Undiagnosed chlamydial and gonococcal infections in an emergency department Public Deposited

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  • March 22, 2019
  • Al-Tayyib, Alia Abdul-Hamid
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Chlamydial and gonococcal infections are the two most commonly reported sexually transmitted infections in the United States. Screening programs in clinics, schools, and communities detect a substantial burden of infection. Extension of current recommended guidelines has been suggested through expanding screening settings. Emergency departments have been proposed as potentially promising venues for screening interventions. The purpose of this dissertation is to investigate the utility and obstacles associated with chlamydial and gonococcal screening in an emergency department. To examine this issue, we analyzed data from a cross-sectional and short duration prospective cohort study of patients aged 18 to 35 years attending a busy urban emergency department. The overall prevalence of infection in this population was 9.6%. Separately for males and females, we developed predictive models and applicable clinical risk scores for chlamydial and gonococcal infections combined and for chlamydial infection alone. Age was the strongest predictor of infection in all four models. We then used the sensitivities and specificities of the clinical risk scores to examine the trade-off in misclassification errors across varying prevalence of infection. Results of this analysis suggest that the consequences of undetected chlamydial and/or gonococcal infection must substantially outweigh the costs of screening to justify incorporating routine screening into emergency department services. In independent models, we evaluated the influence of healthcare coverage status and reporting the emergency department as the main source for healthcare on the risk of not receiving treatment and follow-up services for infections identified in the emergency department. Antibiotic use in the three months prior to the emergency department visit appears to modify both of these associations. Lastly, we described the geospatial distribution of the detected infections and their treatment outcomes. As screening programs move into emergency departments, serious consideration must be given to the costs associated with unnecessarily screening a significant number of patients to detect infections. In addition, consideration must be given to ensuring appropriate treatment and follow-up for all detected infections.
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  • Miller, William
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