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The indolent nature of chlamydia and gonorrhoea, along with the time delay associated with current diagnostic testing, makes definitive diagnosis while in the emergency department impossible. We therefore sought to determine the proportion of patients who receive accurate, presumptive antimicrobial treatment for these infections. A retrospective chart review was performed on all patient encounters that underwent chlamydia and gonorrhoea testing at an urban emergency department during a single month in 2012. Each encounter was reviewed for nucleic acid amplification test results and whether presumptive antibiotics were given during the initial visit. A total of 639 patient encounters were reviewed; 87.2% were female and the mean age was 26.7 years. Chlamydia was present in 11.1%, with women and men having similar infection rates: 10.6% vs. 14.6% (p = 0.277). Gonorrhoea was present in 5.0%, with a lower prevalence among women than men: 3.2% vs. 17.1% (p < 0.001). Women received presumptive treatment less often than men: 37.7% vs. 82.9% (p < 0.001). Presumptive treatment was less accurate in women than men: 7.9% vs. 25.6% (p < 0.001). After combining genders, 10.2% received accurate presumptive treatment; 33.3% were overtreated and 4.4% missed treatment. Presumptive treatment for chlamydia and gonorrhoea was more frequent and more accurate in men than in women. Overall, one-third of patients received unnecessary antibiotics, yet nearly 5% missed treatment. Better methods are needed for identifying patients who need treatment.

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Study Objectives: The 2010 Centers for Disease Control guidelines recommend presumptive treatment of Neisseria gonorrhea and Chlamydia trachomatis for men with urethritis and women with cervicitis who are at increased risk for sexually transmitted infection (STI) and in whom reliable follow-up cannot be ensured. We sought to compare the proportion of men and women tested for STI that accurately received presumptive antimicrobial treatment.Methods: A retrospective chart review was performed on 639 patient encounters that underwent both gonorrhea and chlamydia nucleic acid amplification testing (NAAT) during a single month in July of 2012 at an urban Level 1 trauma center emergency department. Each encounter was reviewed for NAAT result, if presumptive treatment was rendered and the accuracy of treatment. Presumptive antimicrobial treatment was considered accurate if a NAAT result was positive and appropriate antimicrobial treatment was rendered. Wilcoxon signed-rank test was used to compare average age of men and women tested. Chi-square and Fisher's exact tests were used to compare the proportion of men and women with positive NAAT result, those provided presumptive treatment, and the accuracy of those treated.Results: There were 639 patient encounters reviewed. There were 82 (12.8%) men and 557 (88.9%) women. The average age of men was significantly older than women, 29.5 versus 26.3 years (P<.031). Gonorrhea was more prevalent among men, 17.1% (N¼14) versus 3.2% (N¼18) (P<.001). Chlamydia prevalence was not statistically different between men and women, 14.6% (N¼12) versus 10.6% (N¼59) (P¼.277). Men received presumptive treatment more frequently, 82.9% (N¼68) versus 37.7% (N¼210) (P<.001). Men were more frequently provided accurate presumptive treatment, 24.4% (N¼20) versus 7.7% (N¼43) (P<.001).Conclusion: Presumptive treatment for gonorrhea and chlamydia was more frequent and more accurate in men tested for STI when compared to women. Presumptive treatment may be more appropriate in men than in women. However, the significant morbidity associated with these diseases makes undertreatment concerning in women. Future studies should evaluate use of an accurate rapid assay or reliable follow-up system, which may allow for more accurate treatment in women.