Department of Medical Microbiology, Maastricht University Medical Center, Care and Public Health Research Institute (CAPHRI), Maastricht, the Netherlands.
Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Heerlen, the Netherlands.
PLoS One. 2018 Mar 14;13(3):e0194351. doi: 10.1371/journal.pone.0194351. eCollection 2018.
For Chlamydia trachomatis (CT), a test of cure (TOC) within 3-5 weeks is not recommended. International guidelines differ in advising a Neisseria gonorrhoeae (NG) TOC. Retesting CT and NG positives within 3-12 months is recommended in international guidelines. We assessed TOC and retesting practices including extragenital testing in general practitioner (GP) practices located in different socioeconomic status (SES) areas to inform and optimize local test practices.
Laboratory data of 48 Dutch GP practices between January 2011 and July 2016 were used. Based on a patient's first positive CT or NG test, the proportion of TOC (<3 months) and retests (3-12 months) were calculated. Patient- and GP-related factors were assessed using multivariate logistic regression analyses.
For CT (n = 622), 20% had a TOC and 24% had a retest at the GP practice. GP practices in low SES areas were more likely to perform a CT TOC (OR:1.8;95%CI:1.1-3.1). Younger patients (<25 years) were more likely to have a CT TOC (OR:1.6;95%CI:1.0-2.4). For CT (n = 622), 2.4% had a TOC and 6.1% had a retest at another STI care provider. For NG (n = 73), 25% had a TOC and 15% had a retest at the GP practice. For NG (n = 73), 2.7% had a TOC and 12.3% had a retest at another STI care provider. In only 0.3% of the consultations patients were tested on extragenital sites.
Almost 20% of the patients returned for a CT TOC, especially at GP practices in low SES areas. For NG, 1 out of 4 patients returned for a TOC. Retesting rates were low for both CT (24%) and NG (15%), (re)infections including extragenital infections may be missed. Efforts are required to focus TOC and increase retesting practices of GPs in order to improve CT/NG control.
对于沙眼衣原体（CT），不建议在 3-5 周内进行治愈测试（TOC）。国际指南在建议淋病奈瑟菌（NG）TOC 方面存在差异。国际指南建议在 3-12 个月内对 CT 和 NG 阳性患者进行复查。我们评估了 TOC 和复查实践，包括在不同社会经济地位（SES）地区的全科医生（GP）实践中的外生殖器检测，以为当地的检测实践提供信息并进行优化。
使用了 2011 年 1 月至 2016 年 7 月期间 48 家荷兰 GP 诊所的实验室数据。根据患者首次 CT 或 NG 阳性检测结果，计算 TOC（<3 个月）和复查（3-12 个月）的比例。使用多变量逻辑回归分析评估患者和 GP 相关因素。
对于 CT（n=622），20%的患者在 GP 诊所进行了 TOC，24%的患者进行了复查。SES 较低地区的 GP 诊所更有可能进行 CT TOC（OR：1.8；95%CI：1.1-3.1）。年轻患者（<25 岁）更有可能进行 CT TOC（OR：1.6；95%CI：1.0-2.4）。对于 CT（n=622），2.4%的患者在另一家性传播感染（STI）护理提供者处进行了 TOC，6.1%的患者进行了复查。对于 NG（n=73），25%的患者在 GP 诊所进行了 TOC，15%的患者进行了复查。对于 NG（n=73），2.7%的患者在另一家 STI 护理提供者处进行了 TOC，12.3%的患者进行了复查。在只有 0.3%的就诊中，患者在外生殖器部位进行了检测。
近 20%的患者返回进行 CT TOC，尤其是在 SES 较低地区的 GP 诊所。对于 NG，4 名患者中有 1 名返回进行 TOC。对于 CT（24%）和 NG（15%），复查率均较低，可能会漏诊包括外生殖器感染在内的再感染。需要努力使全科医生专注于 TOC，并增加复查实践，以改善 CT/NG 的控制。
