性传播感染的联合检测在一个大型城市急诊部门。

Sexually Transmitted Infection Co-testing in a Large Urban Emergency Department.

机构信息

University of California San Francisco, Department of Emergency Medicine, San Francisco, California.

University of California Davis, Davis, California.

出版信息

West J Emerg Med. 2024 May;25(3):382-388. doi: 10.5811/westjem.18404.

DOI:10.5811/westjem.18404

PMID:38801045

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11112655/

Abstract

INTRODUCTION: The incidence of sexually transmitted infections (STI) increased in the United States between 2017-2021. There is limited data describing STI co-testing practices and the prevalence of STI co-infections in emergency departments (ED). In this study, we aimed to describe the prevalence of co-testing and co-infection of HIV, hepatitis C virus (HCV), syphilis, gonorrhea, and chlamydia, in a large, academic ED. METHODS: This was a single-center, retrospective cross-sectional study of ED patients tested for HIV, HCV, syphilis, gonorrhea or chlamydia between November 27, 2018-May 26, 2019. In 2018, the study institution implemented an ED-based infectious diseases screening program in which any patient being tested for gonorrhea/chlamydia was eligible for opt-out syphilis screening, and any patient 18-64 years who was having blood drawn for any clinical purpose was eligible for opt-out HIV and HCV screening. We analyzed data from all ED patients ≥13 years who had undergone STI testing. The outcomes of interest included prevalence of STI testing/co-testing and the prevalence of STI infection/co-infection. We describe data with simple descriptive statistics. RESULTS: During the study period there were 30,767 ED encounters for patients ≥13 years (mean age: 43 ± 14 years, 52% female), and 7,866 (26%) were tested for at least one of HIV, HCV, syphilis, gonorrhea, or chlamydia. We observed the following testing frequencies (and prevalence of infection): HCV, 7,539 (5.0%); HIV, 7,359 (0.9%); gonorrhea, 574 (6.1%); chlamydia, 574 (9.8%); and syphilis, 420 (10.5%). Infectious etiologies with universal testing protocols (HIV and HCV) made up the majority of STI testing. In patients with syphilis, co-infection with chlamydia (21%, 9/44) and HIV (9%, 4/44) was high. In patients with gonorrhea, co-infection with chlamydia (23%, 8/35) and syphilis (9%, 3/35) was high, and in patients with chlamydia, co-infection with syphilis (16%, 9/56) and gonorrhea (14%, 8/56) was high. Patients with HCV had low co-infection proportions (<2%). CONCLUSION: Prevalence of STI co-testing was low among patients with clinical suspicion for STIs; however, co-infection prevalence was high in several co-infection pairings. Future efforts are needed to improve STI co-testing rates among high-risk individuals.

摘要

简介：2017 年至 2021 年间，美国性传播感染（STI）的发病率有所上升。目前，有关急诊部门（ED）中 STI 联合检测实践和 STI 合并感染的流行情况的数据有限。在这项研究中，我们旨在描述在美国一家大型学术 ED 中进行 HIV、丙型肝炎病毒（HCV）、梅毒、淋病和衣原体联合检测的流行情况。

方法：这是一项在 2018 年 11 月 27 日至 2019 年 5 月 26 日期间对 ED 患者进行 HIV、HCV、梅毒、淋病或衣原体检测的单中心、回顾性横断面研究。2018 年，研究机构在 ED 实施了一项传染病筛查项目，在该项目中，对所有接受淋病/衣原体检测的患者都有资格进行梅毒筛查，对所有 18-64 岁的因任何临床目的采血的患者都有资格进行 HIV 和 HCV 筛查的机会性筛查。我们分析了所有年龄≥13 岁的接受过 STI 检测的 ED 患者的数据。感兴趣的结局包括 STI 检测/联合检测的流行率以及 STI 感染/合并感染的流行率。我们使用简单的描述性统计数据来描述数据。

结果：在研究期间，有 30767 名年龄≥13 岁的 ED 患者就诊（平均年龄：43±14 岁，52%为女性），其中 7866 人（26%）接受了至少一种 HIV、HCV、梅毒、淋病或衣原体检测。我们观察到以下检测频率（以及感染率）：HCV，7539 人（5.0%）；HIV，7359 人（0.9%）；淋病，574 人（6.1%）；衣原体，574 人（9.8%）；梅毒，420 人（10.5%）。具有普遍检测方案的传染性病因（HIV 和 HCV）构成了大多数 STI 检测。在患有梅毒的患者中，与衣原体（21%，9/44）和 HIV（9%，4/44）的合并感染率很高。在患有淋病的患者中，与衣原体（23%，8/35）和梅毒（9%，3/35）的合并感染率很高，在患有衣原体的患者中，与梅毒（16%，9/56）和淋病（14%，8/56）的合并感染率很高。HCV 患者的合并感染比例较低（<2%）。

结论：有 STI 临床疑似症状的患者中 STI 联合检测的流行率较低；然而，几种合并感染配对中合并感染的流行率很高。需要进一步努力提高高危人群的 STI 联合检测率。