Sexually Transmitted Disease Testing of Young Men and Women in Emergency Departments

Sexually transmitted disease testing of young men and women in emergency departments

Background: Unlike young women, young men generally lack a medical home and regular contact with the healthcare system. The emergency department (ED) might be a venue where young men access care for STD testing and treatment.

Objectives: To estimate the proportion of ED visits made by Medicaid enrollees aged 15-21 years where a test for chlamydia, gonorrhea, syphilis, or HIV was conducted.

Methods: Medicaid child claims data from the 2005 MarketScan database were analyzed. STD tests were identified using diagnostic/procedural codes. We estimated the proportion of ED visits made by Medicaid enrollees where a test for chlamydia, gonorrhea, syphilis, or HIV was conducted, overall and by sex.

Results: Medicaid enrollees aged 15 – 21 years in the MarketScan database made 324,358 visits to the ED in 2005. A test for chlamydia was conducted at 3.0% of visits, gonorrhea at 2.3%, syphilis at 0.2%, and HIV at 0.1%. Females were significantly more likely than males to be tested for chlamydia (OR, 9.4; 95% CI, 8.6, 10.3), gonorrhea (OR 7.7, 95% CI 7.0-8.4), syphilis (OR 2.0, 95% CI 1.7-2.5), and HIV (OR 2.0, 95% CI 1.6-2.6).

Conclusions: STD testing in EDs was low with fewer than 3% of young persons tested for any STD. This suggests that in the ED, STD testing is likely performed for the diagnosis of symptomatic persons, and that only limited asymptomatic screening is occurring. An unexpectedly low proportion of STD tests were conducted in men. The large disparity in STD testing that we found in sex likely reflects the higher rates of infection among women in this age group.

Implications for Programs, Policy, and/or Research: Further research is needed to understand the reasons why this young insured Medicaid population is accessing STD care in an ED rather than other clinical settings.