261. STI Screening In An Urban Emergency Department Based On Chief Complaint

Abstract

Adolescents are disproportionally affected by sexually transmitted infections (STIs) and frequently seek care for sexual health in the emergency department (ED) setting. Unfortunately STI testing is not routinely conducted in the ED leading to under-diagnosis and treatment. Although STIs are frequently asymptomatic, symptoms associated with STIs include dysuria, vaginal/urethral bleeding or discharge, or lower abdominal pain. Patients may present to the ED for reasons unrelated to STIs (e.g. ankle injury) but may endorse STI-related symptoms if asked. Thus, the purpose of this study was to determine the proportion of adolescents who presented to the ED for non STI-related complaints but self-reported symptoms associated with STIs and to determine STI positivity rates among this population. We performed a secondary analysis of data from two cross-sectional studies that evaluated STI prevalence when STI screening was implemented into the ED setting. Participants between the ages of 14-19 completed the computerized screening tool and provided a urine sample for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) testing. We calculated the rate of self-reported symptoms of STIs (genitourinary odor, discharge, or bleeding; dysuria; lower abdominal or genitourinary pain; genitourinary itching; or genitourinary rashes) in a sample of patients who presented to the ED with a chief complaint unrelated to an STI and subsequently calculated the prevalence of STIs among this population. Of the 961 adolescents who completed the screening tool, 801 (83.4%) presented to the ED with a chief complaint unrelated to STIs. Of the patients with a chief complaint unrelated to STIs, 128 (16.0%) reported STI-related symptoms on tablet questionnaire. In this population, the mean age was 16.1 (SD +/- 1.7) years. The majority of adolescents were female (60.2%), non-Hispanic black (71.3%) and publicly insured (73.9%). Female gender was associated with a higher likelihood of reporting STI-related symptoms (aOR: 3.1; 95 % CI 1.9, 4.9). The overall STI prevalence among this population was 3.8%. There was no difference in STI prevalence based on presence or absence of STI-related symptoms (p-value=0.5). In this analysis, 1 out every 6 patients who presented for a chief complaint unrelated to STIs reported STI related symptoms on a tablet questionnaire. Therefore, screening patients for STIs solely based on chief complaint may be unreliable. Furthermore, there was no difference in STI positivity between those with and without STI-related symptoms. These results suggest that STI screening should be available to all adolescents regardless of chief complaint or presence of STI-related symptoms.