Underrecognition of cervical Neisseria gonorrhoeae and Chlamydia trachomatis infections in pregnant patients in the ED

Abstract

Study objectives: The purposes of this study were to (1) quantify the frequency of underrecognized Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infections in pregnant women tested in the emergency department (ED), (2) describe the characteristics of those not treated during the initial visit, and (3) determine how many pregnant women with acute cervicitis were lost to follow-up.

Methods: This was a retrospective, cohort analysis of consecutive women seen in the ED of 3 academic medical centers during a 36-month study period, with positive results for GC/CT. Our key outcome measures were the proportion of pregnant women being untreated in the ED, the time to subsequent treatment, and the proportion lost to follow-up.

Results: During the study period, 735 female patients had positive polymerase chain reaction study results for GC and/or CT; 179 (24%) were pregnant. Overall, 143 of these pregnant patients with cervicitis (80%) were not treated in the ED. Presenting symptoms included abdominal pain (71%), nausea (45%), vaginal discharge (35%), vaginal bleeding (34%), and urinary complaints (22%). The most common discharge diagnoses were vaginitis (37%), urinary infection (33%), threatened abortion (19%), nonspecific abdominal pain (9%), and rule-out ectopic pregnancy (6%). Of the 143 patients with sexually transmitted infection not treated in the ED, 114 (80%) were contacted by telephone and/or mail. Twenty-nine (20%) were subsequently lost to follow-up.

Conclusions: Further study is warranted to enhance point-of-contact testing and identify better mechanismsfor contact and follow-up after ED discharge and more liberal policies to treat less symptomatic patients empirically.