Health care access and follow-up of chlamydial and gonococcal infections identified in an emergency department

Background: We examined 2 potentially important factors influencing successful treatment of Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (GC) infections identified in an emergency department (ED), health care coverage and reporting the ED as a primary source for health care. Methods: Adult patients aged 18 to 35 years attending an urban ED were screened for Ct and GC. Patients testing positive were contacted by Disease Intervention Specialists and notified of their infection status. Analyses focus on infected patients for whom we have treatment and follow-up information. We used generalized linear models with log link and binomial error distribution to estimate risk ratios (RRs) and 95% confidence intervals (CI). Results: Of 5537 patients screened in the ED, 348 (6.3%) tested positive for Ct, 143 (2.6%) tested positive for GC, and 43 (0.8%) tested positive for both. Overall, 20% of infected patients did not receive treatment. Among infected patients with no health care coverage 25% (n ≤ 56) were untreated compared with 15% (n ≤ 47) of patients reporting health care coverage (RR: 1.7, 95% CI: 1.2-2.3). Among patients reporting the ED as a primary source for health care 26% (n ≤ 27) were untreated compared with the 18% (n ≤ 77) reporting receiving health care from non-ED sources (RR: 1.4, 95% CI: 1.0-2.1). Conclusions: EDs often serve as primary care sites for difficult-to-reach populations. We were able to successfully locate and treat the greater part of ED-identified infections. However, one-fifth of infected patients did not receive treatment. ED-based screening programs can benefit from integration with local public health infrastructure to improve notification and treatment services.