title: Chlamydia and gonorrhea screening in United States emergency departments.
abstract: BACKGROUND
  Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are the most commonly reported notifiable diseases in the United States, with annual reported cases exceeding 1.2 million and estimated costs exceeding $1.2 billion. Reported Emergency Department (ED) prevalence rates for CT and GC for adolescents and young adults range from 0.9% to 8.1%.
  
  
  OBJECTIVE
  Our aim was to evaluate the burden of CT/GC infection in ED patients, assess the extent of associated under- and overtreatment, and investigate mechanisms whereby ED screening can be feasible.
  
  
  METHODS
  We performed a systematic review of the time period from 1995 to 2010.
  
  
  CONCLUSIONS
  Positivity rates for ED patients are comparable with other high-risk populations, and sufficient for selected screening to be cost-effective. Unfortunately, ED patient follow-up is notoriously difficult, and clinicians frequently must choose to either delay treatment until laboratory confirmation or presumptively treat based on presenting symptoms and clinical diagnosis. This results in high rates of both undertreatment (i.e., not treating those infected) and overtreatment (i.e., treating those who are infection-free). Incorrect on-the-spot treatment decisions can result in potentially infected future partners and lack of follow-up treatment, or unnecessary treatment and personal stress associated with improper diagnosis.
  
  
  CONCLUSIONS
  ED clinician activities are frequently symptom-driven, and screening nonsymptomatic patients presents a major barrier. Educating ED clinicians on the topics of CT/GC epidemiology, sample collection, and analysis will enable them to address the risks in their presenting populations. Collaboration with health department partners for sample analysis, cost-sharing, and patient follow-up can make routine screening feasible and enable EDs to become more important partners in intervention programs.
authors.affiliation: Research and Program Development, Family and Community Medicine, Southern Illinois University School of Medicine, Springfield, IL 62794-9664, USA.
authors.forename: Wiley D
authors.initials: WD
authors.lastname: Jenkins
authors.forename: Whitney
authors.initials: W
authors.lastname: Zahnd
authors.forename: Regina
authors.initials: R
authors.lastname: Kovach
authors.forename: Patricia
authors.initials: P
authors.lastname: Kissinger
mesh_terms: D002690:Chlamydia Infections / Q000175:diagnosis*; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital; D006069:Gonorrhea / Q000175:diagnosis*; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D015995:Prevalence; D014481:United States