Introduction: The incidence of sexually transmitted infections (STI) increased in the United States between 2017–2021. There is limited data describing STI co-testing practices and the prevalence of STI co-infections in emergency departments (ED). In this study, we aimed to describe the prevalence of co-testing and co-infection of HIV, hepatitis C virus (HCV), syphilis, gonorrhea, and chlamydia, in a large, academic ED.
\nMethods: This was a single-center, retrospective cross-sectional study of ED patients tested for HIV, HCV, syphilis, gonorrhea or chlamydia between November 27, 2018–May 26, 2019. In 2018, the study institution implemented an ED-based infectious diseases screening program in which any patient being tested for gonorrhea/chlamydia was eligible for opt-out syphilis screening, and any patient 18–64 years who was having blood drawn for any clinical purpose was eligible for opt-out HIV and HCV screening. We
analyzed data from all ED patients ≥13 years who had undergone STI testing. The outcomes of interest included prevalence of STI testing/co-testing and the prevalence of STI infection/co-infection. We describe data with simple descriptive statistics.
Results: During the study period there were 30,767 ED encounters for patients ≥13 years (mean age: 43 ± 14 years, 52% female), and 7,866 (26%) were tested for at least one of HIV, HCV, syphilis, gonorrhea, or chlamydia. We observed the following testing frequencies (and prevalence of infection): HCV, 7,539 (5.0%); HIV, 7,359 (0.9%); gonorrhea, 574 (6.1%); chlamydia, 574 (9.8%); and syphilis, 420 (10.5%). Infectious etiologies with universal testing protocols (HIV and HCV) made up the majority of STI testing. In patients with syphilis, co-infection with chlamydia (21%, 9/44) and HIV (9%, 4/44) was high. In patients with gonorrhea, co-infection with chlamydia (23%, 8/35) and syphilis (9%, 3/35) was high, and in patients with chlamydia, co-infection with syphilis (16%, 9/56) and gonorrhea (14%, 8/56) was high. Patients with HCV had low co-infection proportions (<2%).
\nConclusion: Prevalence of STI co-testing was low among patients with clinical suspicion for STIs; however, co-infection prevalence was high in several co-infection pairings. Future efforts are needed to improve STI co-testing rates among high-risk individuals.
","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"emergency department"},{"word":"sexually transmitted infection"},{"word":"Sexually Transmitted Disease"},{"word":"Public health"},{"word":"Human immunodeficiency virus"},{"word":"hepatitis C virus"},{"word":"Syphilis"},{"word":"gonorrhea"},{"word":"chlamydia"}],"section":"Endemic Infections","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9tc121t5","frozenauthors":[{"first_name":"James","middle_name":"S.","last_name":"Ford","name_suffix":"","institution":"University of California San Francisco, Department of Emergency Medicine, San Francisco, California","department":"None"},{"first_name":"Joseph","middle_name":"C.","last_name":"Morrison","name_suffix":"","institution":"University of California Davis, Davis, California","department":"None"},{"first_name":"Jenny","middle_name":"L.","last_name":"Wagner","name_suffix":"","institution":"California State University, Department of Public Health, Sacramento, California","department":"None"},{"first_name":"Disha","middle_name":"","last_name":"Nangia","name_suffix":"","institution":"University of California Davis, School of Medicine, Sacramento, California","department":"None"},{"first_name":"Stephanie","middle_name":"","last_name":"Voong","name_suffix":"","institution":"University of California Davis Health, Department of Emergency Medicine, Sacramento, California","department":"None"},{"first_name":"Cynthia","middle_name":"G.","last_name":"Matsumoto","name_suffix":"","institution":"University of California Davis Health, Learning Health System, Department of Population Health and Accountable Care, Sacramento, California","department":"None"},{"first_name":"Tasleem","middle_name":"","last_name":"Chechi","name_suffix":"","institution":"University of California Davis Health, Department of Emergency Medicine, Sacramento, California","department":"None"},{"first_name":"Nam","middle_name":"","last_name":"Tran","name_suffix":"","institution":"University of California Davis Health, Department of Pathology and Laboratory Medicine, Sacramento, California","department":"None"},{"first_name":"Larissa","middle_name":"","last_name":"May","name_suffix":"","institution":"University of California Davis Health, Department of Emergency Medicine, Sacramento, California","department":"None"}],"date_submitted":"2023-07-19T06:10:35-07:00","date_accepted":"2023-07-19T06:10:35-07:00","date_published":"2024-04-09T06:00:00-07:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18404/galley/10537/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18404/galley/9593/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18404/galley/10537/download/"}]}