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Screening for Asymptomatic Gonorrhea and Chlamydia in the Pediatric Emergency Department

Schneider, Kari MD; FitzGerald, Michael PhD; Byczkowski, Terri PhD; Reed, Jennifer MD

Sexually Transmitted Diseases: April 2016 - Volume 43 - Issue 4 - p 209–215
doi: 10.1097/OLQ.0000000000000424
Original Study

Background Because adolescents rely heavily on emergency services for health care, a pediatric emergency department (PED) visit may be their only opportunity for sexually transmitted infection (STI) screening. The primary objectives of this study were to determine the proportion of Neisseria gonorrheae (GC) and Chlamydia trachomatis (CT) infections in asymptomatic PED adolescents and patient-perceived barriers to STI screening.

Methods A convenience sample of patients aged 14 to 21 years presenting to an urban PED with nongenitourinary complaints was offered screening for GC and CT. Regardless of declining or accepting screening, all were asked to complete a questionnaire designed to identify barriers to screening.

Results Sixty-eight percent of those approached participated (n = 719). Those who agreed to STI screening were more likely to be nonwhite (61.4% vs. 38.6%, P = 0.001) and publically insured (63.3%) versus privately insured (29.3%) or no insurance (7.58%). Four hundred three (56%) participants provided urine samples, and of those, 40 (9.9%) were positive for an STI. Controlling for other demographics, race was a significant predictor, with the odds of testing positive for nonwhite participants 5.90 times that of white participants. Patients who refused testing were more likely to report not engaging in sexual activity (54.3% vs. 42.4%, P = 0.009) and less likely to perceive that they were at risk for STIs.

Conclusions There are high proportions of GC and CT among asymptomatic adolescents visiting an academic urban PED. A universal PED STI screening program may be an important component of STI reduction initiatives, especially among adolescents who do not perceive that they are at risk and may not receive testing elsewhere.

The proportions of asymptomatic gonorrhea and chlamydia in adolescents attending a pediatric emergency department are high. Adolescents decline screening due to a perceived lack of risk of infection.

From the*Division of Emergency Medicine, Cincinnati Children's Hospital, Cincinnati, OH; and †Division of Pediatric Emergency Medicine, University of Minnesota Children's Hospital, Minneapolis, MN.

Acknowledgments: Urine GC/CT testing was provided by the Ohio Department of Health.

The principal investigator (K.S.) had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

The authors have no conflicts of interest to disclose.

Correspondence: Kari Schneider, MD, Division of Pediatric Emergency Medicine, University of Minnesota Children's Hospital, 6th Floor East Bldg, 8952G, 2450 Riverside Ave, Minneapolis, MN 55454. E-mail:

Received for publication June 30, 2015, and accepted December 28, 2015.

© Copyright 2016 American Sexually Transmitted Diseases Association