Adult and pediatric emergency department sexually transmitted disease and HIV screening: Programmatic overview and outcomes
Adult and pediatric emergency department sexually transmitted disease and HIV screening: Programmatic overview and outcomes
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DOI：
10.1197/j.aem.2006.10.106
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发表时间：
2007-03-01
影响因子：
4.4
通讯作者：
Kharasch, Sigmund
中科院分区：
文献类型：
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作者：
Mehta, Supriya D.;Hall, Jonathan;Kharasch, Sigmund
目的：测量接受筛查的急诊科 (ED) 患者中淋病、衣原体和人类免疫缺陷病毒 (HIV) 感染的患病率，并评估治疗结果和感染风险。方法：研究人员自愿检测淋病和衣原体（通过尿液转录介导的扩增）和 HIV（通过酶免疫分析/Western blot） 口腔粘膜漏出液印迹）给 ED 患者。儿童（15-21岁）和成人（22-29岁）患者有资格进行淋病和衣原体检测； 15-54岁的患者有资格接受艾滋病毒检测。作者调查了接受 HIV 检测的患者的行为风险。结果：从 2003 年 11 月到 2004 年 5 月，791 名符合条件的儿科患者中的 497 名 (63%) 和 2,180 名符合条件的成年患者中的 1,000 名 (46%) 接受了淋病、衣原体和/或 HIV 筛查。 380 名儿童患者中有 41 名感染淋病、衣原体或两者兼有（10.8%），233 名成人患者中有 11 名感染（4.7%）； 52 名患者中有 14 名 (27%) 接受了急诊科临床医生的治疗。通过研究努力，剩余 38 名患者中的 33 名得到了治疗（总体治疗的 90%）。诊断出 8 名 HIV 感染者：969 名成年患者中的 7 名（0.7%）和 459 名儿童患者中的 1 名（0.2%）；五名艾滋病毒感染者（63%）收到了检测结果，三名（38%）去了艾滋病毒诊所。儿科患者的淋病或衣原体感染与多个性伴侣、同性性交以及 ED 临床医生对性传播疾病的怀疑有关。结论：经测试的儿科 ED 患者中淋病和/或衣原体感染的高患病率支持考虑扩大筛查。鉴于通过筛查、接收检测结果并与护理相关的患者数量较低，因此作者的急诊室值得探索通过快速检测进行有针对性的艾滋病毒筛查。
Objectives: To measure the prevalence of gonorrhea, chlamydia, and human immunodeficiency virus (HIV) infection among emergency department (ED) patients who accept screening, and to assess treatment outcomes and risks for infection.Methods: Research staff offered voluntary testing for gonorrhea and chlamydia (by urine transcription-mediated amplification) and HIV (by enzyme immunoassay/Western blot of oral mucosal transudate) to ED patients. Pediatric (15-21 years) and adult (22-29 years) patients were eligible for gonorrhea and chlamydia testing; patients aged 15-54 years were eligible for HIV testing. The authors surveyed behavioral risks of patients accepting HIV testing.Results: From November 2003 to May 2004, 497 of 791 eligible pediatric patients (63%) and 1,000 of 2,180 eligible adult patients (46%) accepted screening for gonorrhea, chlamydia, and/or HIV. There were 41 patients infected with gonorrhea, chlamydia, or both among 380 pediatric patients (10.8%) and 11 of 233 adult patients (4.7%); 14 of 52 patients (27%) were treated presumptively by ED clinicians. Through study efforts, 33 of the 38 remaining patients were treated (90% overall treatment). Eight HIV infections were diagnosed: seven of 969 adult patients (0.7%) and one of 459 pediatric patients (0.2%); five HIV-infected patients (63%) received test results, and three (38%) attended an HIV clinic. Gonorrhea or chlamydia infection in pediatric patients was associated with multiple sex partners, same-sex intercourse, and suspicion of sexually transmitted diseases by the ED clinician.Conclusions: The high prevalence of gonorrhea and/or chlamydia infection among pediatric ED patients tested supports consideration of expanded screening. Targeted HIV screening with rapid tests merits exploration in the authors' ED, given the low-moderate numbers of patients identified through screening, receiving test results, and linked to care.