alexa Adult and pediatric emergency department sexually transmitted disease and HIV screening: programmatic overview and outcomes.


Health Care : Current Reviews

Author(s): Mehta SD, Hall J, Lyss SB, Skolnik PR, Pealer LN,

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Abstract OBJECTIVES: To measure the prevalence of gonorrhea, chlamydia, and human immunodeficiency virus (HIV) infection among emergency department (ED) patients who accept screening, and to assess treatment outcomes and risks for infection. METHODS: Research staff offered voluntary testing for gonorrhea and chlamydia (by urine transcription-mediated amplification) and HIV (by enzyme immunoassay/Western blot of oral mucosal transudate) to ED patients. Pediatric (15-21 years) and adult (22-29 years) patients were eligible for gonorrhea and chlamydia testing; patients aged 15-54 years were eligible for HIV testing. The authors surveyed behavioral risks of patients accepting HIV testing. RESULTS: From November 2003 to May 2004, 497 of 791 eligible pediatric patients (63\%) and 1,000 of 2,180 eligible adult patients (46\%) accepted screening for gonorrhea, chlamydia, and/or HIV. There were 41 patients infected with gonorrhea, chlamydia, or both among 380 pediatric patients (10.8\%) and 11 of 233 adult patients (4.7\%); 14 of 52 patients (27\%) were treated presumptively by ED clinicians. Through study efforts, 33 of the 38 remaining patients were treated (90\% overall treatment). Eight HIV infections were diagnosed: seven of 969 adult patients (0.7\%) and one of 459 pediatric patients (0.2\%); five HIV-infected patients (63\%) received test results, and three (38\%) attended an HIV clinic. Gonorrhea or chlamydia infection in pediatric patients was associated with multiple sex partners, same-sex intercourse, and suspicion of sexually transmitted diseases by the ED clinician. CONCLUSIONS: The high prevalence of gonorrhea and/or chlamydia infection among pediatric ED patients tested supports consideration of expanded screening. Targeted HIV screening with rapid tests merits exploration in the authors' ED, given the low-moderate numbers of patients identified through screening, receiving test results, and linked to care. This article was published in Acad Emerg Med and referenced in Health Care : Current Reviews

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