Trends in Chlamydia and Gonorrhea Testing and Positivity Rates in a Safety Net Hospital in Georgia: 2014 to 2017.

Abstract

Sexually transmitted infections (STIs) in the United States continue to increase at an alarming rate. Since 2015, reported cases of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC), the 2 most prevalent reportable STIs, have increased by 19% and 56%, respectively. Characterizing testing patterns could elucidate how CT/GC care and positivity have evolved over time in a high-risk urban setting and illustrate how patients use the health care system for their STI needs. Using electronic medical record data from a large safety net hospital in Georgia, patient demographics and clinical characteristics were extracted for all nucleic acid amplification tests ordered from 2014 to 2017 (n = 124,793). Descriptive statistics were performed to understand testing patterns and assess positivity rates. Annual nucleic acid amplification test volume grew by 12.0% from 2014 to 2017. Obstetrics/gynecology consistently accounted for half of all tests ordered; volume in emergency medicine grew by 45.2% (n = 4108 in 2014 to n = 5963 in 2017), whereas primary care volume fell by -4.3% (n = 4186 in 2014 to n = 4005 in 2017). The largest number of positive results was detected among 15- to 24-year-olds. The positivity of CT was higher among females, and GC among males. The percent positivity of CT remained stable (range, 6.4%-7.0%). The percent positivity of GC increased from 2.7% to 4.3% over time. Testing volume in emergency medicine has increased at a faster rate than other specialties; point-of-care testing could ensure more accurate treatment and improve antibiotic stewardship. The rates of CT/GC were high among adolescents and young adults. Tailored approaches are needed to lower barriers to care for this vulnerable population.