Tao Guoyu, Patel Chirag G, Stanford Kimberly A
Division of STD Prevention, NCHHSTP, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA.
Section of Emergency Medicine, University of Chicago, Chicago, Illinois, USA.
Acad Emerg Med. 2025 Mar;32(3):292-299. doi: 10.1111/acem.15058. Epub 2024 Dec 3.
The Centers for Disease Control and Prevention sexually transmitted infection (STI) treatment guidelines state that the decision to provide STI/human immunodeficiency virus (HIV) testing and presumptive treatment after sexual assault (SA) should be made on an individual basis to minimize retraumatization of the patient. However, little is known about STI screening, presumptive treatment, and positivity in the emergency department (ED) setting. The objective of this study was to evaluate STI testing rates and positivity, presumptive gonorrhea and chlamydia treatment, pregnancy testing, and emergency contraception offered to SA survivors in the ED in the United States.
The Premier Healthcare Database, a national administrative data set containing health care information from inpatient and hospital-based outpatient encounters, was used. Approximately 30% of encounters have available laboratory test results. ED visits for SA (identified by ICD-10-CM codes) among female patients aged 15-44 years between 2019 and 2023 were included. For patients presenting multiple times to the ED, only the first ED visit after SA was included.
Of 49,047 total visits where females ages 15-44 years presented to the ED for SA, chlamydia, gonorrhea, syphilis, and HIV tests were conducted in 18.6%, 18.6%, 13.4%, and 16.9%, respectively, and pregnancy tests in 33.1% of visits. Presumptive gonorrhea and chlamydia treatment was provided in 53.7% and 52.2%, respectively, and emergency contraception in 27.2% of visits. Approximately 40% of patients were neither tested nor treated for either chlamydia or gonorrhea. Of patients with available laboratory test results, chlamydia, gonorrhea, and syphilis positivity rates were 10.0%, 3.8%, and 1.0%, respectively.
Low STI testing and treatment rates and high STI positivity identified in this study suggest that an important opportunity exists for improving STI screening and presumptive treatment for female patients presenting to the ED after SA.
美国疾病控制与预防中心的性传播感染（STI）治疗指南指出，对于性侵犯（SA）后进行性传播感染/人类免疫缺陷病毒（HIV）检测和推定治疗的决策应因人而异，以尽量减少对患者的再次创伤。然而，对于急诊科（ED）环境中的性传播感染筛查、推定治疗及阳性率情况，人们了解甚少。本研究的目的是评估美国急诊科为性侵犯幸存者提供的性传播感染检测率及阳性率、淋病和衣原体的推定治疗、妊娠检测以及紧急避孕情况。
使用Premier Healthcare数据库，这是一个包含住院和医院门诊医疗信息的全国性管理数据集。约30%的就诊有可用的实验室检测结果。纳入2019年至2023年期间15 - 44岁女性患者因性侵犯到急诊科就诊的情况（通过ICD - 10 - CM编码识别）。对于多次到急诊科就诊的患者仅纳入性侵犯后的首次急诊科就诊。
在15 - 44岁女性因性侵犯到急诊科就诊的49047次就诊中，衣原体、淋病、梅毒和HIV检测分别进行了18.6%、18.6%、13.4%和16.9%，33.1%的就诊进行了妊娠检测；淋病和衣原体的推定治疗分别提供给了53.7%和52.2%的就诊患者，27.2%的就诊提供了紧急避孕。约40%的患者衣原体或淋病既未检测也未治疗。在有可用实验室检测结果的患者中，衣原体、淋病和梅毒的阳性率分别为10.0%、3.8%和1.0%。
本研究中发现的低性传播感染检测和治疗率以及高性传播感染阳性率表明，对于性侵犯后到急诊科就诊的女性患者，改善性传播感染筛查和推定治疗存在重要契机
