In a hospital emergency department (ED) study, more than 75% of patients who were given antibiotics for suspected gonorrhea or chlamydia were later found to be free of the infections, according to a study to be presented at an infection control conference this week.
The authors said the findings illustrate the difficult balance between treating people appropriately for possible sexually transmitted diseases (STDs) and avoiding unnecessary antibiotic use, which contributes to bacterial resistance.
The findings will be presented at the annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC), scheduled for Jun 11 to 13 in Charlotte, N.C. APIC described the study in a press release today.
Patients who seek treatment for signs and symptoms of STDs commonly have genital cultures collected, but test results take time, and antibiotics are often prescribed without a firm diagnosis, according to the release. ED clinicians must decide whether to treat immediately or wait for test results, risking disease spread and trouble contacting patients later, the authors said in the study abstract.
More than 1,000 patients tested
The researchers, at St. John Hospital & Medical Center in Detroit, sought to assess the extent of unnecessary antibiotic use for STDs by looking at the records of 1,103 patients who were tested for those infections in the hospital's ED.
Of those patients, 40% were treated with antibiotics for gonorrhea and/or chlamydia. But test results showed that of the 40%, 77% did not have either disease. And of the 60% who were not treated, only 7% ultimately tested positive for one or both infections, the release says.
"There is a tricky balance between not furthering antibiotic resistance by over-prescribing, but also still getting people treatment for STDs they might have," said Karen Jones, MPH, BSN, RN, first author and infection preventionist at St. John, in the press release.
In an effort to find clinical predictors that could help reduce unnecessary use of antibiotics, the researchers also looked at the association of various symptoms with positive STD tests.
Among male patients, they found, 60.3% of those with penile discharge and 57.5% who had urethral inflammation tested positive for gonorrhea and/or chlamydia. Among female patients, 25% who had cervical inflammation and 27% who had cervical motion tenderness tested positive for one or both STDs. Thirty-five percent of patients who disclosed they had more than one sex partner also tested positive for gonorrhea and/or chlamydia.
Growing concern over resistant STDs
Antibiotic resistance in Neisseria gonorrhoeae, the cause of gonorrhea, has been a rising concern in recent years. In 2007, the emergence of fluoroquinolone-resistant N gonorrhoeae prompted the Centers for Disease Control and Prevention (CDC) to stop recommending fluoroquinolones for treating the disease, leaving cephalosporins as the only remaining class of antimicrobials for treating gonorrhea in the United States, according to CDC information.
Last November the CDC reported that the rate of N gonorrhoeae resistance to cephalosporins increased from 0.1% of isolates in 2006 to 1.4% in 2006 to 2011. It then dropped to 0.4% in 2013 but inched up to 0.8% in 2014.
Jun 9 APIC press release
CDC information on treatment of gonorrhea
Related Nov 4, 2015, CIDRAP News item