Stracker Norberth, Williford Sarah L, Gilliams Elizabeth, Rives Sarah, Page Kathleen R, Hamill Matthew M, Greenbaum Adena, Schumacher Christina M
Division of Infectious Diseases.
From the Baltimore City Health Department.
Sex Transm Dis. 2023 May 1;50(5):265-273. doi: 10.1097/OLQ.0000000000001770. Epub 2023 Jan 13.
Prompt and appropriate treatment of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) is critical to prevent transmission and serious sequelae. The objectives were to determine the prevalence of CT/NG treatment completion and identify demographic, behavioral, and clinical factors associated with treatment completion at sexual health clinics in Baltimore City, Maryland.
Electronic health record data from patients diagnosed with CT/NG during 2018-2019 were analyzed. Treatment completion was defined as documentation of Centers for Disease Control and Prevention-recommended treatment ≤30 days after testing. Regression was used to assess differences in treatment completion across groups; analyses were stratified by birth sex.
Most of the 2426 male (86%) and 754 (72%) female patients diagnosed with CT/NG completed treatment in ≤30 days; 74% of male and 36% of female patients were treated same-day. Among 890 male patients not treated same-day, treatment completion was associated with other same-day antimicrobial treatments (adjusted prevalence ratio, 0.76 [95% confidence interval, 0.61-0.94]), longer test processing times (≥10 days; 0.78 [0.65-0.95]) infection at multiple anatomic sites (1.49 [1.25-1.76]), and patients with previous clinic visits (1.16 [1.03-1.31]). Among 483 female patients not treated same-day, treatment completion was associated with diagnosis year (2019 vs. 2018; 1.23 [1.05-1.43]) and residential addresses 2 to 5 miles (vs. <2 miles) from clinic (1.25 [1.02-1.53]). Demographic and behavioral characteristics were not associated with treatment completion.
Substantial proportions of male and female sexual health clinic patients did not complete treatment. Our findings underscore the need for implementation of highly sensitive and specific point-of-care (POC) CT/NG testing to improve treatment completion in this setting.
及时且恰当地治疗沙眼衣原体（CT）和淋病奈瑟菌（NG）对于预防传播及严重后遗症至关重要。目标是确定马里兰州巴尔的摩市性健康诊所中CT/NG治疗完成率，并识别与治疗完成相关的人口统计学、行为学和临床因素。
分析了2018 - 2019年期间诊断为CT/NG的患者的电子健康记录数据。治疗完成定义为疾病控制与预防中心推荐的治疗在检测后≤30天内记录在案。采用回归分析评估不同组间治疗完成情况的差异；分析按出生性别分层。
2426名男性和754名女性CT/NG诊断患者中，大多数（男性86%，女性72%）在≤30天内完成治疗；74%的男性患者和36%的女性患者在当天接受治疗。在890名未当天接受治疗的男性患者中，治疗完成与其他当天抗菌治疗相关（调整后的患病率比，0.76 [95%置信区间，0.61 - 0.94]）、检测处理时间较长（≥10天；0.78 [0.65 - 0.95]）、多个解剖部位感染（1.49 [1.25 - 1.76]）以及曾到诊所就诊的患者（1.16 [1.03 - 1.31]）有关。在483名未当天接受治疗的女性患者中，治疗完成与诊断年份（2019年与2018年相比；1.23 [1.05 - 1.43]）以及距离诊所2至5英里（与<2英里相比）的居住地址（1.25 [1.02 - 1.53]）有关。人口统计学和行为特征与治疗完成无关。
性健康诊所的男性和女性患者中有相当比例未完成治疗。我们的研究结果强调需要实施高度敏感和特异的即时检测（POC）CT/NG检测，以改善这种情况下的治疗完成情况。
