Clinical Factors Associated With Accurate Presumptive Treatment of Neisseria gonorrhoeae Infections in Men Who Have Sex with Men and Transgender Women

Abstract

Background Neisseria gonorrhoeae (N. gonorrhoeae) infections have increased among men who have sex with men and are high among transgender women. Presumptive treatment guidelines may lead to inaccurate treatments and possible antibiotic resistance. Using patient data from AIDS Healthcare Foundation sexually transmitted infection (STI) testing clinics in California and Florida, we identified clinical factors associated with accurate presumptive N. gonorrhoeae treatment. Methods Multivariable logistic regression analyses were conducted using patient visit data from 2013-2017. A sample of 42,050 patient encounters were analyzed. The primary outcome variable included accurate versus inaccurate presumptive treatment. Risk ratios were generated for particular symptoms, high risk sexual behavior, and history of N. gonorrhoeae. Results Twelve percent (5,051/42,050) of patients received presumptive N. gonorrhoeae treatment and 46% (2,329/5,051) of presumptively treated patients tested positive for N. gonorrhoeae infection. Patients presenting with discharge or patients presenting with dysuria were more likely to receive accurate presumptive treatment. Conclusion Providers should continue to follow The Centers for Disease Control and Prevention guidelines and consider presumptive N. gonorrhoeae treatment based on specific symptoms. As the STI epidemic continues to rise in the United States, along with increased antibiotic resistance, it is imperative to accurately test, diagnose, and treat populations at risk for N. gonorrhoeae and other STIs.

Findings From a Scoping Review: Presumptive Treatment for Chlamydia trachomatis and Neisseria gonorrhoeae in the United States, 2006–2021

“…All studies used data derived from electronic health records. Three of the 6 articles (50%) 11,14,16 focused primarily on men and the other 3 (50%) included both male and female patients. Four studies (66.7%) included sexual orientation as a variable of interest.…”

“…The majority of the studies consisted of retrospective studies (94.4%) with data extracted from the electronic health record, either via chart review (76.5%) or programmatic data extraction (23%). Analysis methods primarily included frequencies and χ 2 though one-third did include logistic regressions (33.3%) 9–14 . Studies primarily took place at academic medical sites.…”

“…Analysis methods primarily included frequencies and χ 2 though one-third did include logistic regressions (33.3%). [9][10][11][12][13][14] Studies primarily took place at academic medical sites. However, 4 studies did represent data exclusively from clinics primarily providing services related to sexually transmitted disease (22.2%).…”

“…However, 4 studies did represent data exclusively from clinics primarily providing services related to sexually transmitted disease (22.2%). 11,[14][15][16] All of the studies also required testing for CT and GC as part of the inclusion criteria. Only 2 studies (11.1%) 14,16 reported testing results by collection site.…”

“…The remaining studies (44.5%) were either neutral as to presumptive treatment recommendations 10,11,13 or argued for increased awareness and implementation of presumptive treatment. 9,12,17,18,25…”