title: Clinical management of chlamydia and gonorrhea infection in a county teaching emergency department--concerns in overtreatment, undertreatment, and follow-up treatment success.
abstract: To date, several studies have examined overtreatment or undertreatment of Neisseria gonorrheae, Chlamydia trachomatis, or both in women. However, no study has looked at both subpopulations together, along with eventual treatment of disease-positive patients who were not empirically treated. This study is unique, for it looks at all of these subpopulations to assess overall efficacy of management of these diseases in women. A 1-year prospective, descriptive study was performed in a teaching county hospital Emergency Department (ED). There were 1260 women receiving a pelvic examination and routine GEN-PROBE testing for gonorrhea and chlamydia who were studied. The main outcome measures were the proportion of women disease positive and initially not treated (undertreated), the proportion of women disease negative who were initially treated (overtreated), as well as the follow-up treatment rate for those undertreated. Finally, the subpopulation of women disease positive and not empirically treated was examined in detail. Of 1260 GEN-PROBE-tested women, 81 (6.4%, 95% CI 1.1-11.7%) were disease positive and 31/81 (38.3%, 95% CI 21.2-55.4%) of these women were undertreated. Furthermore, 20/31 (64.5%, 95% CI 43.5-85.5%) women did not return for follow-up treatment. The billable health care dollars of routine GENPROBE testing per woman (n = 11/1260, 0.9%) returning for treatment as a result of the test was $4762.80 US dollars. Four hundred twenty-six (33.8%) of the 1260 women were empirically treated on the initial visit. Of these 426 initially treated women, 376 (88.3%, 95% CI 85.1-91.5%) were GEN-PROBE negative for disease (overtreated). The billable health care dollars of this overtreatment was $12,449.51 US dollars. This study demonstrates that health care providers are substantially overtreating women who are gonorrhea and chlamydia negative. This generates moral, ethical, health care, and financial concerns. Additionally, one-third of disease-positive women are not treated on initial visit and the majority of undertreated patients are not returning for subsequent treatment. This study provides support for investigating improved methods in the management of chlamydia and gonorrhea in women.
authors.affiliation: Department of Emergency Medicine, Alameda County Medical Center, Highland Campus, 1411 E. 31st Street, Oakland, CA 94602, USA.
authors.forename: M Andrew
authors.initials: MA
authors.lastname: Levitt
authors.forename: Suzanne
authors.initials: S
authors.lastname: Johnson
authors.forename: Linda
authors.initials: L
authors.lastname: Engelstad
authors.forename: Robert
authors.initials: R
authors.lastname: Montana
authors.forename: Susan
authors.initials: S
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D000328:Adult; D002140:California / Q000453:epidemiology; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015342:DNA Probes / Q000032:analysis / Q000191:economics; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D003951:Diagnostic Errors; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006069:Gonorrhea / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D017048:Health Care Costs; D019538:Health Care Surveys; D006766:Hospitals, County / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D015995:Prevalence; D011446:Prospective Studies
chemical_list: D015342:DNA Probes