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Objective: History and physical examination findings can be unreliable for prediction of genitourinary tract infections and differentiation of urinary tract infections from sexually transmitted infections (STIs). The study objective was to develop a prediction tool to more accurately identify patients with STIs.Methods: A retrospective review of 64,490 emergency department (ED) encounters between April 18, 2014, and March 7, 2017, where patients age 18 years or older had urinalysis and urine culture or testing for gonorrhea, chlamydia, or trichomonas, was used to develop a prediction model for men and women with Neisseria gonorrhoeae or Chlamydia trachomatis, or both, and for women with Trichomonas vaginalis. The data set was randomly divided into two-thirds discovery and one-third validation. Groups were assigned through a random number generator. Backward step regression modeling was used to identify the best model for each outcome.Results: With use of age, race, marital status, and findings from vaginal wet preparation (white blood cells [WBCs], clue cells, and yeast) and urinalysis (squamous epithelial cells, protein, leukocyte esterase, and WBCs), the models had areas under the receiver operating characteristic curve of 0.80 for men with N gonorrhoeae or C trachomatis, or both; 0.75 for women with N gonorrhoeae or C trachomatis, or both; and 0.73 for women with T vaginalis.Conclusions: The model estimated likelihood of ED patients having STIs was reasonably accurate with a limited number of demographic and laboratory variables. In the absence of point-of-care STI testing, use of a prediction tool for STIs may improve antimicrobial stewardship. [ABSTRACT FROM AUTHOR]

Introduction: Prostatitis is one of the most common urologic diseases in ambulatory patients. However, prostatitis data are limited from the emergency department (ED) setting.Methods: A data set was examined of patients age 18 years or older who received urinalysis and urine culture or were tested for gonorrhea, chlamydia, or trichomonas in the ED from a health care system in northeast Ohio.Results: Of 19,308 ED encounters of male patients, 77 encounters (0.4%) involved the diagnosis of prostatitis. Men with prostatitis were younger (52.4 vs 66.3 years), were less likely to be hospitalized (27.3% vs 43.1%), had shorter clinical encounters (1336.5 vs 3019.3 min), and were less likely to arrive by emergency medical services or police (6.5% vs 45.5%) than men diagnosed with urinary tract infection (UTI) without prostatitis (n = 2527) (P ≤ .007 for all). Of the men with urinalysis, those with prostatitis had less bacteria (0.9+ vs 1.8+), blood (0.9+ vs 1.5+), glucose (4.0% vs 13.0%), leukocyte esterase (0.9+ vs 2.3+), nitrite positive (8.0% vs 21.4%), protein (0.5+ vs 1.2+), squamous epithelial cells (0.6 vs 1.7 per high-power field [HPF]), red blood cells (18.3/HPF vs 29.5/HPF), and white blood cells (31.6/HPF vs 57.6/HPF) than men diagnosed with UTI and no prostatitis (P ≤ .005 for all). Escherichia coli was the most common bacterium growing in the urine (58.8%; n = 10) and the blood (100.0%; n = 2) of men with prostatitis; however 73.0% (n = 17) of urine cultures and 90.9% (n = 22) of blood cultures had no bacterial growth. Of 77 patient encounters with prostatitis, 16 (20.8%) underwent testing for Neisseria gonorrhoeae and Chlamydia trachomatis and 3 (3.9%) for Trichomonas vaginalis. Of those tested, only 1 person was infected, with C trachomatis.Conclusion: Prostatitis was uncommonly diagnosed in men undergoing urinalysis and urine culture or testing for sexually transmitted infections in the ED. [ABSTRACT FROM AUTHOR]

Demographic characteristics, risk factors, and clinical variables associated with gonorrhea and chlamydial infection in women being treated in emergency departments (EDs) in the United States are incompletely characterized. We used univariable and multivariable regression analyses on 17,411 encounters from women 18 years and older who presented to EDs in northeast Ohio and were tested for gonorrhea or chlamydial infection. There were 1,360 women (7.8%) who had Chlamydia trachomatis infection and 510 (2.9%) who had Neisseria gonorrhoeae infection. Those infected with C. trachomatis or N. gonorrhoeae were younger (23.8 vs. 29.2 years), unmarried (97.7% vs. 90.1%), Black (93.3% vs. 88.0%), infected with Trichomonas vaginalis (39.9% vs. 27.2%), diagnosed with urinary tract infection (15.7% vs. 10.6%), and treated for gonorrhea and chlamydial infection during the ED visit (31.6% vs. 17.4%) (all p s <.001). Women infected with C. trachomatis or N. gonorrhoeae had more urine white blood cells (WBCs) (23.9 vs. 16.4 cells per high-power field [HPF]) and leukocyte esterase (1.2+ vs. 0.8+) on urinalysis. They had more WBCs (18.5 vs. 12.4 cells/HPF) and odds of having T. vaginalis infection (12.8% vs. 8.2%) on vaginal wet preparation (all p s <.001). Women infected with C. trachomatis were more likely to be younger and not Black; they were less likely to be treated for gonorrhea and chlamydial infection in the ED and to have lower levels of urine WBCs, leukocyte esterase, and blood than those infected with N gonorrhoeae (all p s ≤.05). [ABSTRACT FROM AUTHOR]