title: The rate of sexually transmitted infections in ED patients with vaginal bleeding.
abstract: BACKGROUND
  Early diagnosis of sexually transmitted infections (STI) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoea (NG) is crucial in reducing complications. Vaginal bleeding (VB) has been suggested as a possible presentation of STI.
  
  
  OBJECTIVE
  To identify the rate of STI in sexually active women presenting to the emergency department (ED) with VB.
  
  
  METHODS
  Prospective observational study of females 18-55 years-old presenting to two affiliated urban EDs with VB (convenience sample). Patients with recent STI or antibiotic use (< 3 months) were excluded. To estimate the background rate of STI, we enrolled women with no genitourinary complaints as controls. Specimens for CT and NG were obtained during speculum exam from cases and by self administered vaginal swab in controls. All specimens were analyzed by polymerase chain reaction. Continuous data was presented as mean +/- standard deviation and categorical data as percentages with 95% confidence intervals CI). Fisher's exact test was used to compare the rate of STI between the groups.
  
  
  RESULTS
  From 09.06 to 08.07 a total 273 subjects were enrolled (174 VB and 99 controls, mean age: 33 +/- 10). Groups were similar with regards to baseline characteristics. The majority of STI cases were due to CT: 5.8% in VB group (95% CI, 3.2%-10.4%) vs. 7.1% in controls (95% CI, 3.5%-14.0%). The STI rate was 6.3% (95% CI, 3.5%-11.1%) in VB patients and 8% (95% CI, 3.9%-15.3%) in controls.
  
  
  CONCLUSIONS
  Our ED patients with and without vaginal bleeding had comparable rate of STI.
authors.affiliation: Department of Emergency Medicine, State University of New York, Downstate Medical Center/Kings County Hospital, Brooklyn, NY 11203, USA. nicole.berwald@gmail.com
authors.forename: Nicole
authors.initials: N
authors.lastname: Berwald
authors.forename: Shahriar
authors.initials: S
authors.lastname: Zehtabchi
authors.forename: Susan
authors.initials: S
authors.lastname: Cheng
authors.forename: Michael
authors.initials: M
authors.lastname: Augenbraun
authors.forename: Khaled
authors.initials: K
authors.lastname: Abu-Lawi
authors.forename: Tom
authors.initials: T
authors.lastname: McLaughlin
authors.forename: Michael
authors.initials: M
authors.lastname: Lucchesi
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011446:Prospective Studies; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D014623:Vaginal Diseases / Q000209:etiology*