Better PID management for adolescents in the ED
Since adolescents account for half of all new sexually transmitted infection (STI) diagnoses, increasing screening rates for STIs in the emergency department could have a tremendous impact.
Emergency departments at U.S. children’s hospitals had low rates of complying with recommended HIV and syphilis screening for at-risk adolescents, though larger hospitals were more likely to provide such evidence-based care, according to a study led by Monika Goyal, M.D., M.S.C.E., director of research in the Division of Emergency Medicine at Children’s National Health System.
Presented during the 2017 American Academy of Pediatrics (AAP) national conference, the study also found low compliance with CDC recommendations for antibiotic treatment of adolescents diagnosed with pelvic inflammatory disease (PID), a complication of undiagnosed or undertreated sexually transmitted infection that can signal heightened risk for syphilis or HIV.
“Adolescents account for half of all new sexually transmitted infections (STIs) and often view the emergency department (ED) as the primary place to receive health care. If we are able to increase screening rates for sexually transmitted infections in the ED setting, we could have a tremendous impact on the STI epidemic,” Dr. Goyal says.
Although gonorrhea and chlamydia are implicated in most cases of PID, The Centers for Disease Control and Prevention (CDC) recommend that all women diagnosed with PID be screened for HIV and also recommends syphilis screening for all people at high risk for infection. The research team conducted a cross-sectional study using a database that captures details from 48 children’s hospitals to determine how often the CDC’s recommendations are carried out within the nation’s EDs.
The research team combed through records from 2010 to 2015 to identify all ED visits by adolescent women younger than 21 and found 10,698 PID diagnoses. The girls’ mean age was 16.7. Nearly 54 percent were non-Latino black, and 37.8 percent ultimately were hospitalized.
“It is encouraging that testing for other sexually transmitted infections, such as gonorrhea and chlamydia, occurred for more than 80 percent of patients diagnosed with PID. Unfortunately, just 27.7 percent of these young women underwent syphilis screening, and only 22 percent were screened for HIV,” Dr. Goyal says.
