Almost Half of Adolescents Dont Fill Prescriptions for STIs Diagnosed in ED

More than 40% of adolescents diagnosed with sexually transmitted infections (STIs) in an emergency department did not fill antibiotic prescriptions for the treatment of those infections, according to a new research letter.

The research letter, published in JAMA Pediatrics, highlighted a retrospective medical record review of visits to 2 emergency departments in Washington DC in 2016-2017 involving adolescents ages 13 to 19 years. It identified 696 ED visits during which STIs were diagnosed, resulting in 208 prescriptions for Chlamydia trachomatis (CT) cervicitis/urethritis or pelvic inflammatory disease (PID).

The study determined that 54.1% of adolescents filled their prescriptions.

“We were surprised by how few teenagers fill prescriptions they were given after STI diagnosis, and this underscores the importance of eliminating barriers that may hinder treatment adherence in this high-risk group,” the study’s senior author Monika K. Goyal, MD, MSCE, assistant chief of Children’s Division of Emergency Medicine and Trauma Services told Contagion^®.

The majority of the patients included in the review were female (92.8%), and 18% were admitted to the hospital for treatment of PID. The patients in the study also were predominantly non-Hispanic black (84.1%), and publicly insured (81.6%). Prescriptions were more likely to be filled among those who were admitted to the hospital and those diagnosed with PID.

The next steps for investigators will be conducting interviews with adolescents to explore barriers to treatment adherence, Goyal said. Things to consider include costs, access to transportation and confidentiality.

“We as clinicians, health care systems and society need to do more to improve the health of adolescents,” Goyal told Contagion^®. “We need to provide more education about safer sex practices and need to create access for youths to free and confidential sexual health services.”

The research letter noted that nearly half of all diagnosed STIs annually are among adolescents, and those diagnoses are often made in emergency departments.

Sexually transmitted diseases have increased sharply in recent years, with more than 2.3 million cases of chlamydia, gonorrhea, and syphilis diagnosed in the US in 2017, according to an analysis by the US Centers for Disease Control and Prevention. That represents a 31% increase from 2013.

A report published in 2017 suggested that STIs are often over- or under-treated, raising concerns about antibiotic resistance. That study found that when comparing emergency department visits from 2008-2010 with those from 2011-2013, prescriptions for azithromycin and ceftriaxone increased more than 80% in visits with an STI diagnosis and doxycycline prescriptions increased 24%.

A study released last year found that only 81% of patients infected with uncomplicated gonorrhea received the recommended treatment designed to ward off drug resistance, which includes 2 antimicrobials.