Attending Physician, Associate Professor of Pediatrics Children's Hospital of Philadelphia Children’s Hospital of Philadelphia Philadelphia, Pennsylvania, United States
Background: Emergency departments (ED) are a common site for the diagnosis of Neisseria gonorrhea (GC) and chlamydia trachomatis (CT) among adolescents. Pediatric EDs experienced an unprecedented decline in ED visits during the pandemic period. Hospital laboratories concentrated their efforts on ramping up SARS-CoV-2 testing early in the COVID-19 pandemic, resulting in a decrease in STI testing availability and delays in GC/CT test processing. Because of the inability to meet the testing demand, many healthcare facilities were forced to send these tests to outside laboratories for processing. Such procedures may have led to a lower rate of STI detection and treatment delays. We describe trends in STI testing, positivity and treatment at six institutions across the US.
Objective: To describe trends in STI testing, positivity and treatment at six institutions across the US.
Design/Methods: Sites in a national intervention study completed a survey in September 2020 regarding institutional changes in STI testing practices. Using the number of ED visits made by 15-21 year olds as the denominator, we measured rates of GC/CT tests ordered and GC/CT positivity from January-October 2020 across six EDs pre- and during the COVID19 pandemic using March 16, 2020 as the beginning of the US pandemic. Additionally, we compared time to treatment between these two periods.
Results: 50% (n=3) of sites reported restrictions, including sending STI tests out to other laboratories. From January- October 2020 there were 38,659 visits made by adolescents among the 6 EDs (5037 visits/month pre-pandemic vs. 3476 visits/month during pandemic; % change: -31%). During these visits, 3,150 underwent GC/CT testing (375/month pre-pandemic vs. 295/month during pandemic; % change: -21.3%). Of these, 597 tested positive for GC/CT (61.2/month pre-pandemic and 59.2/month during pandemic; % change: -3.3%). Of adolescents who tested positive for GC/CT, time to treatment did not differ between those pre-vs. during pandemic (p=0.14). Conclusion(s): Adolescent ED visits decreased by 30% during the pandemic. Although STI testing rates decreased by 21% during the pandemic, STI positivity rates remained similar. Decrease in rates of STI testing may have substantial impact on the health not only of the individuals affected, but also on the community at large, as there may be increased community spread with underdiagnosed and undertreated GC/CT infection. This has important policy implications for prioritizing manufacture and distribution of STI testing and laboratory supplies.
Authors/Institutions: Nadia Dowshen, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States; Jennifer L. Reed, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States; Theron C. Casper, University of Utah, Salt Lake City, Utah, United States; Erin M. Augustine, Lurie Children's Hospital, Chicago, Illinois, United States; Andrea T. Cruz, Baylor College of Medicine, Houston, Texas, United States; Cynthia Mollen, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States; Michelle L. Pickett, Medical College of Wisconsin, Milwaukee, Wisconsin, United States; Sarah Schmidt, University of Colorado School of Medicine, Aurora, Colorado, United States; Kristin Stukus, Nationwide Children's Hospital, New Albany, Ohio, United States; Cara L. Elsholz, University of Utah, Salt Lake City, Utah, United States; Krista Ellis, University of Utah, Salt Lake City, Utah, United States; Monika K. Goyal, Children's National Medical Center, Bethesda, Maryland, United States