Universal Screening for Sexually Transmitted Infections among Asymptomatic Adolescents in an Urban Emergency Department: High Acceptance but Low Prevalence of Infection
OBJECTIVES:
To
evaluate acceptance of sexually transmitted infection (STI) screening and
measure STI prevalence in an asymptomatic adolescent emergency department (ED)
population.
STUDY DESIGN:
This
was a prospectively enrolled cross-sectional study of 14- to 21-year-old
patients who sought care at an urban pediatric ED with non-STI related
complaints. Participants completed a computer-assisted questionnaire to collect
demographic and behavioral data and were asked to provide a urine sample to
screen for Chlamydia trachomatis and Neisseria gonorrhoeae infection. We
calculated STI screening acceptance and STI prevalence. We used logistic
regression to identify factors associated with screening acceptance and
presence of infection.
RESULTS:
Of 553
enrolled patients, 326 (59.0%) agreed to be screened for STIs. STI screening
acceptability was associated with having public health insurance (aOR 1.7; 1.1,
2.5) and being sexually active (sexually active but denying high risk activity
[aOR 1.7; 1.1, 2.5]; sexually active and reporting high risk activity [aOR 2.6;
1.5, 4.6]). Sixteen patients (4.9%; 95% CI 2.6, 7.3) had an asymptomatic STI.
High-risk sexual behavior (aOR 7.2; 1.4, 37.7) and preferential use of the ED
rather than primary care for acute medical needs (aOR 4.0; 1.3, 12.3) were
associated with STI.
CONCLUSIONS:
STI
screening is acceptable to adolescents in the ED, especially among those who
declare sexual experience. Overall, there was a low prevalence of asymptomatic
STI. Risk of STI was higher among youth engaging in high-risk sexual behavior
and those relying on the ED for acute health care access. Targeted screening
interventions may be more efficient than universal screening for STI detection
in the ED.
- 1Children's National Health System, Washington, DC; Departments of Pediatrics and Emergency Medicine, the George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address: mgoyal@childrensnational.org.
- 2Children's National Health System, Washington, DC; Departments of Pediatrics and Emergency Medicine, the George Washington University School of Medicine and Health Sciences, Washington, DC.
- 3Children's National Health System, Washington, DC.
- 4Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD.
- J Pediatr. 2016 Feb 2. pii: S0022-3476(16)00021-4. doi: 10.1016/j.jpeds.2016.01.019.
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