The incidence of sexually transmitted infections (STIs) has increased during the last two decades in Europe.1 The Costa del Sol Hospital (HCS), located in southern Spain and serving a population of 404,000 inhabitants; has witnessed this increase in STI cases. There were 242 new cases in 2016 and 313 in 2017 including Herpes simplex virus (VHS), Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and syphilis, in spite of prevention and training campaigns on STIs. STIs are frequent in consultations of the emergency departments (ED)2 where they remain frequently undetected due to the lack of symptoms in many affected individuals or the failure to seek routine medical care.3 The medical history of patients with STIs referred to the Dermatology Unit of HCS revealed that the ED clinicians did not ask them about their sexual behaviour, and that their tests and treatments were often inappropriate. Therefore, an improvement of the management of STIs in ED interventions was needed.3 ED staff should be current STIs treatment guidelines described by the U.S. Center for Disease Control and Prevention (CDC) in their Sexually Transmitted Diseases Treatment Guidelines.

We conducted one-day training sessions on the management of STIs for all emergency health professionals who could attend, and a copy of the presentations and leaflets was provided for all computers in the emergency department. The training consisted of two parts: first, the main symptoms of each STI were explained, and the professionals were briefed on the type as well as the manner of asking questions in order to identify people at risk. The second part was focused on teaching how to choose the proper swab, complementary test, and empiric treatment if needed, in accordance to the CDC guidelines4 (Table 1). The briefing was accompanied with an information brochure (Table 2). A total of 301 patients for which urethral and cervical cultures had been performed at the ED of the centre between January 2016 and December 2017 were monitored (Table 3). In order to assess the impact of the training sessions, the medical history of these patients was retrieved in compliance with the Biomedical Research Law. The relevance of these tests was assessed with reference to the symptoms reported in the medical history. The suitability of prescribed empirical treatments and their effectiveness were checked for that both the microbiological isolates and the antibiogram matched the treatment. The statistical significance (p<0.05) of the observed differences between the data from both years, before and after the training, were analysed by means of a Chi-Square (SPSS v.15). Results are summarised in Table 3.

We could note how two training sessions on ED professionals significantly improved the management of STIs in the HCS. Our data show that, before the training sessions, ED professionals omitted asking questions about patients’ sexual behaviour and did not select a complementary test or treatment corresponding to their clinical suspicion. Similarly to what has been concluded in other works,5 the omission of sexual behaviour questions could account for the inappropriate testing6 or lack thereof7 and treatment of the infections particularly with STIs with symptoms similar to others diseases. After our training there was a global improvement. In 2017 ED professionals collected more information of sexual behaviour in the medical history and at the same time we observed an increase of the use of specific swabs without which certain infections would often remain without diagnosis. In addition some hospitals have set up a contact system for patients with a positive result of NG and CT who have not received proper treatment.8 This is implemented in our hospital, also including HVS and HIV. Consequently, the importance of having ED professionals use the proper swabs and request the proper STIs tests, lies in that it makes it possible to efficiently track the patient with these infections and prescribe an accurate treatment. The treatments recommended in the clinical guidelines for the management of STIs are not frequently followed by the emergency physicians.5 In our study, an improvement of the prescribed treatments was observed after training reaching a percentage, which fall in to the range reported in the literature. This general positive impact reflected in our results has also been observed in other studies on STI9 in other areas, like maternity, where training has been shown to play a crucial role in improving quality of care.10 In summary, the training has led to a significant improvement in the handling of symptomatic patients with STIs arriving to the ED in our hospital. These results could be consolidated if this procedure could be applied to a broader sample. We are therefore currently working in developing education of particularly exposed groups such as teenagers.