When young women visit the emergency room complaining of symptoms that mirror those of a sexually transmitted disease, many aren't tested for a possible infection — unless the young woman happens to be African-American, that is, provocative new research shows.
Uninsured young women often rely on emergency rooms as their main source of medical care, and missing an STD diagnosis could have severe consequences for them and their sexual partners, say doctors who conducted two separate studies recently presented at a meeting of the Pediatric Academic Societies. Untreated conditions such as chlamydia can lead to pelvic inflammatory disease and infertility, as well as undermine public health efforts.
However, young African-American women and girls who show up in the ER are far more likely to have their sexual histories taken and to be tested for STDs than young Caucasian women and girls, researchers say. (Researchers did not specifically study rates of STD testing in Hispanic or Asian young women.)
Dr. Carolyn K. Holland, a pediatric emergency room specialist at Cincinnati Children’s Hospital, studied the hospital's records of 293 patients aged 13 to 21 with abdominal, urinary or gynecological symptoms that could indicate an STD. The records, from 2010, revealed that 71.3 percent of young black women were tested, compared to only 18.6 percent of young Caucasian women.
Overall, young black women had a 2.6 times greater chance of having their sexual history documented on medical records. Of those who said they were sexually active, 87 percent were tested for STDs, but only 58 percent of young Caucasian women who said they had sex were tested.
Even young black women who said they did not have sex were tested, and at far higher rates than whites: 30 percent compared to 2 percent.
'Troubling' disparities
The disparities are "troubling," Holland told msnbc.com. Any bias, even if unconscious — in this case, the presumption that young black women are more promiscuous than whites or more likely to lie about sex — can cause doctors to miss a diagnosis.
“Everybody should have their sexual history collected,” Holland said. “My practice now is that if you are sexually active and come in with a complaint — urinary, vaginal — yes, I am testing you.”
Holland said, “many do not have primary care doctors; an ER visit might be the only time they can get tested.”
The importance of checking a young patient's sexual history in the ER is underscored by researchers at Children’s Hospital of Philadelphia. In the other study,Dr. Monika Goyal, a pediatric emergency room physician, examined the records of 236 teenage girls, ages 14 to 19, all of whom had come into her hospital’s ER with symptoms that could indicate an STD. Of those that were tested, 26.3 percent turned up positive for an infection, sometimes more than one.
In past research, Goyal has found that taking a sexual history and being tested “were significantly associated with race and insurance status,” she said. “Patients who did not have private insurance [relying on programs like Medicaid or who were uninsured] were more likely to be tested."
ER doctors can be uncomfortable asking young patients about sex, especially when a parent is hovering nearby. In some states, the doctor can insist the parent leave the room so she can have a private chat with the young patient about sex or drug use, but not in all.
Ideally, school health centers, not ERs, should not function as STD screening locations, Goyal suggested. However, recently the U.S. House of Representatives voted to block funding allocated in the new health care reform law for school-based health centers.
“If there are all these barriers to accessing adolescent sexual health services, then do emergency departments need to provide them?” Goyal asked. “Because that’s where kids are coming.”
Brian Alexander is the author of the book “America Unzipped: In Search of Sex and Satisfaction," now in paperback.
