Clinical management of chlamydia and gonorrhea infection in a county teaching emergency department--concerns in overtreatment, undertreatment, and follow-up treatment success.

摘要

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