Emergency Department Diagnosis and Treatment of Sexually Transmitted Diseases

Points and Pearls Excerpt

• The CDC estimates that there are 20 million new sexually transmitted disease (STD) diagnoses each year, which presents not only a massive public health challenge, but $16 billion in direct costs to the healthcare system.
• Patients can present with multiple concurrent STDs. Avoid premature diagnostic closure and consider multiple simultaneous processes.
• Urinary tract infections and STDs can present similarly. Be sure to do a pelvic examination to avoid misdiagnosis.
• Chlamydia is the most common bacterial STD. The diagnostic test of choice is nucleic acid amplification testing (NAAT). Treat with azithro-mycin or doxycycline. See Table 3 for dosages.

Most Important References

• Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(Rr- 03):1-137. (Expert guidelines/systematic review)
• Torrone E, Papp J, Weinstock H. Prevalence of Chlamydia trachomatis genital infection among persons aged 14-39 years- -United States, 2007-2012. MMWR Morb Mortal Wkly Rep. 2014;63(38):834-838. (Expert guideline/systematic review)
• Schillinger JA, Gorwitz R, Rietmeijer C, et al. The expedited partner therapy continuum: a conceptual framework to guide programmatic efforts to increase partner treatment. Sex Transm Dis. 2016;43(2 Suppl 1):S63-S75. (Systematic review; 42 articles) 
• Centers for Disease Control and Prevention. 2018 National Notifiable Conditions (Historical). National Notifiable Diseases Surveillance System (NNDSS). Accessed March 10, 2019. (CDC website)
• Carter MW, Wu H, Cohen S, et al. Linkage and referral to HIV and other medical and social services: a focused literature review for sexually transmitted disease prevention and control programs. Sex Transm Dis. 2016;43(2 Suppl 1):S76-S82. (Systematic review; 33 studies)