Adequacy of testing, empiric treatment, and referral for adult male emergency department patients with possible chlamydia and/or gonorrhoea urethritis

This study evaluated the adequacy of testing, empiric treatment and referral for further evaluation of adult male emergency department (ED) patients with possible chlamydia and/or gonorrhoea urethritis. Of 968 adult male ED patients, 84% were tested for chlamydia and gonorrhoea, 16% for HIV and 27% for syphilis; 92% received empiric treatment for chlamydia and gonorrhoea and 71% were referred for further evaluation; of those tested, 29% were infected with chlamydia, gonorrhoea or both; and 3% of those tested had a positive syphilis test. The results of logistic regression modelling indicated that testing, treatment and referral were not related to a history of sexual contact with someone known to have a sexually transmitted disease or to the patient's ultimate diagnosis of a laboratory-confirmed infection. Compliance with Centers for Disease Control and Prevention (CDC) recommendations for chlamydia and gonorrhoea testing and treatment regimens was high, but was poor for HIV testing. More explicit guidance from CDC regarding syphilis testing and referral for further evaluation is needed.

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Effect of Provider Type and Sex on Empiric Treatment of Sexually Transmitted Infections in Adolescent Emergency Department Patients

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2013.07.476 ◽

2013 ◽

Vol 62 (4) ◽

pp. S70 ◽

Cited By ~ 1

Author(s):

J. Law ◽

E. Bicker ◽

T. Joseph ◽

J. Zhan ◽

C. Ardary ◽

...

Keyword(s):

Emergency Department ◽

Sexually Transmitted Infections ◽

Provider Type ◽

Sexually Transmitted ◽

Empiric Treatment ◽

Emergency Department Patients

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Assessing Prior History of Sexually Transmitted Disease

JAMA ◽

10.1001/jama.1992.03480120048020 ◽

1992 ◽

Vol 267 (12) ◽

pp. 1610 ◽

Cited By ~ 1

Author(s):

Margaret T. McHugh

Keyword(s):

Sexually Transmitted Disease ◽

Transmitted Disease ◽

Prior History ◽

Sexually Transmitted ◽

History Of

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945. Prevalence of HIV Associated Non-AIDS Conditions and Associated Risk Factors among Hospitalized HIV-infected Patients in India

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1131 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S504-S505

Author(s):

Amyeo A Jereen ◽

Celia Kucera ◽

Saniya Pervin ◽

Muralidhar Varma ◽

Radhakrishnan Rajesh ◽

...

Keyword(s):

Risk Factors ◽

Transmitted Disease ◽

Multivariate Logistic Regression Analysis ◽

Patient Risk ◽

Sexually Transmitted ◽

Factors Associated ◽

Immunodeficiency Virus ◽

History Of ◽

Artery Disease ◽

Associated Risk Factors

Abstract Background HIV-associated non-AIDS (HANA) conditions are becoming common as People Living with Human Immunodeficiency Virus (PLWHIV) age. However, data estimating the prevalence of HANA conditions and associated risk factors is lacking in developing countries. This study evaluates reasons for hospitalizations among PLWHIV in Udupi, India in the antiretroviral era, and describes associated risk factors. Methods Demographic and clinical data were extracted from medical charts of 1280 HIV-infected patients 18 years and older who were admitted to Kasturba Hospital, Manipal, India between January 1, 2013 and December 31, 2017, for a total of 2157 hospitalizations. Primary reasons for hospitalization were categorized into AIDS-defining vs Non-AIDS-defining and HANA vs Non-HANA conditions (Fig 1). Multivariate logistic regression analysis was performed to estimate demographic and clinical factors associated with hospitalizations due to AIDS-defining illness and HANA conditions. Categorization of Reasons for Hospitalization Results Patients’ median age was 45 (18-80) years; 70% male. Median age of patients with AIDS-defining illness (45% of hospitalizations) was lower at 44 (18-75) years compared with HANA (15% of hospitalizations) at 48 (21-80) years. Age (OR, 95% CI) (0.985, 0.974-0.995), admission CD4 (0.998, 0.997 - 0.998), history of hypertension (HTN) (0.59, 0.42-0.82), stroke (0.49, 0.24 - 0.93), diabetes (1.56, 1.10 - 2.19), and AIDS-defining cancers (1.74, 1.05 - 2.89) were associated with AIDS-defining hospitalizations (Fig 2). Additionally, age (1.016, 1.001 - 1.031), history of HTN (1.70, 1.16 - 2.46), coronary artery disease (CAD) (4.02, 1.87- 9.02), chronic kidney disease (CKD) (2.30, 1.15 - 4.61), stroke (2.93, 1.46 - 5.96), Hepatitis B (3.32, 1.66- 6.72), Hepatitis C (16.1, 2.84 - 314), sexually transmitted disease (STD) (3.76, 1.38- 10.8), and HANA-associated cancer (2.44, 1.28- 6.42) were associated with HANA hospitalizations (Fig 3). Patient Risk Factors for AIDS-related Hospitalization Patient Risk Factors for HANA-related Hospitalization Conclusion Prevalence of HANA conditions was lower than AIDS-defining illnesses possibly because of a younger population. Patients with AIDS-defining illnesses were also likely to have HANA conditions. Early detection and effective treatment of both HIV and HANA conditions is essential to decrease hospitalizations in low-resource settings. Disclosures All Authors: No reported disclosures

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Developing a System to Predict Laboratory-Confirmed Chlamydial and/or Gonococcal Urethritis in Adult Male Emergency Department Patients

Postgraduate Medicine ◽

10.3810/pgm.2010.01.2099 ◽

2010 ◽

Vol 122 (1) ◽

pp. 52-60 ◽

Cited By ~ 5

Author(s):

Roland C. Merchant ◽

Dina M. DePalo ◽

Tao Liu ◽

Josiah D. Rich ◽

Michael D. Stein

Keyword(s):

Emergency Department ◽

Adult Male ◽

Gonococcal Urethritis ◽

Emergency Department Patients

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Compliance and Treatment Outcomes of Various Regimens for Trichomoniasis in Trinidad and Tobago

Medical Sciences ◽

10.3390/medsci7100097 ◽

2019 ◽

Vol 7 (10) ◽

pp. 97

Author(s):

Divakaruni ◽

Mahabir ◽

Orrett ◽

Adidam ◽

Venkata ◽

...

Keyword(s):

Single Dose ◽

Side Effects ◽

Trichomonas Vaginalis ◽

Transmitted Disease ◽

World Health ◽

Sexually Transmitted ◽

Treatment Regimens ◽

Significant Difference ◽

Compliance To Treatment ◽

Health Organization

Trichomoniasis is the most common non-viral sexually transmitted disease (STD) globally and yet is not a reportable disease. Trichomonas vaginalis is an important source of reproductive morbidity and may increase risk of acquisition and transmission of human immunodeficiency viruses (HIV). The World Health Organization (WHO) and the Control Disease Center (CDC) recommend various regimens of nitroimidazole s for treatment. The common nitroimidazoles used for trichomoniasis are metronidazole and tinidazole, which vary in their cost, efficacy, and side effect profile. It is relevant to study these factors for better management of the patients. This study aimed to compare and study the efficacy, compliance of various treatment regimens, their outcomes, and side-effects for trichomoniasis, among STI clinic attendees in Trinidad. A clinical trial study was designed, and after obtaining the informed consent, a routine clinical examination was conducted and the swabs for trichomoniasis tests were collected for diagnosis from the 692 participants. Out of 692 participants, 82 patients with positive diagnosis of Trichomonas infection were treated according to the patient’s choice, using different drug regimens. Compliance to treatment, side effects, and outcome were evaluated. The prevalence of trichomoniasis in the population attending our STI clinic is 11.9% and prevalence of HIV is 9%. Of the total 82 participants for the treatment, 80% were females; nearly 90% of the patients belonged to age group 15–45 years, and over 60% were below 30 years. Among those diagnosed for Trichomonas vaginalis, 14.6% had coexistent HIV infection. The compliance with respect to single dose treatment was significantly better than the long-duration oral regimen and has a significant relation with side effects of the treatment. The outcome is generally better and comparable and shows no significant difference between different treatment regimens used in the study. Metronidazole and tinidazole are commonly used drugs in various regimens. Compliance is better with those treated with tinidazole and metronidazole single dose than with other groups. Outcome is comparable between these regimens, especially when combined with other important factors like abstinence and treatment of the partners. The treatment regimens mainly differed in the compliance side effects profile and duration of therapy, which suggests that to improve the compliance of the drugs with fewer side effects, short course regimen would be a preferred choice.

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Adult and Pediatric Emergency Department Sexually Transmitted Disease and HIV Screening: Programmatic Overview and Outcomes

Academic Emergency Medicine ◽

10.1197/j.aem.2006.10.106 ◽

2007 ◽

Vol 14 (3) ◽

pp. 250-258 ◽

Cited By ~ 17

Author(s):

Supriya D. Mehta ◽

Jonathan Hall ◽

Sheryl B. Lyss ◽

Paul R. Skolnik ◽

Lisa N. Pealer ◽

...

Keyword(s):

Emergency Department ◽

Sexually Transmitted Disease ◽

Transmitted Disease ◽

Pediatric Emergency ◽

Pediatric Emergency Department ◽

Hiv Screening ◽

Sexually Transmitted

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Assessing prior history of sexually transmitted disease

JAMA ◽

10.1001/jama.266.12.1646b ◽

1991 ◽

Vol 266 (12) ◽

pp. 1646b-1646 ◽

Cited By ~ 1

Author(s):

J. M. Fleisher

Keyword(s):

Sexually Transmitted Disease ◽

Transmitted Disease ◽

Prior History ◽

Sexually Transmitted ◽

History Of

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How do we manage emergency department patients diagnosed with transient ischemic attack?

CJEM ◽

10.2310/8000.2011.110533 ◽

2012 ◽

Vol 14 (01) ◽

pp. 20-24 ◽

Cited By ~ 7

Author(s):

Jeffrey J. Perry ◽

Jonathan Kerr ◽

Cheryl Symington ◽

Jane Sutherland

Keyword(s):

Emergency Department ◽

Transient Ischemic Attack ◽

Data Extraction ◽

Tertiary Care ◽

Clinical Findings ◽

Stroke Rate ◽

Historical Cohort ◽

History Of ◽

Emergency Department Patients ◽

Ischemic Attack

ABSTRACTIntroduction:Multiple studies have demonstrated low rates of antithrombotic use, low neuroimaging rates, and high subsequent risk of stroke at 90 days following an emergency department (ED) diagnosis of transient ischemic attack (TIA). This study assessed the use of antithrombotic medications, neuroimaging, and subsequent 90-day stroke rate for patients in a more recent cohort of ED patients discharged home with TIA.Methods:We conducted a 1-year historical cohort study of all patients discharged with a TIA at a tertiary care ED (census 60,000 visits/year), which was one of the four sites participating in one of the aforementioned studies. Data were extracted from paper and electronic records onto standardized data extraction forms. Clinical findings, medications, and tests were recorded.Results:A total of 211 patients were enrolled in the study. The patients had the following characteristics: the mean age was 71.2 years (SD 13.8 years), 56.9% were female, 53.1% had a history of hypertension, 26.5% had a history of ischemic heart disease, and 17.1% had a previous stroke. The most frequent neurologic deficit was unilateral weakness (53.6%), and most deficits lasted for more than 60 minutes (71.6%). Antithrombotic medications were used for 96.7% of patients at ED discharge. Neuroimaging was conducted in 94.3% of patients while in the ED. Our cohort had a 90-day stroke rate of 1.9%.Conclusions:This study established that most TIA patients receive neuroimaging in the ED and are started on or maintained on antithrombotic agents. Clinicians are encouraged to ensure that electrocardiography is done routinely and to involve Neurology in follow-up care.

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