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Adherence to CDC Guidelines for mpox Evaluation: Practice Patterns Across an Academic Medical System During the 2022
William M Garneau1, Joyce L Jones2, Gabriella M Dashler3
1Department of Medicine/Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Open Forum Infectious Diseases
|September 26, 2024
Summary
Mpox testing and care varied by clinic. Infectious disease (ID) clinics provided more thorough evaluations, including sexual history and STI testing, compared to emergency departments or primary care. Standardizing care is crucial for optimal patient outcomes.
Area of Science:
- Infectious Diseases
- Public Health
- Clinical Medicine
Background:
- The 2022 mpox outbreak saw patients seeking care at diverse clinical settings.
- Variations in clinical practice patterns across different healthcare venues were hypothesized.
Purpose of the Study:
- To investigate differences in mpox evaluation practices across various healthcare settings.
- To assess the documentation rates of sexual history, anogenital examination, and sexually transmitted infection (STI) testing.
- To determine the association between venue of care and the completeness of patient evaluation.
Main Methods:
- An observational study included 276 patients tested for mpox between June 1 and December 15, 2022.
- Data were stratified by venue of care: emergency department (ED), infectious disease (ID) clinic, or primary care (PCP).
- Concomitant STI testing, sexual history, and anogenital examination were assessed as a composite outcome.
Main Results:
- Over half (62.7%) of patients were evaluated in the ED.
- ID clinics demonstrated higher rates of documented sexual history, anogenital examination, and STI testing compared to ED and PCP settings.
- Mpox patients had a 20.4% STI coinfection rate, with syphilis being the most common (17.5%).
- Patients in ID clinics had significantly higher odds of receiving a complete evaluation (aOR, 3.6).
- Certain demographic groups, including men who have sex with men and transgender individuals, were more likely to receive a complete evaluation (aOR, 4.0).
Conclusions:
- Clinical care for suspected mpox varied significantly across different healthcare venues.
- Infectious disease clinics provided more comprehensive evaluations for mpox patients.
- High rates of STI coinfection underscore the importance of thorough STI screening.
- Standardizing evaluation protocols across all clinical sites is essential for ensuring equitable and optimal patient care during mpox outbreaks.
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