High Frequencies of Negative Pretreatment Results Following Presumptive Antibiotic Treatment for Chlamydia and Gonorrhea
ABSTRACT INTRODUCTION: The purpose of this study was to determine the frequencies of negative test results among all patients aged 18 years and older receiving presumptive antibiotic treatment for chlamydia and/or gonorrhea at the Sexually Transmitted Disease Clinic of the Palm Beach County Health Department. The treatment algorithms were based on guidelines of the Centers for Disease Control and Prevention. METHODS: Clinic logs were retrospectively reviewed for a consecutive case series of all 1209 patients treated from November 1, 2007 to October 31, 2008. Urogenital specimens were collected and analyzed. Laboratory results were obtained from the Health Management System of the Palm Beach County Health Department. RESULTS: Of the 1209 patients, 556 (46%) were treated for chlamydia, 30 (2.5%) for gonorrhea, and 623 (51.5%) for both. The frequencies of negative results were 68% for chlamydia or gonorrhea, 70.9% for chlamydia, 86.6% for gonorrhea, and 65.2% for chlamydia + gonorrhea. CONCLUSIONS: These data indicate that implementation of the Centers for Disease Control and Prevention guidelines by the Sexually Transmitted Disease Clinic of the Palm Beach County Health Department results in presumptive treatment of more than two-thirds of patients with negative nucleic acid amplification test results for chlamydia, gonorrhea, or both. They also suggest the potential value of developing treatment algorithms to maximize treatment of patients with positive test results and minimize treatment of those with negative test results. One possible strategy to explore is the future utility of new testing and treatment methodologies in development.
- [Show abstract] [Hide abstract]
ABSTRACT: Patients attending sexually transmitted disease (STD) clinics are frequently screened for gonorrhea and chlamydial infection. To determine the efficiency of these screening efforts as a component of STD control, we evaluated treatment outcomes of patients with positive cultures who had not received presumptive treatment at their initial visit. To determine the treatment outcomes of patients screened for STDs who have positive test results. Retrospective chart review of the computerized medical record. Between January 1, 1994 and June 30, 1995, 24,823 patients were tested for gonorrhea, of whom 19.3% (4791) had positive cultures. Of patients with positive gonorrhea cultures, 564 (11.8%) had positive screening cultures and did not receive therapy at the time of evaluation. Similarly, screening chlamydial cultures were positive in 1539 (10.9%) of 14,162 patients screened for chlamydial infection. Forty-four percent (677) of these did not receive presumptive treatment for chlamydial infection at their initial visit. Overall, 20% of patients with positive cultures failed to return to the clinic for treatment within 30 days of screening. Of those who did return, 30% did so only after at least 2 weeks had elapsed. A substantial proportion of patients with positive screening tests for gonorrhea and chlamydial infection fail to comply with follow-up recommendations and thus are likely to remain infectious. Methods must be sought to enhance patient compliance with follow-up of test results and treatment if indicated.Sex Transm Dis 05/1997; 24(4):181-4. DOI:10.1097/00007435-199704000-00001 · 2.75 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Our goals were to determine the prevalence of chlamydial infection, to identify criteria for selective screening, and to compare the sensitivity of selective screening to presumptive treatment criteria in different clinical settings. A total of 5128 women enrolled in a cross-sectional study in public clinics in New Jersey. Univariate and multivariate methods of statistical analysis were used. The prevalence of chlamydia varied across type of public clinic and ranged from 8% to 15%. Selective screening criteria were developed for women attending each type of public clinic by use of risk factors significant in the multivariate analyses. A combination of young age and attending an urban clinic was highly predictive of chlamydia infection and identified a minimum of 85% of infected women in all public clinic settings. The use of presumptive treatment criteria identified 78% of infected women in sexually transmitted disease clinics but only 4% to 9% of infected women in other clinical settings. A chlamydia program that includes presumptive treatment of women attending sexually transmitted disease clinics and selective screening of women in other clinical settings where women are more likely to asymptomatic is a clinically appropriate and economically feasible approach to directing treatment of women with chlamydial infection.American Journal of Obstetrics and Gynecology 06/1996; 174(5):1527-33. DOI:10.1016/S0002-9378(96)70601-4 · 3.97 Impact Factor
- Sexually Transmitted Infections 01/2002; 77(6):397-8. · 3.08 Impact Factor