Many ED Patients Positive for STIs Are Unaware of Infection

BALTIMORE — Empiric treatment for sexually transmitted infections among adolescent girls presenting to a pediatric emergency department is high, but many patients are unreachable for follow-up and some remain unaware that they are infected, according to a 3-month baseline study.

In all, 120 young women aged 14–21 years who were seen at the Cincinnati Children's Hospital pediatric emergency department (PED) tested positive for Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis between July 1 and Sept. 23, 2008, reported Dr. Jennifer Reed of the division of emergency medicine at the hospital.

More than two-thirds of adolescents (69%) who tested positive for sexually transmitted infections (STIs) were treated empirically in the PED. The researchers were able to contact only 46% of STI-positive patients within 7 days and 60% within 30 days, according to data presented as a poster at the annual meeting of the Pediatric Academic Societies.

“The most prevalent reasons for the unreachable patients included phones being disconnected, no answer, and full voice mailboxes,” Dr. Reed said in an interview. However, she noted that these data have not been analyzed yet.

The researchers tracked adolescent patients who tested positive for any STI. The usual clinical protocol involved contacting only those patients who tested positive for an STI but who were not treated empirically in the PED.

During the study period, a nurse practitioner attempted to contact all patients who tested positive for an STI, as soon as test results were available, regardless of documentation of PED treatment. Patients contacted at home were notified of their results and offered treatment if needed.

After three unsuccessful phone attempts to contact the patient, a registered letter was sent to the patient with the STI test results and a request to return to the PED. Those without treatment and no telephone contact or follow-up in the PED were classified as lost to follow-up.

The researchers recorded the date of contact and calculated the proportion of patients successfully contacted, the mean and median days to treatment/notification, and the proportions notified within 7 days and within 30 days.

For the 36 patients untreated at the initial PED visit but who tested positive and were successfully contacted, the median number of days to treatment was 8. In all, 9% of girls were lost to follow-up.

A total of 33 patients (28%) were empirically treated for STIs but remained unaware of their infections, putting their partners at risk and themselves at risk for reinfection from positive untreated partners. A total of 11 patients (9%) were untreated and were unaware of their infections, putting themselves at risk for complications from STIs, as well as for spreading infection.

This study is phase I of a quality improvement project designed to make the STI reporting system in the pediatric emergency department better. The results will serve as the baseline data that will be used to determine the efficacy of interventions aimed at improving follow-up.

The researchers are looking into “alternative ways to better contact these patients,” Dr. Reed said, and are in the process of performing experiments to determine what interventions or combinations of interventions will best improve the contact rate. These include “providing a cell phone for the nurse practitioner who makes calls so she has better accessibility when these patients call back at nontraditional times.”

The investigators also have developed a card to be handed out to each patient when she undergoes a pelvic exam. The card provides a phone number to reach the nurse practitioner to obtain culture results. “Lastly, we are encouraging nurses and physicians to obtain a confidential number at the time of the exam, since the number given in registration is often a nonworking one,” said Dr. Reed.

The study was supported by a Cincinnati Hospital Research Foundation Outcomes award, as well as a K23 award from the National Institute of Allergy and Infectious Diseases.

BALTIMORE — Empiric treatment for sexually transmitted infections among adolescent girls presenting to a pediatric emergency department is high, but many patients are unreachable for follow-up and some remain unaware that they are infected, according to a 3-month baseline study.

In all, 120 young women aged 14–21 years who were seen at the Cincinnati Children's Hospital pediatric emergency department (PED) tested positive for Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis between July 1 and Sept. 23, 2008, reported Dr. Jennifer Reed of the division of emergency medicine at the hospital.

More than two-thirds of adolescents (69%) who tested positive for sexually transmitted infections (STIs) were treated empirically in the PED. The researchers were able to contact only 46% of STI-positive patients within 7 days and 60% within 30 days, according to data presented as a poster at the annual meeting of the Pediatric Academic Societies.

“The most prevalent reasons for the unreachable patients included phones being disconnected, no answer, and full voice mailboxes,” Dr. Reed said in an interview. However, she noted that these data have not been analyzed yet.

The researchers tracked adolescent patients who tested positive for any STI. The usual clinical protocol involved contacting only those patients who tested positive for an STI but who were not treated empirically in the PED.

During the study period, a nurse practitioner attempted to contact all patients who tested positive for an STI, as soon as test results were available, regardless of documentation of PED treatment. Patients contacted at home were notified of their results and offered treatment if needed.

After three unsuccessful phone attempts to contact the patient, a registered letter was sent to the patient with the STI test results and a request to return to the PED. Those without treatment and no telephone contact or follow-up in the PED were classified as lost to follow-up.

The researchers recorded the date of contact and calculated the proportion of patients successfully contacted, the mean and median days to treatment/notification, and the proportions notified within 7 days and within 30 days.

For the 36 patients untreated at the initial PED visit but who tested positive and were successfully contacted, the median number of days to treatment was 8. In all, 9% of girls were lost to follow-up.

A total of 33 patients (28%) were empirically treated for STIs but remained unaware of their infections, putting their partners at risk and themselves at risk for reinfection from positive untreated partners. A total of 11 patients (9%) were untreated and were unaware of their infections, putting themselves at risk for complications from STIs, as well as for spreading infection.

This study is phase I of a quality improvement project designed to make the STI reporting system in the pediatric emergency department better. The results will serve as the baseline data that will be used to determine the efficacy of interventions aimed at improving follow-up.

The researchers are looking into “alternative ways to better contact these patients,” Dr. Reed said, and are in the process of performing experiments to determine what interventions or combinations of interventions will best improve the contact rate. These include “providing a cell phone for the nurse practitioner who makes calls so she has better accessibility when these patients call back at nontraditional times.”

The investigators also have developed a card to be handed out to each patient when she undergoes a pelvic exam. The card provides a phone number to reach the nurse practitioner to obtain culture results. “Lastly, we are encouraging nurses and physicians to obtain a confidential number at the time of the exam, since the number given in registration is often a nonworking one,” said Dr. Reed.

The study was supported by a Cincinnati Hospital Research Foundation Outcomes award, as well as a K23 award from the National Institute of Allergy and Infectious Diseases.

BALTIMORE — Empiric treatment for sexually transmitted infections among adolescent girls presenting to a pediatric emergency department is high, but many patients are unreachable for follow-up and some remain unaware that they are infected, according to a 3-month baseline study.

In all, 120 young women aged 14–21 years who were seen at the Cincinnati Children's Hospital pediatric emergency department (PED) tested positive for Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis between July 1 and Sept. 23, 2008, reported Dr. Jennifer Reed of the division of emergency medicine at the hospital.

More than two-thirds of adolescents (69%) who tested positive for sexually transmitted infections (STIs) were treated empirically in the PED. The researchers were able to contact only 46% of STI-positive patients within 7 days and 60% within 30 days, according to data presented as a poster at the annual meeting of the Pediatric Academic Societies.

“The most prevalent reasons for the unreachable patients included phones being disconnected, no answer, and full voice mailboxes,” Dr. Reed said in an interview. However, she noted that these data have not been analyzed yet.

The researchers tracked adolescent patients who tested positive for any STI. The usual clinical protocol involved contacting only those patients who tested positive for an STI but who were not treated empirically in the PED.

During the study period, a nurse practitioner attempted to contact all patients who tested positive for an STI, as soon as test results were available, regardless of documentation of PED treatment. Patients contacted at home were notified of their results and offered treatment if needed.

After three unsuccessful phone attempts to contact the patient, a registered letter was sent to the patient with the STI test results and a request to return to the PED. Those without treatment and no telephone contact or follow-up in the PED were classified as lost to follow-up.

The researchers recorded the date of contact and calculated the proportion of patients successfully contacted, the mean and median days to treatment/notification, and the proportions notified within 7 days and within 30 days.

For the 36 patients untreated at the initial PED visit but who tested positive and were successfully contacted, the median number of days to treatment was 8. In all, 9% of girls were lost to follow-up.

A total of 33 patients (28%) were empirically treated for STIs but remained unaware of their infections, putting their partners at risk and themselves at risk for reinfection from positive untreated partners. A total of 11 patients (9%) were untreated and were unaware of their infections, putting themselves at risk for complications from STIs, as well as for spreading infection.

This study is phase I of a quality improvement project designed to make the STI reporting system in the pediatric emergency department better. The results will serve as the baseline data that will be used to determine the efficacy of interventions aimed at improving follow-up.

The researchers are looking into “alternative ways to better contact these patients,” Dr. Reed said, and are in the process of performing experiments to determine what interventions or combinations of interventions will best improve the contact rate. These include “providing a cell phone for the nurse practitioner who makes calls so she has better accessibility when these patients call back at nontraditional times.”

The investigators also have developed a card to be handed out to each patient when she undergoes a pelvic exam. The card provides a phone number to reach the nurse practitioner to obtain culture results. “Lastly, we are encouraging nurses and physicians to obtain a confidential number at the time of the exam, since the number given in registration is often a nonworking one,” said Dr. Reed.

The study was supported by a Cincinnati Hospital Research Foundation Outcomes award, as well as a K23 award from the National Institute of Allergy and Infectious Diseases.