emergency department setting for STDs could have important ramifications, although it would not be simple to implement as a population-based preventive health measure, Dr. Stoler noted. Yet with the increasing use of molecular diagnostics for screening for STDs such as chlamydia or gonorrhea, men who present in the emergency department could be tested quickly and could receive results and initial treatment within a few hours.

"We now clearly have the molecular tools that allow us the compress the time frame for collecting samples and screening for STDs such as chlamydia and gonorrhea — and getting answers that will allow us to act in a clinically useful manner," Dr. Stoler said.

Dr. LaFrance and Dr. Stoler have disclosed no relevant financial relationships.

American Society for Clinical Pathology 2010 Annual Meeting: Abstract 46. Presented October 28, 2010.

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