Incidence of Asymptomatic Gonorrhea and Chlamydia in An Urban Emergency Department in Newark, NJ

Background: United States Preventive Services Taskforce recommends routine screening of all sexually active non-pregnant females 24 years and younger for sexually transmitted infections.  It is known that symptomatic gonorrhea and chlamydia rates are highest in adolescents ages 15-24.  Prior studies have shown asymptomatic gonorrhea/chlamydia rates to be as high as 5-11% and have suggested wider screening may lead to community wide prevention. 

 

Objectives: To identify the asymptomatic carriage rates of gonorrhea and chlamydia in Newark, NJ and to evalaute the need for asymptomatic screening in the Emergency Department.

Methods: A retrospective review of the results obtained from a convenience sample of male and female patients ages 14-24 who presented to the pediatric and adut emergency departments of a large urban private hospital in Newark, NJ between January and October 2011 without abdominal or genitourinary complaints who were screened by an opt-out testing for gonorrhea and chlamydia was performed.  Urine samples from asymptomatic patients were sent in CDC/NJDHSS supplied tubes by courrier to a CDC/NJDHSS approved laboratory for testing.  Patients were given written follow up instructions for obtaining test results.  If a positive result was obtained, specific follow up instructions for free treatment and for partner notification and treatment were given. 

Results: A total of 254 patients were included in the initial asymptomatic screen, 13 tests were returned as improper collection. Thirty nine patients (15%) tested positive, having either gonorrhea or chlamydia or both.  There were no statically significant differences in the rates of asymptomatic infection in patients aged 14-20 (mean 18.9%, p=0.9).

Conclusions: The prevalence of asymptomatic carriage of gonorrhea and/ or chlamydia may be higher within urban populations than previously identified. Screening with the emergency department may capture a large percentage of patients with asymptomatic infection.

Implications for Programs, Policy, and Research: Rountine screening for asymptomatic gonorrhea and chlamydia in patients ages 14-24 in an emergency department setting may reduce symptomatic presentation to the ED.  Further research into the sexual and behavioral attitudes of these patients is needed.