We have previously demonstrated a prevalence of sexually transmitted infections (STIs) of 25% among symptomatic urban adolescent pediatric emergency department (ED) patients. Since STIs may be asymptomatic, screening studies of asymptomatic patients are needed to determine unmet need for STI screening in ED settings and therefore, we sought to determine the prevalence of asymptomatic STIs in adolescents served by a large pediatric ED in a community with high STI prevalence.
We assembled a cross-sectional convenience sample of 14-21 year old patients presenting to an urban pediatric ED between December 2013 - July 2014. Participants were tested for Chlamydia Trachomatis (CT) and Neisseria Gonorrhea (NG) using urine-based polymerase chain reaction. Additionally, we administered a validated sexual health survey to understand factors associated with presence of infection. We defined high risk sexual behavior as lack of condom use during last sexual intercourse and/or identification of >1 sexual partner in the last 3 months. STI prevalence was calculated and logistic regression was used to measure the associations between sexual behavior and STI outcomes.
The 326 patients enrolled had a mean age of 16.4 years (SD +/- 1.8); 50.3% were male; 68.3% were non-Hispanic Black; and 23.62% were covered by private insurance. Sixteen patients (4.9%; 95% CI 2.6, 7.3) had an asymptomatic STI, 15 with CT alone, and one with CT and NG. Nearly half (46.7%) of patients with an STI had been tested within the last 6 months, and 80% of these tests had been negative. 50% of infections were diagnosed among patients who “definitely did not” think they had an STI. The prevalence of STI was significantly higher among those who reported being sexually active (7.6% vs 1.4%, OR=5.8; 95% CI 1.3, 25.8), among those who reported high risk sexual behaviors (10.4% vs 3.2%, OR=3.49; 95%CI 1.3, 9.7) and among those who reported preferentially using the ED rather than a PCP/health clinic when sick (12.0% vs 2.5%, OR=5.4; 95% CI 1.9, 15.4). There was no relationship between STI and age, gender, racial/ethnic group, insurance status, not having a primary care physician or prior history of STI. In a multivariable model, STI positivity was associated with high risk sexual behavior (AOR 3.4; 95% CI 1.0, 11.2) and preferential use of the ED when sick (AOR 4.2; 95% CI 1.2, 14.4).
In an unselected population of largely minority and disadvantaged adolescents seeking care in an urban ED; asymptomatic STIs were detected in approximately 5%. Targeted screening interventions to focus on patients at increased risk (e.g. those who rely on the ED for health care access and those who engage in high risk sexual activity) are needed to improve diagnosis of asymptomatic STIs.