Article of the Week: STI Follow-up

by Kristen Breslin

In this article, the authors (from Cincinnati Childrens) looked at problems with STI treatment and notification in their pediatric ED. I wanted to share this article because the group developing the STI pathway has been discussing many of the same issues. 

The problems they found: 
1. High rates of STIs, including GC, chlamydia, and trich 
2. Only 70% of their patients were presumptively treated. Nearly one-third of the untreated patients with positive test results were lost to follow-up and were never informed or treated for their infection. 
3. Many adolescents were not notified of positive results. Notification of positive results, even if the patient has already been treated, may be more likely to change future behavior and can facilitate partner treatment. 

The interventions they trialed included: 
1. A designated follow up provider 
2. Obtaining a phone number from the adolescent for confidential test results and documenting it in the electronic chart 
3. Giving the patient a card ("patient activation card") explaining that test results were pending and asking them to call back in 3-4 days to get the results 

They found: 
1. Provider education did increase the documentation of confidential phone numbers, and this did improve notification and decrease loss-to-follow-up 
2. The patient activation card significant improved follow-up, especially during periods when fewer confidential phone numbers were documented. 

We continue to have problems reaching patients in follow-up, especially contacting the teenagers themselves to give STI results. 

Some things to think about for our ED as we work on the STI pathway: 
1. The CDC recommends presumptive treatment, without waiting for test results, for cervicitis/urethritis (vaginal or penile discharge) for anyone under 25 years old - the incidence of STIs in this age group makes them a high-risk group. 
2. In 2011, participants in the National Job Training Program (ages 16-24 years) were screened for STIs; among residents from the District of Columbia, the prevalence of chlamydia was >10% for both men and women.

Huppert, J.S., Reed, J.L., Munafo, J.K., et al. (2011). Improving Notification of Sexually Transmitted Infections: A Quality Improvement Project and Planned Experiment. Pediatrics, 130, e415-422.