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Background: Individuals presenting to the emergency department (ED) are at increased risk of infection with chlamydia (CT) and gonorrhea (GC). Clinical symptoms of infection may be absent or ambiguous, leading to under- and over-treatment. Objectives: To determine if patient survey responses at ED admittance predict CT/GC infection. Methods: Female patients aged 15-34 admitted to an ED were asked to complete a survey and provide a urine sample for CT/GC testing. Surveys were analyzed for associations between specific answers and infection status. Results: (as of 10/1/11) Of 184 participants, mean age was 25.3 years, 58.2% were white, 40.2% black, 84 aged 15-24 and 100 aged 25-34. Survey responses showed that 94.0% were sexually active, 36.4% were previously diagnosed with an STI, and 25.0% thought their sex partner had other partners. In the past year, 16.8% had engaged in anal sex (A12) and had a mean of 1.66 partners. There were no differences between the age groups. Of the15 (8.2%) who tested positive, 11 had CT, 3 had GC and 1 had both (no difference by race or age group). Significant associations were found between infection and: anal sex in the past 3 months (21.7% vs. 6.2%; p=0.011), A12 (19.4% vs. 5.9%; p=0.012), and number of male partners in the past 3 months (M3; mean 1.93 vs. 1.09; p=0.002). Sensitivity analysis showed that screening only those reporting A12 or >1 M3 identified 66.7% of those infected, increased the positivity rate to 16.9%, and reduced the number of those screened by 67.9% (to 59 samples).
Conclusions: This preliminary data shows that screening only females answering affirmatively to two questions will double the sample positivity rate while reducing sample volume by two thirds. Implications for Programs, Policy, and Research: EDs may be effective venues for CT/GC screening and asking patients these two questions upon admittance may provide substantial guidance.