STI Screening Advocated for Pediatric EDs

By Marilynn Larkin

March 22, 2016

NEW YORK (Reuters Health) - Screening for sexually transmitted infections in a pediatric emergency department (PED) could help identify those who are infected despite lack of symptoms, researchers at Cincinnati Children's Hospital in Ohio report.

"Adolescents and young adults 15 to 24 years of age represent approximately 25% of the sexually active US population, but account for half of all new sexually transmitted infection (STI) cases and have the highest incidence of Chlamydia trachomatis (CT) and Neisseria gonorrhea (GC) among any sexually active age group. A large proportion of these infections are asymptomatic; thus, diagnosis and prompt treatment are vitally important to prevent transmission and long-term morbidity," the researchers write in the April issue of Sexually Transmitted Diseases.

To determine the proportions of GC and CT infections in asymptomatic adolescents in an academic urban PED, as well as patient-related predictors of screening refusals, the team recruited a convenience sample of patients aged 14 to 21 years presenting to the PED with nongenitourinary complaints. Patients were offered screening for GC and CT and asked to complete a questionnaire designed to identify barriers to screening.

A total of 719 (68%) of those approached participated. Nonwhites were more likely to agree to screening compared with whites (61.4% versus 38.6%) and were more likely to be publicly insured (63.3%) versus privately insured (29.3%) or uninsured (7.58%).

A total of 403 (56%) participants provided urine samples. Of those, 40 (9.9%) were positive for an STI. Controlling for other demographics, race was a significant predictor; the odds of testing positive for nonwhite participants were 5.90 times those of white participants.

Patients who refused testing were more likely to report not engaging in sexual activity (54.3% versus 42.4%) and less likely to perceive that they were at risk for STIs.

Coauthor Dr. Kari Schneider noted that Centers for Disease Control and Prevention guidelines state that all sexually active adolescents should be screened yearly. "Adolescents seek care infrequently and so wherever/whenever they do, it should be considered a precious opportunity to screen," she told Reuters Health by email.

Coauthor Dr. Jennifer Reed added that, "ideally, screening should occur in the primary care setting. But we know that adolescents in particular do not usually have regular well child checks or preventive care visits and often only seek care when they have an acute illness or injury. Therefore, it is important to take advantage of nontraditional settings, such as the ED, to promote screening."

Dr. Reed currently has a grant that allows Cincinnati Children's Hospital to offer universal GC and CT screening to all pediatric ED patients between the ages of 14 and 21.

"We are using a tablet to offer the screening to adolescents and are integrating their responses into our electronic medical record," she told Reuters Health. "The goal is to reach those adolescents who are at high risk and otherwise would not have any opportunities to be screened for STIs."

Echoing the authors' advocacy of ED screening for adolescents, Dr. Mobeen H. Rathore, immediate past president of the American Academy of Pediatrics and chief, Division of Pediatric Infectious Diseases and Immunology at the University of Florida College of Medicine, Jacksonville, told Reuters Health by email, "It's not ideal for anybody to get their primary care in the emergency department. But until we fix the issue of primary care for everyone, not just children and adolescents, we need to make the best of the time and circumstances when we have access to our patients who are at high risk. We have to capture them when we can."

Once acute problems have been addressed, the ED provides an opportunity "not just to test for STIs, but also to give vaccines and take other preventive measures," Dr. Rathore continued. "Normally, we don't want to think that routine care will be done in the ED, but in this population, we should do as much as we can."


Sex Transm Dis 2016.