title: Evaluation of gonorrhea test of cure at 1 week in a Los Angeles community-based clinic serving men who have sex with men.
abstract: BACKGROUND
  Because of the decreasing susceptibility of Neisseria gonorrhoeae to cephalosporin therapy, the Centers for Disease Control and Prevention recommends test of cure (TOC) 1 week after gonorrhea (GC) treatment if therapies other than ceftriaxone are used. In addition, the Centers for Disease Control and Prevention asks clinicians, particularly those caring for men who have sex with men (MSM) on the west coast, to consider retesting all MSM at 1 week. However, it is unclear if this is acceptable to providers and patients or if nucleic acid amplification tests (NAATs) are useful for TOC at 7 days.
  
  
  METHODS
  Between January and July 2012, MSM with GC were advised to return 1 week after treatment for TOC using NAAT. A multivariate logistic regression model was used to determine demographic and behavioral differences between MSM who returned for follow-up and MSM who did not.
  
  
  RESULTS
  Of 737 men with GC, 194 (26.3%) returned between 3 and 21 days of treatment. Individuals who returned were more likely to have no GC history (P = 0.0001) and to report no initial symptoms (P = 0.02) when compared with individuals who did not return for TOC. Of those who returned, 0% of urethral samples, 7.4% of rectal samples, and 5.3% of pharyngeal samples were NAAT positive at TOC.
  
  
  CONCLUSIONS
  Although TOC may be an important strategy in reducing complications and the spread of GC, low return rates may make implementation challenging. If implemented, extra efforts should be considered to enhance return rates among individuals with a history of GC. If TOCs are recommended at 1 week and NAATs are used, the interpretation of positive results, particularly those from extragenital sites, may be difficult.
authors.affiliation: From the *Los Angeles LGBT Center, Los Angeles, CA; †Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA; ‡Division of STD Prevention (NCCHSTP), Centers for Disease Control and Prevention, Epidemiology and Surveillance Branch, Atlanta, GA; and §County of Los Angeles, Department of Public Health, Los Angeles, CA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Beymer
authors.forename: Eloisa
authors.initials: E
authors.lastname: Llata
authors.forename: Ali M
authors.initials: AM
authors.lastname: Stirland
authors.forename: Hillard S
authors.initials: HS
authors.lastname: Weinstock
authors.forename: Christine L
authors.initials: CL
authors.lastname: Wigen
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Guerry
authors.forename: Everardo
authors.initials: E
authors.lastname: Mejia
authors.forename: Robert K
authors.initials: RK
authors.lastname: Bolan
mesh_terms: D000293:Adolescent; D000328:Adult; D017963:Azithromycin / Q000008:administration & dosage; D002443:Ceftriaxone / Q000008:administration & dosage; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D005500:Follow-Up Studies; D006069:Gonorrhea / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D018451:Homosexuality, Male; D006801:Humans; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000187:drug effects / Q000302:isolation & purification*; D021141:Nucleic Acid Amplification Techniques; D010349:Patient Compliance; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010608:Pharyngeal Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D012002:Rectal Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D018571:Sentinel Surveillance; D012725:Sexual Behavior; D013997:Time Factors
chemical_list: D002443:Ceftriaxone; D017963:Azithromycin