Adolescent women with sexually transmitted infections: who gets lost to follow-up?

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. OBJECTIVES: 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. CONCLUSION: The majority of adolescent women found to have GC or CT or both in the ED were not treated at presentation.

Underrecognition of cervical Neisseria gonorrhoeae and Chlamydia trachomatis infections in pregnant patients in the ED.

STUDY OBJECTIVES: The purposes of this study were to (1) quantify the frequency of underrecognized Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infections in pregnant women tested in the emergency department (ED), (2) describe the characteristics of those not treated during the initial visit, and (3) determine how many pregnant women with acute cervicitis were lost to follow-up. METHODS: This was a retrospective, cohort analysis of consecutive women seen in the ED of 3 academic medical centers during a 36-month study period, with positive results for GC/CT. Our key outcome measures were the proportion of pregnant women being untreated in the ED, the time to subsequent treatment, and the proportion lost to follow-up. RESULTS: During the study period, 735 female patients had positive polymerase chain reaction study results for GC and/or CT; 179 (24%) were pregnant. Overall, 143 of these pregnant patients with cervicitis (80%) were not treated in the ED. Presenting symptoms included abdominal pain (71%), nausea (45%), vaginal discharge (35%), vaginal bleeding (34%), and urinary complaints (22%). The most common discharge diagnoses were vaginitis (37%), urinary infection (33%), threatened abortion (19%), nonspecific abdominal pain (9%), and rule-out ectopic pregnancy (6%). Of the 143 patients with sexually transmitted infection not treated in the ED, 114 (80%) were contacted by telephone and/or mail. Twenty-nine (20%) were subsequently lost to follow-up. CONCLUSIONS: Further study is warranted to enhance point-of-contact testing and identify better mechanismsfor contact and follow-up after ED discharge and more liberal policies to treat less symptomatic patients empirically.