Washington, DC—Nearly half of patients diagnosed with sexually transmitted infections (STIs) each year are adolescents. Yet among those who received a diagnosis and a prescription at an emergency department (ED), more than 40% never get their drugs, according to a new study.

That is especially disturbing, according to a research letter in JAMA Pediatrics, because untreated sexually transmitted diseases in women can cause pelvic inflammatory disease (PID) and potentially complicate future pregnancies.

“We were astonished to find that teenagers’ rates of filling STI prescriptions were so low,” explained senior author Monika K. Goyal, MD, MSCE, assistant chief of Children’s Division of Emergency Medicine and Trauma Services at Children’s National Health System here. “Our findings demonstrate the imperative need to identify innovative methods to improve treatment adherence for this high-risk population.”

The retrospective cohort study was conducted at two emergency departments affiliated with a large, urban, tertiary care children’s hospital. Participants were adolescents aged 13 to 19 years who were prescribed antimicrobial treatment from January 1, 2016, to December 31, 2017, after being diagnosed with PID or testing positive for chlamydia.

During the study period, there were 696 ED visits with diagnosed STIs. Of these, 208 patients received outpatient prescriptions for antimicrobial treatment for cervicitis/urethritis (n = 65; 31.2%) or PID (n = 143; 68.8%). Yet, only 57.7% (95% CI, 50.9-64.5) of the prescriptions were filled. Researchers determined that the only factor associated with prescription filling was hospital admission (73.7% vs. 54.1%; adjusted odds ratio, 2.3; 95% CI, 1.0-5.0). 

“Teenagers may face a number of hurdles when it comes to STI treatment, including out-of-pocket cost, access to transportation and confidentiality concerns,” Goyal explained.

“The proportion of prescriptions filled for the treatment of STIs among adolescents diagnosed in the pediatric ED was low. Hospital admission was associated with prescription filling,” study authors conclude. “Future studies should strive to understand the barriers underlying prescription filling to aid the development of targeted, ED-based interventions to promote STI-related treatment adherence.”

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