Pediatric Emergency Department Testing for Gonorrhea and Chlamydia in Children

Area of Science:

• Pediatric Emergency Medicine
• Infectious Diseases
• Clinical Diagnostics

Background:

• Guidelines recommend Nucleic Acid Amplification Testing (NAAT) over genital culture for diagnosing gonorrhea and chlamydia in children.
• This is particularly relevant for children evaluated for sexual abuse or presenting with genitourinary (GU) symptoms.

Purpose of the Study:

• To describe trends in NAAT and culture utilization for gonorrhea and chlamydia testing in US pediatric emergency departments.
• To analyze testing patterns based on patient sex and diagnostic indications (maltreatment vs. GU symptoms).

Main Methods:

• A multicenter study analyzed data from 36,312 pediatric visits (ages 1-11) between 2004 and 2018.
• Included patients with maltreatment concerns and/or GU symptoms, utilizing the Pediatric Health Information System.
• Primary outcome was the prevalence of NAAT, culture, or combined testing, analyzed by sex and diagnosis.

Main Results:

• NAAT-only testing increased substantially for both girls (49.3% to 94.3%) and boys (54.5% to 96.1%) (P < 0.001).
• Culture-only testing decreased significantly for girls (40% to 1.6%) and boys (38.7% to 0.8%) (P < 0.001).
• Dual testing (NAAT and culture) was more common in children with maltreatment diagnoses than GU symptoms (P < 0.001).

Conclusions:

• A significant shift from culture to NAAT for gonorrhea and chlamydia testing in pediatric EDs was observed over 14 years.
• This trend suggests adherence to evidence-based guidelines for STI diagnosis in children.
• A notable proportion (~10%) of children with maltreatment concerns still received culture testing, potentially due to concerns about NAAT accuracy, legal admissibility, or availability.