Background: Undiagnosed sexually transmitted infections (STIs) can complicate pregnancy and may have serious consequences for both the young woman and the developing fetus. The aim of this study was to evaluate the frequency of screening and treatment of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC), and Trichomonas vaginalis (TV) in newly diagnosed pregnant adolescents presenting to the emergency department (ED).
Methods: This was a retrospective cohort analysis of all adolescent females (ages 12-19 years) initially diagnosed as pregnant in the ED. The data was reviewed from seven EDs in Michigan between 2007-2017. Affiliated institutions included three rural centers, three university-affiliated hospitals and a children’s tertiary care facility. Demographics, clinical and laboratory findings and treatment were obtained from ED records using an honest broker system. Outcome measures were the proportion of newly pregnant females screened for STIs, incidence of STIs in these patients, and the proportion treated in ED or on follow up. Descriptive statistics were used to describe the demographic variables and clinical findings.
Results: A total of 116,531 consecutive adolescents presented to the ED during the study period; 2312 (1.9%) had positive pregnancy tests in the ED and met the inclusion criteria. The mean age was 17.8 ± 1.3 years; 336 patients (14.5%) were 16 years of age or younger. Of the newly diagnosed pregnant patients, 1133 (49.0%) had a pelvic examination in the ED and 1042 (45.1%) adolescents were screened for STIs. A total of 215 (20.6%) had at least STI. The most common infections were CT (65.1%), Trichomonas (32.6%) and GC (15.3%). Of the 187 patients who had either GC or CT, only 60 (32.1%) were treated empirically in the ED. Of the 127 pregnant patients with STI, left untreated in the ED, 103 (81.1%) were able to be contacted either by telephone or mail. The remaining 24 patients (18.9%) were lost to follow-up.
Conclusion: More than 50% of adolescents diagnosed as pregnant in the ED were not tested for STIs. Of the patients that were screened, 21% had at least one infection. Only 32% of adolescents found to have either GC or CT, were treated empirically in the ED. Further study is warranted to assess point-of-contact testing, identify better mechanisms for follow-up after ED discharge, and more liberal policies for empiric treatment.