Presumptive Treatment of Chlamydia and Gonorrhea Infections in a Canadian Ambulatory Emergency Department Setting

Abstract

Objectives Presumptive antibiotic treatment may be given for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infections before a laboratory diagnosis is established, but overtreatment can increase resistance rates. We sought to determine the presumptive treatment prevalence in our emergency department (ED) setting, as well as the number of overtreated and undertreated patients. Methods We performed a retrospective cohort study of all patients tested for CT/GC in an urban academic ED during a 6-month period in 2015. Presumptive treatment prevalence, overtreatment and undertreatment proportions, and CT- and GC-positive test proportions were calculated with 95% Wald confidence interval (CI) and compared across age and sex. Results Of 209 included cases (male n = 3, female n = 206), 27 (13%; CI, 8%–18%) received presumptive treatment for CT and 19 (9%; CI, 5%–14%) for GC. Seven cases (3%; CI, 1%–6%) were positive for CT and 0 for GC. Of the 7 CT-positive cases, 2 (29%) received presumptive treatment in the ED, and 5 (71%) were treated after the positive test results were obtained. There was no loss to follow-up. Mean delay to treatment was 10 days, including a mean of 3 days for laboratory analysis. Overtreatment and undertreatment proportions were 93% (CI, 83%–100%) and 3% (CI, 0%–5%) for CT and 100% and 0% for GC, respectively. Positive test result, presumptive treatment, overtreatment, and undertreatment were not associated with age or sex. Conclusions Given the low CT/GC incidence and good follow-up, at our institution, it would be reasonable to wait for a laboratory diagnosis rather than give presumptive treatment.