Screening for sexually transmitted infections in a pediatric emergency department (PED) could help identify those who are infected despite lack of symptoms, researchers at Cincinnati Children’s Hospital in Ohio report.

“Adolescents and young adults 15 to 24 years of age represent approximately 25 percent of the sexually active US population, but account for half of all new sexually transmitted infection (STI) cases and have the highest incidence of Chlamydia trachomatis (CT) and Neisseria gonorrhea (GC) among any sexually active age group. A large proportion of these infections are asymptomatic; thus, diagnosis and prompt treatment are vitally important to prevent transmission and long-term morbidity,” the researchers write in Sexually Transmitted Diseases.

To determine the proportions of GC and CT infections in asymptomatic adolescents in an academic urban PED, as well as patient-related predictors of screening refusals, the team recruited a convenience sample of patients aged 14 to 21 years presenting to the PED with nongenitourinary complaints. Patients were offered screening for GC and CT and asked to complete a questionnaire designed to identify barriers to screening.

A total of 719 (68 percent) of those approached participated. Nonwhites were more likely to agree to screening compared with whites (61.4 percent versus 38.6 percent) and were more likely to be publicly insured (63.3 percent) versus privately insured (29.3 percent) or uninsured (7.58 percent).

A total of 403 (56 percent) participants provided urine samples. Of those, 40 (9.9 percent) were positive for an STI. Controlling for other demographics, race was a significant predictor; the odds of testing positive for nonwhite participants were 5.90 times those of white participants.

Patients who refused testing were more likely to report not engaging in sexual activity (54.3 percent versus 42.4 percent) and less likely to perceive that they were at risk for STIs.

Coauthor Dr. Kari Schneider noted that Centers for Disease Control and Prevention guidelines state that all sexually active adolescents should be screened yearly. “Adolescents seek care infrequently and so wherever/whenever they do, it should be considered a precious opportunity to screen,” she told Reuters Health by email.

Coauthor Dr. Jennifer Reed added that, “ideally, screening should occur in the primary care setting. But we know that adolescents in particular do not usually have regular well child checks or preventive care visits and often only seek care when they have an acute illness or injury. Therefore, it is important to take advantage of nontraditional settings, such as the ED, to promote screening.”