Schneider Kari, FitzGerald Michael, Byczkowski Terri, Reed Jennifer
From the*Division of Emergency Medicine, Cincinnati Children's Hospital, Cincinnati, OH; and †Division of Pediatric Emergency Medicine, University of Minnesota Children's Hospital, Minneapolis, MN.
Sex Transm Dis. 2016 Apr;43(4):209-15. doi: 10.1097/OLQ.0000000000000424.
Because adolescents rely heavily on emergency services for health care, a pediatric emergency department (PED) visit may be their only opportunity for sexually transmitted infection (STI) screening. The primary objectives of this study were to determine the proportion of Neisseria gonorrheae (GC) and Chlamydia trachomatis (CT) infections in asymptomatic PED adolescents and patient-perceived barriers to STI screening.
A convenience sample of patients aged 14 to 21 years presenting to an urban PED with nongenitourinary complaints was offered screening for GC and CT. Regardless of declining or accepting screening, all were asked to complete a questionnaire designed to identify barriers to screening.
Sixty-eight percent of those approached participated (n = 719). Those who agreed to STI screening were more likely to be nonwhite (61.4% vs. 38.6%, P = 0.001) and publically insured (63.3%) versus privately insured (29.3%) or no insurance (7.58%). Four hundred three (56%) participants provided urine samples, and of those, 40 (9.9%) were positive for an STI. Controlling for other demographics, race was a significant predictor, with the odds of testing positive for nonwhite participants 5.90 times that of white participants. Patients who refused testing were more likely to report not engaging in sexual activity (54.3% vs. 42.4%, P = 0.009) and less likely to perceive that they were at risk for STIs.
There are high proportions of GC and CT among asymptomatic adolescents visiting an academic urban PED. A universal PED STI screening program may be an important component of STI reduction initiatives, especially among adolescents who do not perceive that they are at risk and may not receive testing elsewhere.
由于青少年严重依赖急诊服务来获取医疗保健，前往儿科急诊科（PED）就诊可能是他们接受性传播感染（STI）筛查的唯一机会。本研究的主要目的是确定无症状PED青少年中淋病奈瑟菌（GC）和沙眼衣原体（CT）感染的比例以及患者感知到的STI筛查障碍。
对前往城市PED就诊且有非泌尿生殖系统症状的14至21岁患者进行便利抽样，提供GC和CT筛查。无论是否拒绝或接受筛查，所有患者均被要求完成一份旨在识别筛查障碍的问卷。
68%的被邀请者参与了研究（n = 719）。同意接受STI筛查的患者更有可能是非白人（61.4%对38.6%，P = 0.001），且公共保险覆盖者占比（63.3%）高于私人保险覆盖者（29.3%）或无保险者（7.58%）。403名（56%）参与者提供了尿液样本，其中40名（9.9%）STI检测呈阳性。在控制其他人口统计学因素后，种族是一个显著的预测因素，非白人参与者检测呈阳性的几率是白人参与者的5.90倍。拒绝检测的患者更有可能报告未进行性行为（54.3%对42.4%，P = 0.009），且不太可能认为自己有感染STI的风险。
在前往城市学术性PED就诊的无症状青少年中，GC和CT感染比例较高。普遍的PED STI筛查项目可能是减少STI传播举措的重要组成部分，尤其是对于那些未意识到自身风险且可能无法在其他地方接受检测的青少年。
