258 - Under the Radar: Evaluating Sexual Health Screening in Female Adolescents with Chronic Conditions Presenting to the Pediatric ED

Publication Number: 258.6785

Megan Lucas, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Rebecca Freese, University of Minnesota, Minneapolis, MN, United States; Kari Schneider, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States

Background: Sexual health history documentation and sexually transmitted infection (STI) testing are often insufficient in the pediatric emergency department (PED), with screening practices varying by patient population. Prior studies indicate inadequate screening within specific higher-risk groups (e.g. patients with mental health concerns), whereas other studies have shown differences by age, race, and insurance status. Research outside the PED shows that adolescents with chronic conditions (CCs) are as sexually active as their peers but may receive less sexual and reproductive care. Existing studies are frequently limited to specific conditions (e.g. sickle cell, renal disease, diabetes) and primarily focus on inpatient or outpatient settings. No studies have yet examined sexual history documentation or STI screening in PED patients with CCs.

Objective: This study aims to assess whether there are differences in the frequency of sexual history documentation and STI screening among female adolescents with a known CC who present to the PED with abdominal pain or genitourinary (GU) complaints.

Design/Methods: Retrospective study of female patients aged 14-18 who presented to our tertiary care PED from June 2014 to June 2019 with a chief complaint of abdominal pain or GU issue. Electronic medical records were reviewed for demographics, chief complaint, sexual history documentation, gonorrhea and chlamydia testing, and previously documented CCs (including but not limited to diabetes, solid organ transplant, gastrointestinal disease, and hematologic/oncologic disease). Proportions were calculated for frequencies, and logistic regression was used to evaluate sexual history documentation and STI screening as outcomes, with CC status as the primary predictor.

Results: 676 patient encounters were identified. 78 (11.5%) of these had a documented CC. After adjusting for age, patients with CCs were less likely to have sexual history documented (OR = 0.27, 95% CI: 0.16-0.47, p < 0.001), although there was no statistically significant difference in sexual activity reported between the groups. Patients with CCs were also less likely to be screened for chlamydia (OR = 0.28, 95% CI: 0.10-0.64, p = 0.01) and gonorrhea (OR = 0.28, 95% CI: 0.10-0.64, p = 0.01).

Conclusion(s): Adolescent females with CCs presenting to our PED with abdominal pain or GU complaints were significantly less likely to have a documented sexual health history and to undergo STI screening. Future efforts should focus on enhancing screening for all patients in this setting, with particular attention to addressing potential biases toward adolescents with CCs.