Missed Opportunities to Screen and Treat Chlamydia and Gonorrhea in the Emergency Department Setting

Background: Previous studies suggest emergency departments (EDs) may be an ideal setting for chlamydia and gonorrhea screening. However, there are limited data on frequency of adequate treatment for chlamydia and gonorrhea in the ED at the time of testing and the ability of ED staff to contact and reach patients to ensure treatment. 

Methods: We conducted a retrospective analysis of clinical and STI callback data collected at the University of Alabama at Birmingham Hospital ED of women with a positive chlamydia and/or gonorrhea test from January 2013 to April 2014. Both chlamydia and gonorrhea were diagnosed by nucleic acid amplification testing. 

Results: 155 women were included in the study: 96 (62%) with chlamydia, 42 (27%) with gonorrhea, and 17 (11%) with co-infection. Rates of adequate treatment at time of visit were 60% for chlamydia alone, 48% for gonorrhea alone, and 18% for co-infection. Of those not adequately treated at time of visit (n=74), 78% were successfully notified of the diagnosis. Rates for treatment initiated upon notification (either a prescription called in or patient advised to return to the ED for treatment) were 43% for chlamydia alone, 94% for gonorrhea alone, and 40% for co-infection. Average time to successful notification was 3.53 days (95% CI 2.95-4.12) and required an average of 1.55 callback attempts (95% CI 1.34-1.77).  Age, race, and insurance type did not affect rates of adequate treatment or successful notification. 

Conclusions: A significant proportion of chlamydia and gonorrhea is not adequately treated in the ED setting at time of visit. Callback by ED staff may be an effective method of notifying patients of their diagnosis; however, it is not a reliable method for initiating follow-up treatment. Our results suggest ED settings may benefit from point of care tests for chlamydia and gonorrhea to facilitate screening and prompt treatment.