Monika K. Goyal
Among adolescent girls with pelvic inflammatory disease, screening rates for HIV and syphilis are low, according to findings published in Pediatrics.
“The majority of diagnoses of pelvic inflammatory disease (PID) among young women occur in the emergency room setting, rather than in primary care practices,” Monika K. Goyal, MD, MSCE, assistant professor of pediatrics and emergency medicine at George Washington University and director of research in the division of emergency medicine and trauma services at Children’s National Health System, told Infectious Diseases in Children. “However, our findings strongly suggest there is ample room for improvement.”
Pelvic inflammatory disease (PID) has been associated with an increased risk of contracting HIV and syphilis but “screening rates among adolescents have been understudied,” according to researchers. Goyal and colleagues conducted a retrospective cohort study to determine the frequency of HIV and syphilis screening among adolescents diagnosed with PID. The study included 10,698 girls aged 12 to 21 years who were diagnosed with PID and visited the ED for any reason. The study’s primary outcome was documentation of laboratory testing for HIV and/or syphilis.
According to the study, the mean age of the patients was 16.7 years, 70.5% were publicly insured and 54.2% were non-Hispanic black.
Despite an increase in HIV and syphilis testing observed from 2010 to 2015, only 22% underwent HIV screening (95% CI, 21.2-22.8), 27.7% underwent syphilis screening (95% CI, 26.9-28.6) and 18.4% were screened for both (95% CI, 17.6-19.1) during that time period. The researchers said screening rates varied by hospital, with anywhere from 2.6% to 60.4% for HIV and 2.9% to 62.2% for syphilis.
When compared with older adolescents, the researchers reported that patients aged 12 to 16 years were more likely to be screened for HIV (adjusted OR = 1.2; 95% CI, 1-1.3) and syphilis (aOR = 1.1; 95% CI, 1-1.3). Additionally, HIV screening was more likely to occur in non-Hispanic blacks (aOR = 1.4; 95% CI, 1.2-1.7) and nonprivately insured patients (aOR = 1.3; 95% CI, 1.1–1.5 for publicly insured patients and aOR = 1.6; 95% CI, 1.2-2 for uninsured patients). Goyal and colleagues observed a similar trend in syphilis screening, with nonprivately insured patients (aOR = 1.4; 95% CI, 1.2–1.6 for publicly insured patients and aOR = 1.6; 95% CI, 1.2-1.9 for uninsured patients), and non-Hispanic black adolescents (aOR = 1.8; 95% CI, 1.2-2.8) more likely to be tested. Moreover, patients whose visits resulted in an admission at smaller hospital — with equal to or less than 300 beds — were more likely to receive HIV screening (aOR = 7; 95% CI, 5.1-9.4), whereas the prevalence of syphilis screening among admissions was independent of hospital size (aOR = 4.6; 95% CI, 3.3-6.4).
Goyal and colleagues suggested that adolescents have lower testing rates than adults because of confidentiality concerns. Physicians may be unable to confidentially notify adolescent patients of their laboratory results after discharge from the ED, and they worry that parents and caregivers could be made aware of their STI testing through hospital or insurance bills.
“Young women come to the emergency room to be seen for a range of health conditions,” Goyal said. “The next phase of our research will explore which interventions are best suited for patients of this age in order to increase overall screening rates for HIV and syphilis among adolescents at risk for infection.” – By Marley Ghizzone
Disclosures: The authors report no relevant financial disclosures.