The rate of sexually transmitted infections in ED patients with vaginal bleeding.

BACKGROUND: Early diagnosis of sexually transmitted infections (STI) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoea (NG) is crucial in reducing complications. Vaginal bleeding (VB) has been suggested as a possible presentation of STI. OBJECTIVE: To identify the rate of STI in sexually active women presenting to the emergency department (ED) with VB. METHODS: Prospective observational study of females 18-55 years-old presenting to two affiliated urban EDs with VB (convenience sample). Patients with recent STI or antibiotic use (< 3 months) were excluded. To estimate the background rate of STI, we enrolled women with no genitourinary complaints as controls. Specimens for CT and NG were obtained during speculum exam from cases and by self administered vaginal swab in controls. All specimens were analyzed by polymerase chain reaction. Continuous data was presented as mean +/- standard deviation and categorical data as percentages with 95% confidence intervals CI). Fisher's exact test was used to compare the rate of STI between the groups. RESULTS: From 09.06 to 08.07 a total 273 subjects were enrolled (174 VB and 99 controls, mean age: 33 +/- 10). Groups were similar with regards to baseline characteristics. The majority of STI cases were due to CT: 5.8% in VB group (95% CI, 3.2%-10.4%) vs. 7.1% in controls (95% CI, 3.5%-14.0%). The STI rate was 6.3% (95% CI, 3.5%-11.1%) in VB patients and 8% (95% CI, 3.9%-15.3%) in controls. CONCLUSIONS: Our ED patients with and without vaginal bleeding had comparable rate of STI.

Self-administered vaginal swabs are a feasible alternative to physician-assisted cervical swabs for sexually transmitted infection screening in the emergency department.

BACKGROUND: Screening for sexually transmitted infections (STIs) in the emergency department (ED) is limited by the need for pelvic examination. It has been suggested that using self-administered vaginal swabs (SAVS) for this purpose may save time and resources and may be more comfortable for patients. OBJECTIVES: The objective was to test the feasibility of using SAVS for STI screening in the ED. METHODS: This was a prospective study of female ED patients 18 to 55 years old who consented to physician-assisted cervical swab (PACS) and SAVS in two urban teaching hospitals. The ED personnel offered the test to all patients, whether or not a pelvic examination was indicated, based on their chief complaint. All specimens were analyzed by polymerase chain reaction (PCR) assay. Data are presented as mean +/- standard deviation (SD). Categorical data are presented as percentages with 95% confidence intervals (CIs). Patients with a positive test result for Chlamydia trachomatis and/or Neisseria gonorrhoeae were considered positive for STI. PACS were used as the criterion standard. RESULTS: One-hundred sixty-two subjects were enrolled from July 2006 to July 2007 (mean [+/-SD] age = 32 [+/-10] years). Eighty-one percent of patients had a genitourinary symptom (most common: vaginal bleeding/spotting). SAVS had a sensitivity of 91% (95% CI = 60% to 99%), specificity of 99% (95% CI = 95% to 99%), positive likelihood ratio of 91, and negative likelihood ratio of 0.09 in diagnosing STIs. None of the patients reported difficulty or discomfort using this technique. CONCLUSIONS: Self-administered vaginal swabs can be utilized as a feasible alternative to PACS for STI screening in the ED.

Mycobacterium xenopi: Evidence for Increased Rate of Clinical Isolation.

In light of recent reports of increased isolation of M. xenopi, we reviewed the number of M. xenopi isolates in a hospital setting over five years. A total of 133 isolates from 100 patients were reported, of these isolates, 8 were reported over the first two years, 21 isolates in the third year, 47 isolates in year four and 57 isolates in year five. The specimen sources were mainly respiratory specimens; however a few specimens were isolated from other sources. Clinical data on 12 patients with repeated isolates are presented. Patient conditions upon admission and previous medical histories are shown and compared to earlier reports. An increased awareness of the presence of this organism is necessary since the clinical presentation of patients with M. xenopi can be confused with tuberculosis.