A Randomized Controlled Trial Comparing the Treatment of Patients Tested for Chlamydia and Gonorrhea After a Rapid Polymerase Chain Reaction Test Versus Standard of Care Testing.
BACKGROUND
We tested the effect of a rapid molecular test for Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (NG) diagnosis on clinical emergency department decision making compared with standard care. The new test presents an opportunity to improve antibiotic management and patient outcomes.


METHODS
We conducted a randomized controlled trial of 70 consenting patients 18 years or older presenting to an urban emergency department with sexually transmitted infections complaints (vaginal/penile discharge, dysuria, vaginal/penile itching/pain, dyspareunia). Participants were randomized to rapid testing or standard care if a sexually transmitted infection was suspected. Follow-up phone calls were performed 7 to 10 days postdischarge. The primary outcomes included: antibiotic overtreatment rates, partner notification, and health care utilization.


RESULTS
A total of 12.9% tested positive for CT or NG and received antibiotics. Test patients with negative results were less likely to receive empirical antibiotic treatment than control patients, absolute risk difference [RD], 33.4 (95% confidence interval [CI], 7.9%-58.9%), risk ratio [RR], 0.39 (95% CI, 0.19-0.82). Thirty-seven participants (53%) were contacted for follow-up 7 to 10 days postdischarge. Test patients were less likely to report missed antibiotic doses (RD, -51.3%; 95% CI, -84.4% to -18.2%; RR, 0.23; 95% CI, 0.06-0.88). Test patients were more likely to be notified of their results (RD, 50.6%; 95% CI, 22.7%-78.5%; RR, 2.72; 95% CI, 1.26-5.86). There were no significant differences in charges or health care utilization measures.


CONCLUSIONS
We found a significant reduction in unnecessary antibiotic treatment for CT/NG in subjects receiving the rapid molecular test compared with those receiving nucleic acid amplification test.
From the *Emergency Department Antibiotic Stewardship, University of California-Davis, Sacramento, CA; †Department of Emergency Medicine; ‡Department of Epidemiology and Biostatistics School of Public Health; and §Office for Clinical Practice Innovation, The George Washington University, Washington, DC.
Larissa
L
May
Chelsea E
CE
Ware
Jeanne A
JA
Jordan
Mark
M
Zocchi
Catherine
C
Zatorski
Yasser
Y
Ajabnoor
Jesse M
JM
Pines
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002690:Chlamydia Infections / Q000175:diagnosis / Q000188:drug therapy*; D002692:Chlamydia trachomatis / Q000235:genetics / Q000302:isolation & purification*; D016358:Contact Tracing; D004636:Emergency Service, Hospital; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D009344:Neisseria gonorrhoeae / Q000235:genetics / Q000302:isolation & purification*; D016017:Odds Ratio; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D059039:Standard of Care; D013997:Time Factors; D055815:Young Adult
D000900:Anti-Bacterial Agents