Opportunistic urine ligase chain reaction screening for sexually transmitted diseases in adolescents seeking care in an urban emergency department

Study objective: Neisseria gonorrhoeae and Chlamydia trachomatis are the mo st common bacterial sexually transmitted diseases (STDs) in sexually active youth and many infections are asymptomatic or unrecognized. This study use d ligase chain reaction assays for determination of prevalence of gonococca l and chlamydial infections in adolescents seeking care at an urban emergen cy department. Methods: An unlinked prevalence study was performed with ligase chain react ion tests on Voided urine specimens from a convenience sample of adolescent s 14 years or older who sought care at the Children's Hospital of Alabama E D. Demographic data and data an care provided in the ED were determined fro m retrospective chart review of those patients whose urine specimens were t ested. Results: Of 282 urine specimens screened, 13.5% (38) yielded positive findi ngs on ligase chain reaction testing for either or both pathogens (20 [7%] positive for N gonorrhoeae, 23 [8%] positive for C trachomatis). In the con text of acute care, gonorrhea or chlamydial infection was diagnosed in 5 (1 .8%). STD prevalence did not vary significantly by age. Only 39% (15/38) of patients with infections detected by ligase chain reaction testing receive d potentially effective antibiotics as a result of their urgent care evalua tion. Conclusion: Many adolescents use the ED for nonurgent care and unsuspected STDs are often missed. Urine ligase chain reaction testing is a sensitive, noninvasive means of detecting STDs by which unsuspected adolescent STD cas es can be detected in an ED setting.