Urethritis in men: benefits, risks, and costs of alternative strategies of management.
Four alternative strategies for the management of men with acute urethritis were analyzed: treating patients with tetracycline, with or without a urethral culture, without basing the initial treatment decision on the results of a gram-stained smear; treating patients with penicillin, without basing initial treatment on the results of a gram-stained smear; basing initial treatment with tetracycline or penicillin on the results of a gram-stained smear; and basing treatment on the results of both a gram-stained smear and a culture. The tetracycline strategy resulted in fewer days of morbidity, a lower probability of premature death, lower dollar costs, and a much lower rate of uncured nongonococcal urethritis, but in slightly higher rates of uncured gonorrhea and syphilis than more traditional strategies. Use of culture with the tetracycline strategy (1A) permitted tracing of gonorrhea contacts, achieved the same low morbidity, and added little cost. The conclusions were true regardless of the probability of gonorrhea and for reasonable estimates of probable compliance with oral medication regimens. Test-of-cure cultures for patients who were asymptomatic after treatment for gonorrhea required the expenditure of from $4,900 to $109,800 for each case of asymptomatic persistent gonorrhea discovered and cured, depending on the strategy used.
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D006069:Gonorrhea / Q000188:drug therapy; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D013587:Syphilis / Q000188:drug therapy; D014521:Urethra / Q000382:microbiology; D014526:Urethritis / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology
D000900:Anti-Bacterial Agents