68 - Poor Compliance to CDC’s STI Treatment Guidelines 2020 among Adolescents in the Pediatric Emergency Department

Poster Number: 68
Publication Number: 68.408

Marc Berenson, Rutgers New Jersey Medical School, Newaark, NJ, United States; Robert J. Adrian, Rutgers New Jersey Medical School, Newark, NJ, United States; Daniel Pleskowicz, Rutgers New Jersey Medical School, Dumont, NJ, United States; Brianna Mendiola, Rutgers New Jersey Medical School, Paterson, NJ, United States; Megana Hedni, Rutgers New Jersey Medical School, Newark, NJ, United States; James Liebow, Rutgers New Jersey Medical School, Newark, NJ, United States; Kei U. Wong, Rutgers University- NJMS, Newark, NJ, United States

Background: Chlamydia (CT) and gonorrhea (NG) are the most common reportable sexually transmitted infections (STIs) in the United States and rates have been rising among adolescents over the last decade. In 2020, the CDC released updated guidelines recommending a single 500mg IM dose of ceftriaxone and concurrent treatment with twice-daily 100mg PO doxycycline for a week replacing azithromycin single-dose. These changes raise concerns about adherence among adolescents given a baseline prescription fill rate of 58% in this age-group who were prescribed STI treatment from the emergency department.

Objective: The objective of our study was to determine if medical providers are following CDC’s STI treatment guidelines 2020 in the pediatric emergency department (PED).

Design/Methods: We conducted a retrospective, structured chart review for patients aged 13-21 who presented to the PED and were found to have positive GC or CT PCR tests from 2/1/2021-7/31/2021. The primary outcome was complete adherence with guideline-recommended care for treatment of GC/CT infection. Exclusion criteria included pregnancy, penicillin allergy, or prisoners/wards of the state, and those who declined treatment, were treated for presumed PID, or required admission. Abstractors followed a coding guide with quality assurance checks on 10% of reviewed charts. We calculated a sample size of 85 charts, enrolled 77 and excluded 21 patients. Data was analyzed using descriptive statistics such as means and proportions.

Results: Fifty-six charts were included for analysis, with an average age of 18.6 (SD=1.77, range=13-21). Sixty-four percent were female, 79% were black, 71% were uninsured, and 96% were seen by a physician. Forty-five cases (80%) tested positive for CT and 19 (34%) tested positive for GC, with 8 (14%) testing positive for both. While at least partial empiric treatment at the index visit occurred in 70% (39/56), 95% CI [56, 80], only 54% (30/56),  95% CI [40, 66] fully adhered to CDC recommendations. Of those treated, four (8%) did not receive the correct dose and/or duration of medications. Eleven patients with CT and one patient with NG never received the correct treatment for their specific disease in the ED.Conclusion(s): There is a significant gap in provider adherence with the CDC guidelines and a missed-opportunity for intervention among adolescents in our sample. Future efforts should focus on determining the underlying causes for non-adherence to guidelines by providers and evaluating whether or not patients are adherent to doxycycline for the treatment of common STIs.