Emergency Department Diagnosis and Treatment of Sexually Transmitted Diseases -

Emergency Department Diagnosis and Treatment of Sexually Transmitted Diseases
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Publication Date: April 2019 (Volume 21, Number 4)

No CME for this activity


Camiron L. Pfennig-Bass, MD, MHPE
Associate Professor, Emergency Medicine Residency Director, University of South Carolina School of Medicine Greenville; Department of Emergency Medicine, Prisma Health-Upstate, Greenville, SC
Elizabeth Page Bridges, MD
Clinical Assistant Professor, Assistant Clerkship Director, University of South Carolina School of Medicine Greenville; Department of Emergency Medicine, Prisma Health-Upstate, Greenville, SC

Peer Reviewers

Joelle Borhart, MD, FACEP, FAAEM
Associate Program Director, Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Georgetown University & Washington Hospital Center, Washington, DC
James Castellone, MD, MBA, FACEP, CHCQM
Vice Chairman, Department of Emergency Medicine, Eastern Connecticut Health Network, Manchester, CT
Sexually transmitted diseases are a growing threat to public health, but are often underrecognized, due to the often nonspecific (or absent) signs and symptoms, the myriad diseases, and the possibility of co-infection. Emergency clinicians play a critical role in improving healthcare outcomes for both patients and their partners. Optimizing the history and physical examination, ordering appropriate testing, and prescribing antimicrobial therapies, when required, will improve outcomes for men, women, and pregnant women and their babies. This issue reviews the latest evidence in the diagnosis and treatment of sexually transmitted diseases, focusing on efficient and safe strategies to optimize outcomes.
Excerpt From This Issue

You are getting close to the end of your busy shift, but you have time to pick up 1 more low-acuity patient triaged with the chief complaint of urinary tract infection. On review of her chart, you note reassuring vital signs, with a blood pressure of 120/63 mm Hg; heart rate of 71 beats/min; respiratory rate of 18 breaths/min; oxygen saturation of 100% on room air; and temperature of 37°C (98.6°F). Nurse triage note states: “Patient presents today with 3 weeks of dysuria, urinary frequency, and lower abdominal pain despite a full course of nitrofurantoin prescribed by a local urgent care clinic, followed by a full course of ciprofloxacin prescribed by her primary care provider.” When you examine the patient, she claims mild improvement in her symptoms 2 days prior, but now has persistent dysuria again. Initial physical exam is positive only for mild suprapubic discomfort with palpation. Urinalysis is notable for negative pregnancy test, small leukocyte esterase, and negative nitrite. You wonder whether to prescribe a third antibiotic and send a urine culture, or if there is something else you should be considering . . .

Just as you are walking out of the first patient’s room, you are called urgently to the room of a 50-year-old man who is agitated, aggressive, and profoundly tachycardic. The patient had been brought in by family for a “psychiatric eval.” His family reports a history of worsening bizarre behaviors, staying up all night, and hallucinations. These symptoms have been worsening over several weeks, but they brought him to the ED tonight after his brother realized that he had not slept in 3 days. The family is unaware of any recent fevers or infectious symptoms. They are also unaware of any recent alcohol or drug use, but his brother notes that he had a “wild” youth. The family is unaware of any history of psychiatric illness. On exam, the patient appears disheveled and is fidgeting frequently. He appears to be responding to internal stimuli. He is oriented to person only and states that he is not sure why his family brought him to the ED. He is able to recall 0 of 3 objects at 5 minutes. He denies recent drug or alcohol use, and there are no track marks visible on his arms. He has an ataxic gait and diminished reflexes in his lower extremities. You decide to pursue further medical evaluation before calling psychiatry. Basic metabolic panel and CBC are unremarkable. A CT scan shows mild atrophy, but no acute findings. You decide to perform a lumbar puncture for evaluation and wonder if there are any specialized tests you should consider…


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