Trends in STI testing and diagnosis rates during the COVID-19 pandemic at a large urban tertiary care center, and the role of the emergency department in STI care.
Trends in STI testing and diagnosis rates during the COVID-19 pandemic at a large urban tertiary care center, and the role of the emergency department in STI care.
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DOI：
10.3389/frph.2023.1082429
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发表时间：
2023
影响因子：
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通讯作者：
Friedman, Eleanor E
中科院分区：
文献类型：
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作者：
Stanford, Kimberly A;Mason, Joseph A;Friedman, Eleanor E
COVID-19 大流行对获得护理的机会产生了深远影响，包括门诊性传播感染 (STI) 检测和治疗。在大流行之前，许多弱势群体就已经依赖急诊科 (ED) 提供大部分护理。这项研究调查了大型城市医疗中心在大流行之前和期间的性传播感染检测和阳性率的趋势，并评估了急诊室在提供性传播感染护理方面的作用。这是对 2018 年 11 月 1 日至 2021 年 7 月 31 日期间所有淋病、衣原体和滴虫检测的回顾性审查。人口统计信息以及性传播感染检测的位置和结果是从电子病历中提取的。对COVID-19大流行开始前后（2020年3月15日）16个月内的性传播感染检测和阳性趋势进行了检查，后者分为大流行早期（EPP：2020年3月15日至7月31日）和大流行晚期（LPP：2020年8月1日至2021年7月31日）。 EPP 期间每月检测数量减少了 42.4%，但到 2020 年 7 月有所反弹。 EPP 期间，源自急诊室的所有性传播感染检测比例从大流行前的 21.4% 增加到 29.3%，孕妇中的比例从 45.2% 增加到 51.5%。 EPP 的总体 STI 阳性率从大流行前的 4.4% 上升至 6.2%。淋病和衣原体分别观察到平行趋势。 ED 占总体阳性检测的 50.5%，在 EPP 期间占阳性检测的 63.1%。 73.4% 的孕妇检测结果呈阳性，来自 ED，而在 EPP 期间这一比例上升至 82.1%。这个大型城市医疗中心的性传播感染趋势与全国趋势一致，阳性病例早期减少，随后在 2020 年 5 月底出现反弹。在整个研究期间，急诊科是所有患者（尤其是怀孕患者）检测的重要来源，但在大流行早期更是如此。这表明，应将更多资源用于急诊科的性传播感染检测、教育和预防，并支持急诊科就诊期间与门诊初级护理和产科护理的联系。
The COVID-19 pandemic has had profound effects on access to care, including outpatient sexually transmitted infection (STI) testing and treatment. Many vulnerable populations already relied on the emergency department (ED) for much of their care prior to the pandemic. This study examines trends in STI testing and positivity before and during the pandemic at a large urban medical center and evaluates the role of the ED in providing STI care. This is a retrospective review of all gonorrhea, chlamydia, and trichomonas tests from November 1, 2018, through July 31, 2021. Demographic information and location and results of STI testing were extracted from the electronic medical record. Trends in STI testing and positivity were examined for 16 month periods before and after the COVID-19 pandemic started (March 15, 2020), with the latter divided into the early pandemic period (EPP: March 15 -July 31, 2020) and late pandemic period (LPP: August 1, 2020 - July 31, 2021). Tests per month decreased by 42.4% during the EPP, but rebounded by July 2020. During the EPP, the proportion of all STI testing originating in the ED increased from 21.4% pre-pandemic to 29.3%, and among pregnant women from 45.2% to 51.5%. Overall STI positivity rate increased from 4.4% pre-pandemic to 6.2% in the EPP. Parallel trends were observed for gonorrhea and chlamydia individually. The ED represented 50.5% of overall positive tests, and as much as 63.1% of positive testing during the EPP. The ED was the source of 73.4% of positive tests among pregnant women, which increased to 82.1% during the EPP. STI trends from this large urban medical center paralleled national trends, with an early decrease in positive cases followed by a rebound by the end of May 2020. The ED represented an important source of testing for all patients, and especially for pregnant patients, throughout the study period, but even more so early in the pandemic. This suggests that more resources should be directed towards STI testing, education, and prevention in the ED, as well as to support linkage to outpatient primary and obstetric care during the ED visit.