title: Adolescent women with sexually transmitted infections: who gets lost to follow-up?
abstract: BACKGROUND
  Adolescent patients comprise the highest rate of Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) in the United States. These patients often initially present to the emergency department (ED) with vague symptoms.
  
  
  OBJECTIVE
  1) Quantify the frequency of underrecognized GC and CT cervical infections in adolescent women tested in the ED; 2) describe and compare the characteristics of those treated and not treated during the initial visit; and 3) quantify the delay interval until treatment was provided.
  
  
  METHODS
  This was a retrospective, cohort analysis of consecutive females (ages 13-19 years) seen at four academic medical centers over a 36-month period with positive results for GC/CT. Our key outcome measures were the proportion of adolescent females being untreated in the ED, the time to subsequent treatment, and the proportion lost to follow-up.
  
  
  RESULTS
  During the study period, 382 female adolescents had positive polymerase chain reaction studies for GC or CT or both; 266 (70%) were not treated in the ED. Untreated patients were significantly more likely to have a discharge diagnosis of urinary tract infection (23% vs. 11%, p < 0.008), new pregnancy (29% vs. 8%, p < 0.001), and vaginitis (24.8% vs. 5%, p < 0.001). Subsequently, only 11.7% (31/266) of the untreated patients fit the Centers for Disease Control and Prevention guidelines for empiric treatment of pelvic inflammatory disease. After telephone, mail, and public health follow-up, treatment could be documented for only 59% of the patients.
  
  
  CONCLUSIONS
  The majority of adolescent women found to have GC or CT or both in the ED were not treated at presentation.
authors.affiliation: Michigan State University College of Human Medicine, Grand Rapids, Michigan.
authors.forename: Roman
authors.initials: R
authors.lastname: Krivochenitser
authors.affiliation: Michigan State University College of Human Medicine, Grand Rapids, Michigan.
authors.forename: Erica
authors.initials: E
authors.lastname: Bicker
authors.affiliation: Department of Emergency Medicine, Saint Mary's Health Care, Grand Rapids, Michigan.
authors.forename: David
authors.initials: D
authors.lastname: Whalen
authors.affiliation: Department of Emergency Medicine, Helen DeVos Children's Hospital, Grand Rapids, Michigan.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gardiner
authors.affiliation: Michigan State University Program in Emergency Medicine, Spectrum Health Hospital-Butterworth Campus, Grand Rapids, Michigan.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Jones
mesh_terms: D015746:Abdominal Pain / Q000382:microbiology; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002690:Chlamydia Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D004269:DNA, Bacterial / Q000032:analysis; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D059012:Lost to Follow-Up; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014481:United States; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000382:microbiology; D014592:Uterine Hemorrhage / Q000382:microbiology; D014627:Vaginitis / Q000175:diagnosis / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial
keywords: Chlamydia trachomatis; Neisseria gonorrhea; adolescents; diagnosis; emergency department; follow-up; treatment