Treatment of Cases of Neisseria gonorrhoeae and Chlamydia trachomatis in Emergency Department Patients

Background The aim of this study was to determine the proportion of patients treated appropriately, both presumptively in the emergency department (ED), and at follow-up, among those patients who ultimately tested positive for either Neisseria gonorrhoeae (NG) or Chlamydia trachomatis (CT). Secondary aims were to characterize patients who received appropriate presumptive antibiotic treatment of both NG and CT at the time of ED visit and to compare them to patients who did not receive appropriate presumptive therapy. Methods A retrospective chart review was performed on 500 patients randomly chosen from those that had positive NG or CT test results performed in the ED between January 10 and June 11. The Center for Disease Control and Prevention 2010 STD Treatment Guidelines were used to determine appropriate antibiotics. Results We found 54% (95% confidence interval [CI], 49%-58%) of patients received appropriate antibiotics at ED visit and an additional 31% (95% CI, 27%-35%) were treated at our medical center on follow-up. Fifteen percent did not have documented treatment. Providers presumptively treated 46% (95% CI, 42%-50%) of patients studied with antibiotics appropriate for both NG and CT. The presence of behavioral risk factors and, for males, the presence of genital symptoms were the only factors independently associated with presumptive ED treatment. Conclusions Among patients diagnosed as having NG or CT in this ED, a portion were not documented to ever receive appropriate antibiotics, although a call-back system is in place. Presumptive treatment was not commonly used in this ED but may be necessary given the high number of patients who never got treated.