Identifying a need for more focused treatment of chlamydia and gonorrhoea in the emergency department

Abstract

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.

Association of Marital Status in the Testing and Treatment of Sexually Transmitted Infections in the Emergency Department

“…Clinicians may need to provide empiric treatment for STIs in the emergency department (ED) because definitive STI testing results may not be available during the clinical encounter. Both overtreatment and undertreatment of STIs in the ED are common, and more accurate risk stratification for STIs in the ED could lead to better antibiotic stewardship 1 1 [2][3][4][5].…”

Descriptive Epidemiology of Women in the Emergency Department With Gonorrhea and Chlamydial Infection in the United States

“…Genitourinary concerns are common among women in the emergency department (ED) (Garlock et al, 2019; Goyal et al, 2016; Schneider, Fitzgerald, Byczkowski, & Reed, 2016; Shipman, Risinger, Evans, Gilbertson, & Hogan, 2018; Wilson et al, 2017). Symptoms of a urinary tract infection (UTI) can overlap with those of a sexually transmitted infection (STI), and at-risk individuals with genitourinary symptoms should be screened for both UTI and STI (Anaene, Soyemi, & Caskey, 2016; Schneider et al, 2016; Shapiro et al, 2005; Sheele et al, 2019; Wilson, Knych, Iordanova, Mahan, & Vohra, 2016; Wilson et al, 2017; Wilbanks, Galbraith, & Geisler, 2014). The Centers for Disease Control and Prevention recommends the use of nucleic acid amplification tests (NAATs) for the diagnosis of C. trachomatis , N. gonorrhoeae , and Trichomonas vaginalis infection (Workowski, Bolan, & Centers for Disease Control and Prevention, 2015).…”

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

“…However, this masks the heterogeneity found across the studies and care settings, which is important for demonstrating the true variability uncovered. The individual articles included in this review showed highly Breslin et al 10 Wilson et al 19 Holley et al 20 Huppert et al 21 Sheele et al 22 Garlock et al 13 Wilson et al 23 Burkins et al 24 Glasgow* et al 8 Positive among presumptive treatment is defined as those patients who received treatment at the time of encounter and were subsequently confirmed to be positive by laboratory testing. variable rates of presumptive treatment.…”

“…An informal thematic analysis was undertaken related to the conclusions and policy recommendations of the studies included in this review. A little more than half (55.5%) 8,[14][15][16][19][20][21][22][23][24] of the studies suggest that clinicians may be over treating patients for CT and GC, especially in light of antimicrobial resistance. These studies suggest advancements in POC testing would allow for identification of cases in a more timely manner.…”