TP 41 Unmet Need for Adolescent STI Screening on Inpatient Psychiatric Units

Tuesday, June 10, 2014
Exhibit Hall
Kelly Colden, MD, MPH1, Maria Trent, MD, MPH2, Emily Frosch, MD3 and Marco Grados, MD, MPH3, 1Community Health Services Bureau, Arlington County Department of Human Services, Arlington, VA, 2Pediatrics/Population, Family and Reproductive Health Sciences, Johns Hopkins University School of Medicine & School of Public Health, Baltimore, MD, 3Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD

Background: Adolescents with psychiatric disorders are at increased risk for sexually transmitted infection (STI) due to increased sexual risk taking behaviors, particularly if they reside in communities with high STI prevalence. The Centers for Disease Control and Prevention recommends routine STI screening in adolescents at risk for STIs when they interface with the medical system. Our study evaluated the existing STI screening practices for adolescents admitted for psychiatric care as a first step in determining unmet need for STI screening and in designing a screening and treatment protocol. 

Methods: This IRB-approved study utilized administrative billing data to identify adolescents admitted onto the Child and Adolescent Psychiatry Unit within a major academic medical center. A standardized data extraction form was used to collect demographic, diagnostic, historical, and laboratory data from consecutive patients in the electronic health record (N=181). Logistic regression analyses were used to evaluate the factors associated with STI screening on the unit.  

Results: The majority of patients were African American (57%), female (64%), and publicly insured (70%). Forty-eight percent of patients reported a history of sexual intercourse. Less than 1/3 of sexually active adolescents were screened for Neisseria gonorrhoeae or Chlamydia trachomatis. History of sexual activity, gender (female), and concerning sexual risk behaviors was more predictive of screening. After controlling for gender, patients with a history of prior sexual activity were 13 [AOR: 13, 95% CI (2.9, 58.5); p=. 001] and 28 times [AOR: 28, 95% CI (3.7, 214.6); p=. 001] more likely to be screened for gonorrhea and chlamydia respectively. 

Conclusions:  Psychiatric hospitalization presents an important opportunity for STI screening. A universal STI screening and treatment protocol may identify individuals at risk for STIs, addressing unmet need, and allow for effective treatment in a supportive environment.