title: Gonorrhea and chlamydia in the emergency department: Continued need for more focused treatment for men, women and pregnant women.
abstract: BACKGROUND
  Delay in current nucleic acid amplification testing for Neisseria gonorrhoeae and Chlamydia trachomatis has led to recommendations for presumptive treatment in patients with concern for infection and unreliable follow-up. In the urban setting, it is assumed that many patients have unreliable follow-up, therefore presumptive therapy is thought to be used frequently. We sought to measure the frequency of disease and accuracy of presumptive treatment for these infections.
  
  
  METHODS
  This was an observational cohort study performed at an urban academic Level 1 trauma center ED with an annual census of 95,000 visits per year. Testing was performed using the APTIMA Unisex swab assay (Gen-Probe Incorporated, San Diego, CA). Presumptive therapy was defined as receiving treatment for both infections during the initial encounter without confirmation of diagnosis.
  
  
  RESULTS
  A total of 1162 patients enrolled. Infection was present in 26% of men, 14% of all women and 11% of pregnant women. Despite high frequency of presumptive treatment, >4% of infected patients in each category went untreated.
  
  
  CONCLUSIONS
  Inaccuracy of presumptive treatment was common for these sexually transmitted infections. There is an opportunity to improve diagnostic accuracy for treatment.
authors.affiliation: Department of Emergency Medicine, Kaiser Permanente Medical Center, Anaheim, CA, United States. Electronic address: wilsonseanpatrick@gmail.com.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Wilson
authors.affiliation: Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States.
authors.forename: Taher
authors.initials: T
authors.lastname: Vohra
authors.affiliation: Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States.
authors.forename: McKenna
authors.initials: M
authors.lastname: Knych
authors.affiliation: Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States.
authors.forename: Jared
authors.initials: J
authors.lastname: Goldberg
authors.affiliation: Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States.
authors.forename: Christopher
authors.initials: C
authors.lastname: Price
authors.affiliation: Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States.
authors.forename: Sean
authors.initials: S
authors.lastname: Calo
authors.affiliation: Department of Public Health, Henry Ford Hospital, Detroit, MI, United States.
authors.forename: Meredith
authors.initials: M
authors.lastname: Mahan
authors.affiliation: Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States.
authors.forename: Joseph
authors.initials: J
authors.lastname: Miller
mesh_terms: D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology; D002692:Chlamydia trachomatis / Q000235:genetics / Q000302:isolation & purification*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D005500:Follow-Up Studies; D006069:Gonorrhea / Q000175:diagnosis* / Q000453:epidemiology; D006302:Health Services Research; D006801:Humans; D008297:Male; D020380:Needs Assessment / Q000458:organization & administration*; D009344:Neisseria gonorrhoeae / Q000235:genetics / Q000302:isolation & purification*; D021141:Nucleic Acid Amplification Techniques / Q000379:methods*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000453:epidemiology; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology; D014505:Urban Population