Sheele Johnathan M, Smith Justin, Niforatos Joshua D, Wessling Emily, Hilliker Benjamin, Bragg Bradley, Mandac Ed
Emergency Medicine, Mayo Clinic, Jacksonville, USA.
Surgery, Division of Vascular Surgery and Endovascular Therapy, Case Western Reserve University, Cleveland, USA.
Cureus. 2019 Dec 27;11(12):e6482. doi: 10.7759/cureus.6482.
Background Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), and Trichomonas vaginalis (TV) are common sexually transmitted infections (STIs) treated in the emergency department (ED). Objectives To assess the history, physical examination, and laboratory findings associated with NG and CT infection and the decision to administer empiric antibiotic treatment for the diseases in the ED. Methods A retrospective review of 566 clinical encounters of adult female patients tested for STIs between January 1, 2013 and December 31, 2014. An analysis of patient- and provider-level variables was assessed to determine the characteristics associated with empiric antibiotic treatment in the ED and post-discharge laboratory confirmed NG or CT. Results Younger age and the presence of TV on vaginal wet prep had a higher association with being infected with NG or CT (p < 0.05). Subjective exam findings, such as vaginal discharge, abdominal pain, urinary urgency, urinary frequency, dysuria, objective vaginal discharge, cervical motion tenderness, adnexal tenderness, vaginal bleeding, as well as positive leukocyte esterase and nitrites on urinalysis were all not associated with NG or CT infection (p > 0.05). ED providers were more likely to treat subjects in the ED for NG and CT when there was subjective and objective vaginal discharge, cervical motion tenderness, adnexal tenderness, and vaginal bleeding, TV on wet prep, and leukocyte esterase on urinalysis (p < 0.05). Conclusions Only younger age women and the presence of TV on vaginal wet prep were associated with NG or CT infection. ED providers empirically over-treated with antibiotics ~20 patients uninfected with NG and CT by laboratory confirmation, for every one patient with a laboratory confirmed infection.
淋病奈瑟菌（NG）、沙眼衣原体（CT）和阴道毛滴虫（TV）是急诊科（ED）常见的性传播感染（STIs）。目的：评估与NG和CT感染相关的病史、体格检查及实验室检查结果，以及在急诊科对这些疾病进行经验性抗生素治疗的决策。方法：回顾性分析2013年1月1日至2014年12月31日期间566例接受性传播感染检测的成年女性患者的临床诊疗情况。对患者和医疗服务提供者层面的变量进行分析，以确定与急诊科经验性抗生素治疗及出院后实验室确诊的NG或CT相关的特征。结果：年龄较小以及阴道湿片检查发现有TV与感染NG或CT的关联性更高（p<0.05）。主观检查结果，如阴道分泌物、腹痛、尿急、尿频、尿痛、客观的阴道分泌物、宫颈举痛、附件压痛、阴道出血，以及尿液分析中白细胞酯酶和亚硝酸盐阳性，均与NG或CT感染无关（p>0.05）。当存在主观和客观的阴道分泌物、宫颈举痛、附件压痛、阴道出血、湿片检查发现有TV以及尿液分析有白细胞酯酶时，急诊科医疗服务提供者更有可能在急诊科对患者进行NG和CT的治疗（p<0.05）。结论：只有年龄较小的女性以及阴道湿片检查发现有TV与NG或CT感染有关。对于每一例实验室确诊感染的患者，急诊科医疗服务提供者会对约20例实验室确诊未感染NG和CT的患者进行经验性过度抗生素治疗。
