Presumptive and Follow-Up Treatment Associated With Gonorrhea and Chlamydia Testing Episodes in Sexually Transmitted Disease Clinics: Impact of Changing Treatment Guidelines for Gonorrhea, Sexually Transmitted Disease Surveillance Network, 2015-2018

Background: Centers for Disease Control and Prevention recommendation for treatment of uncomplicated gonorrhea (NG) were revised in December 2020 and include ceftriaxone monotherapy when chlamydial infection was excluded. We evaluated the impact of these revised treatment recommendations using data from a network of sexually transmitted disease (STD) clinics before the change in guidelines. Methods: We performed a cross-sectional analysis from 8 STD clinics participating in the STD Surveillance Network from January 2015 to June 2018 assessing NG/chlamydia (CT) testing episodes, nucleic acid amplification test results, CT only and NG/CT treatment records, and timing of treatment. We describe the frequency of NG and CT treatment practices and what proportion of patients treated would not have had to receive an antichlamydial agent. Results: Of 190,589 episodes that occurred during the study period, 67,895 (35.6%) episodes were associated with a treatment record consistent with NG or chlamydia (CT only [n = 37,530] or NG/CT [n = 30,365]), most (similar to 86%) were prescribed on the same-day as initial testing. Of the 67,895 episodes with corresponding treatment record(s), 42.1% were positive for either NG or CT compared with 3.7% were positive for NG or CT for those not associated with treatment records (n = 122,694 episodes). Among 30,365 episodes associated with NG/CT treatment records, monotherapy would only have been indicated for 10.1% (3081/30,365) of the episodes as they were treated on follow-up and were NG positive and CT negative. Conclusions: Treatment was prescribed in one-third of NG/CT testing episodes, with the majority provided same day. Despite changes in NG treatment guidelines to ceftriaxone monotherapy, majority of patients would continue to receive an antichlamydia agent when treated for NG in these settings.