Evaluation and management of sexually transmitted infections in adolescent males presenting to a pediatric emergency department: is the chief complaint diagnostic?

Objectives: The objectives of the study were to (1) describe evaluation and treatment patterns for adolescent males presenting with a concern for sexually transmitted infection (STI) in a pediatric emergency department, (2) assess the rates of STIs in symptomatic males, and (3) determine the utility of urinalysis alone in predicting STIs in adolescent males.

Methods: A retrospective cohort study was conducted of all patients presenting to our pediatric emergency department from January 1, 2007, to December 31, 2007. Inclusion criteria included males, aged 15 to 21 years, with an STI or urinary chief complaint. Exclusion criteria were referrals from pediatricians, a previous history of urinary tract infection or preexisting urologic condition, or primary complaint of scrotal and/or testicular pain.

Results: A total of 270 patients were identified. Testing included urinalysis with microscopy (UA) (64%), urine culture (53%), Neisseria gonorrhoeae (GC), and Chlamydia trachomatis (CT) (93%), and Trichomonas vaginalis (5%). Sixty-four percent of males tested positive for either GC or CT, or both. Overall, 91% of patients were treated for CT and GC, 18% for T. vaginalis, and 5% for urinary tract infection. The sensitivity and specificity of a positive UA for presence of GC and/or CT were 86% and 82%, respectively, whereas the positive and negative predictive values were 89% and 77%, respectively. There were no positive urine cultures in the cohort.

Conclusions: Sixty-four percent of patients were diagnosed with either GC or CT. Although UA is helpful in predicting STI, limited use is warranted, given the high prevalence of disease in this selected population. The urine culture does not appear to be a necessary adjunct in the management of these patients.