title: Identifying a need for more focused treatment of chlamydia and gonorrhoea in the emergency department.
abstract: The indolent nature of chlamydia and gonorrhoea, along with the time delay associated with current diagnostic testing, makes definitive diagnosis while in the emergency department impossible. We therefore sought to determine the proportion of patients who receive accurate, presumptive antimicrobial treatment for these infections. A retrospective chart review was performed on all patient encounters that underwent chlamydia and gonorrhoea testing at an urban emergency department during a single month in 2012. Each encounter was reviewed for nucleic acid amplification test results and whether presumptive antibiotics were given during the initial visit. A total of 639 patient encounters were reviewed; 87.2% were female and the mean age was 26.7 years. Chlamydia was present in 11.1%, with women and men having similar infection rates: 10.6% vs. 14.6% (p = 0.277). Gonorrhoea was present in 5.0%, with a lower prevalence among women than men: 3.2% vs. 17.1% (p < 0.001). Women received presumptive treatment less often than men: 37.7% vs. 82.9% (p < 0.001). Presumptive treatment was less accurate in women than men: 7.9% vs. 25.6% (p < 0.001). After combining genders, 10.2% received accurate presumptive treatment; 33.3% were overtreated and 4.4% missed treatment. Presumptive treatment for chlamydia and gonorrhoea was more frequent and more accurate in men than in women. Overall, one-third of patients received unnecessary antibiotics, yet nearly 5% missed treatment. Better methods are needed for identifying patients who need treatment.
authors.affiliation: Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA wilsonseanpatrick@gmail.com.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Wilson
authors.affiliation: Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: McKenna
authors.initials: M
authors.lastname: Knych
authors.affiliation: Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Rossitza
authors.initials: R
authors.lastname: Iordanova
authors.affiliation: Department of Statistics, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Meredith
authors.initials: M
authors.lastname: Mahan
authors.affiliation: Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Taher
authors.initials: T
authors.lastname: Vohra
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; 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; D006801:Humans; D008297:Male; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D021141:Nucleic Acid Amplification Techniques; D019095:Point-of-Care Systems; D015995:Prevalence; D012189:Retrospective Studies; D017678:Sex Distribution; D014505:Urban Population
chemical_list: D000900:Anti-Bacterial Agents
keywords: Chlamydia; emergency department; gonorrhoea; presumptive treatment; sexually transmitted infection