UNDERRECOGNITION OF CERVICAL NEISSERIA-GONORRHOEAE AND CHLAMYDIA-TRACHOMATIS INFECTIONS IN THE EMERGENCY DEPARTMENT

Objectives: 1) To quantify the frequency of underrecognized Neisseria gonorrhoeae and Chlamydia trachomatis cervical infections in women tes ted in the ED, 2) to describe and compare the characteristics of those treated and not treated during the initial visit, and 3) to quantify the delay interval until treatment was provided. Methods: A 2-year, re trospective consecutive case series was performed from June 1, 1992, t o May 31, 1994. There were 148 women with greater than or equal to 1 d iscrete occurrence of culture-proven cervical N. gonorrhoeae or C. tra chomatis infection studied, All the patients were evaluated in a unive rsity-affiliated, tertiary care hospital-based ED with a large rural r eferral area. The main outcome measures were the proportions of patien ts with positive cultures both treated and not treated in the ED, the clinical characteristics of each group, and the proportion remaining u ntreated or experiencing treatment delays of >2 weeks after attempted phone, mail, and public health follow-up, Results: Of 157 occurrences of positive cultures for N. gonorrhoeae or C. trachomatis, 86 (53%) we re treated with a regimen suggested by the CDC prior to ED release, Th e proportion of women with isolated C. trachomatis infections that wer e underrecognized and untreated initially was larger than the proporti ons with isolated N. gonorrhoeae or combined infections (79% vs 27% an d 53%, respectively, p < 0.0001). Women with findings suggestive of ad vanced disease (history of fever or chills, or examination evidence of temperature >38 degrees C, purulent vaginal discharge, or any uterine /salpinx/ovarian tenderness) were more often recognized and treated wi th appropriate antibiotics initially (p = 0.02 to <0.00001 for all), A fter phone, mail, and public health follow-up, treatment could not be documented for 25% of the occurrences, in all cases due to an inabilit y to locate the patient, An additional 20% of the women did not receiv e treatment for 14-60 days. Conclusions: In this population, both N. g onorrhoeae and C. trachomatis cervical infections are frequently under recognized in the ED, with isolated C. trachomatis infections associat ed with significantly higher proportions of underrecognition, Many aff ected women remain untreated for extended intervals, creating public a nd individual health risks. Improved point of contact detection, follo w-up, and treatment policies are needed to limit these risks.