Cervicitis: to treat or not to treat? The role of patient preferences and decision analysis.
OBJECTIVE
Mucopurulent cervicitis is neither a sensitive nor a specific indicator of antibiotic sensitive infection. This analysis examines the positive and negative ramifications of treating cervicitis empirically as a Chlamydial (CT) infection. It begins where prior analyses leave off, with the number of cases of pelvic inflammatory disease (PID) prevented.


METHODS
Three treatments were compared: 1) treat empirically/refer partner; 2) test, treat, and base partner treatment on results; 3) test, base treatment on results. The outcomes were the physical sequelae of PID and the psychological sequelae of being diagnosed with CT in a hypothetical cohort of 500 teenagers with cervicitis, among whom the prevalence of CT averaged 33%, but ranged between 10% and 70%.


RESULTS
At a CT prevalence of 33%, Treatments 1 and 2 prevented three times as many cases of PID-related physical sequelae (n = 14) as Treatment 3 (n = 5). However, to prevent these 14 cases of physical sequelae, with Treatment 1, 163 teens needlessly suffer the psychological sequelae of a false CT diagnosis and with Treatment 2, 101 do so. The ratio of physical sequelae prevented to psychological sequelae caused, changed in relationship to the prevalence of CT, but was always numerically most favorable with Treatment 3. Moreover, it was the only therapeutic approach for which overall morbidity never exceeded the PID-related physical morbidity incurred in the absence of treatment.


CONCLUSIONS
By including the effects of over diagnosing and treating CT, we have demonstrated how the risks and benefits of empiric and nonempiric cervicitis therapy vary in relationship to CT prevalence. Failure to consider both the physical and the psychological aspects of patient well-being may mean that well-intentioned policies to reduce physical morbidity do not result in an overall improvement in health of teenagers.
Sheeder
Jeanelle
J
Department of Pediatrics, Division of Adolescent Medicine, University of Colorado Health Sciences Center, The Children's Hospital, 1056 East 19th Street, Box B025, Denver, CO 80218, USA. jeanelle.sheeder@uchsc.edu
Stevens-Simon
Catherine
C
Lezotte
Dennis
D
Glazner
Judith
J
Scott
Stephen
S
D000293:Adolescent; D000294:Adolescent Behavior; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D015897:Comorbidity; D003661:Decision Support Techniques; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D018579:Patient Selection; D015995:Prevalence; D018570:Risk Assessment; D012747:Sexual Partners / Q000523:psychology; D014481:United States / Q000453:epidemiology; D002575:Uterine Cervicitis / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*
D000900:Anti-Bacterial Agents; D017963:Azithromycin