title: Health care access and follow-up of chlamydial and gonococcal infections identified in an emergency department.
abstract: BACKGROUND
  We examined 2 potentially important factors influencing successful treatment of Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (GC) infections identified in an emergency department (ED), health care coverage and reporting the ED as a primary source for health care.
  
  
  METHODS
  Adult patients aged 18 to 35 years attending an urban ED were screened for Ct and GC. Patients testing positive were contacted by Disease Intervention Specialists and notified of their infection status. Analyses focus on infected patients for whom we have treatment and follow-up information. We used generalized linear models with log link and binomial error distribution to estimate risk ratios (RRs) and 95% confidence intervals (CI).
  
  
  RESULTS
  Of 5537 patients screened in the ED, 348 (6.3%) tested positive for Ct, 143 (2.6%) tested positive for GC, and 43 (0.8%) tested positive for both. Overall, 20% of infected patients did not receive treatment. Among infected patients with no health care coverage 25% (n = 56) were untreated compared with 15% (n = 47) of patients reporting health care coverage (RR: 1.7, 95% CI: 1.2-2.3). Among patients reporting the ED as a primary source for health care 26% (n = 27) were untreated compared with the 18% (n = 77) reporting receiving health care from non-ED sources (RR: 1.4, 95% CI: 1.0-2.1).
  
  
  CONCLUSIONS
  EDs often serve as primary care sites for difficult-to-reach populations. We were able to successfully locate and treat the greater part of ED-identified infections. However, one-fifth of infected patients did not receive treatment. ED-based screening programs can benefit from integration with local public health infrastructure to improve notification and treatment services.
authors.affiliation: Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. Alia.Al-Tayyib@dhha.org
authors.forename: Alia A
authors.initials: AA
authors.lastname: Al-Tayyib
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
authors.forename: Susan M
authors.initials: SM
authors.lastname: Rogers
authors.forename: Peter A
authors.initials: PA
authors.lastname: Leone
authors.forename: Dionne C
authors.initials: DC
authors.lastname: Gesink Law
authors.forename: Carol A
authors.initials: CA
authors.lastname: Ford
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Ellen
mesh_terms: D000293:Adolescent; D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D002690:Chlamydia Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D010043:Outcome and Process Assessment, Health Care