Gonorrhea In Adolescents Research Articles

Improving Management of Suspected Chlamydia and Gonorrhea in Adolescents with a Rapid Diagnostic Test.

Before 2020, we tested for CT/GC using a batched nucleic acid amplification test, with results available the following day. Starting in January 2020, we implemented rapid nucleic acid amplification test. Our primary outcome variables were undertreatment and overtreatment. We defined undertreatment as GC and/or CT-positive patients who did not receive appropriate treatment. We defined overtreatment as GC or CT-negative patients who received antibiotics. The balancing measure was the LOS. There were 758 patients evaluated in the preimplementation period (2019), 612 in the implementation period (2020), and 626 in the postimplementation period (2021). Postimplementation, overtreatment decreased from 18.4% to 8.1%. Undertreatment did not differ by period but was less common among those tested with rapid versus standard testing (12.7% versus 9.9%, P = 0.05). Median LOS increased from 166 minutes (preimplementation) to 187 minutes (implementation) and 202 minutes (postimplementation; P < 0.001). Rapid CT/GC testing reduced unnecessary antibiotic use but increased LOS due to patients waiting for the test results before being discharged. Given the rapid increases in CT/GC rates and antimicrobial resistance, health systems should consider implementing rapid testing to appropriately direct antimicrobials to patients most likely to benefit.

194. Rapid diagnostic testing to improve management of suspected chlamydia and gonorrhea in adolescents in a Pediatric Emergency Department

Abstract Background Standard turnaround times for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) testing result in unnecessary antibiotic use for patients without infection and undertreatment of patients with infection(s). We aimed to determine the impact of rapid CT/GC testing on reducing unnecessary antibiotic use, undertreatment of CT and/or GC, and length of stay in an urban safety-net pediatric emergency department (PED). Methods Before 2020, testing for CT/GC was performed using a batched nucleic acid amplification test (NAAT; Hologic Aptima Combo2) with results available the following day. Starting January 2020, the GeneXpert rapid NAAT (Cepheid Xpert CT/NG) with turnaround time between 90-120 minutes was available. Our primary outcome variables were under- and over-treatment. Undertreatment was defined as GC and/or CT positive patients who did not receive appropriate antibiotic treatment in the PED. Overtreatment was defined as GC or CT negative patients who received antibiotic treatment in the PED. Under- and over-treatment percentages were plotted on Statistical Process Control p charts. The balancing measure was length of stay (LOS). Results There were 739 patients evaluated in the baseline period (2019), 631 in the intervention period (2020) and 626 in the post-intervention period (2021). There were no differences in gender, race, ethnicity, and insurance across the 3 time periods. After introduction of the GeneXpert, over-treatment decreased from 18.4% to 8.1% (Figure). Under-treatment did not differ. Median turnaround for the GeneXpert was 119 minutes. Median LOS in minutes increased from 165 minutes (baseline) to 182 minutes (intervention) and 202 minutes (post-intervention; p&amp;lt; .001). Percentage of patients over-treated for chlamydia and gonorrhea. Conclusion Rapid CT/GC testing substantially reduced unnecessary antibiotic use but increased LOS. Given the rapid increases in CT/GC rates and antimicrobial resistance health systems should consider implementation of rapid testing to appropriately direct antimicrobials to patients most likely to benefit. A more rapid test would likely increase appropriate antibiotic use and limit impact on LOS. Disclosures All Authors: No reported disclosures.

Population-Level Provider Compliance With Provincial Treatment Guidelines for the Management of Gonorrhea in Adolescents and Adults in Alberta, Canada; 2000 to 2019.

Background Appropriate antimicrobial therapy is one of the essential strategies in the global control of gonorrhea. We sought to determine the provider compliance with provincial treatment guidelines for gonococcal infections in Alberta, Canada, and to identify characteristics associated with provider noncompliance. Methods A retrospective population-based analysis of gonorrhea treatment from January 1, 2000, to December 31, 2019, using data extracted from a communicable disease database was performed. Prevalence ratios were calculated for provider compliance to treatment guidelines of patient, infection, and treating provider characteristics. Results We identified a total of 42,875 cases of gonorrhea, 58.3% were men, 40.3% were White, 28.2% were First Nations, and 16% were “unknown ethnicity.” Most cases were treated by family physicians (43.4%), sexually transmitted infection (STI) clinics (31.9%) and urgent care centers/hospitals (10%). Overall, there was 80.3% provider compliance with treatment guidelines. Provider compliance to treatment guidelines had the highest rates of compliance when treatment was provided by STI nurses in correctional facilities, STI clinics, and treatment of men having sex with men (94.7%, 91.7%, and 87.5%, respectively). Provider compliance to treatment guidelines was lowest when treating women (75.5%), pregnancy status (68.4), individuals of “unknown race/ethnicity” (74.8%), and those treated in urgent care centers and emergency department (66.7%). Conclusions Delivery of STI care by nurse-led models had the highest level of compliance with treatment guidelines. Our study informs areas for targeted interventions to improve the uptake of treatment guidelines, including the provision of treatment in urgent care centers and among women.

An Observational Study to Assess the Effectiveness of 4CMenB against Meningococcal Disease and Carriage and Gonorrhea in Adolescents in the Northern Territory, Australia-Study Protocol.

Invasive meningococcal disease (IMD) causes significant morbidity and mortality worldwide with serogroup B being the predominant serogroup in Australia and other countries for the past few decades. The licensed 4CMenB vaccine is effective in preventing meningococcal B disease. Emerging evidence suggests that although 4CMenB impact on carriage is limited, it may be effective against gonorrhoea due to genetic similarities between Neisseria meningitidis and Neisseria gonorrhoeae. This study protocol describes an observational study that will assess the effect of the 4CMenB vaccine against meningococcal carriage, IMD and gonorrhoea among adolescents in the Northern Territory (NT). All 14–19-year-olds residing in the NT with no contraindication for 4CMenB vaccine will be eligible to participate in this cohort study. Following consent, two doses of 4CMenB vaccine will be administered two months apart. An oropharyngeal swab will be collected at baseline and 12 months to detect pharyngeal carriage of Neisseria meningitidis by PCR. The main methodological approaches to assess the effect of 4CMenB involve a nested case control analysis and screening method to assess vaccine effectiveness and an Interrupted Time Series regression analysis to assess vaccine impact. Research ethics approvals have been obtained from Menzies and Central Australian Human Research Ethics Committees and the Western Australian Aboriginal Health Ethics Committee. Results will be provided in culturally appropriate formats for NT remote and regional communities and published in international peer reviewed journals. ClinicalTrials.gov Identifier: NCT04398849.

Factors Associated With Primary Care Physician Knowledge of the Recommended Regimen for Treating Gonorrhea.

The recommended regimen for treating uncomplicated gonorrhea has changed over time, due to the emergence of antimicrobial resistance. We assessed physician knowledge of the recommendation for treating uncomplicated urogenital gonorrhea in adolescents and adults using ceftriaxone and azithromycin dual therapy. We analyzed DocStyles 2015 survey data from 1357 primary care physicians practicing for at least 3 years who provided screening, diagnosis, or treatment for sexually transmitted diseases to one or more patients in an average month. Logistic regression and χ analyses were used to identify factors associated with knowledge of dual therapy. Among the options of treatment with ceftriaxone alone, azithromycin alone, both of these, or spectinomycin plus levofloxacin, 64% of physicians correctly preferred ceftriaxone plus azithromycin. Knowledge of the recommended dual therapy decreased with increasing years of practice, ranging from 74% among physicians with 3-9 years of practice to 57% among those practicing for ≥24 years (adjusted odds ratio, ORa, for ≥24 vs 3-9 years of practice, 0.50; 95% confidence interval [CI], 0.35-0.70). Knowledge of dual therapy decreased with higher socioeconomic status of patients (ORa for high income vs poor/lower middle income patients, 0.47; 95% CI, 0.32-0.69). Physicians who pursued continuing medical education using journals, podcasts, and government health agencies were more likely to report dual therapy than those who did not use these sources (ORa, 2.09; 95% CI, 1.31-3.33). Knowledge of the recommended regimen for treating gonorrhea decreased with increasing years of practice and with higher socioeconomic status of patients.

Management of Gonorrhea in Adolescents and Adults in the United States.

Gonorrhea is the second most commonly reported notifiable disease in the United States and is associated with serious health sequelae, including pelvic inflammatory disease, infertility, and ectopic pregnancy. Treatment for gonorrhea has been complicated by antimicrobial resistance. Neisseria gonorrhoeae has developed resistance to each of the antimicrobials that were previously recommended as first-line treatment regimens, and current treatment options are severely limited. This article summarizes the key questions and data that were discussed at the Sexually Transmitted Diseases (STD) Treatment Guidelines Expert Consultation meeting in April 2013, and the rationale for the 2015 Centers for Disease Control and Prevention STD treatment guidelines for gonococcal infections in adolescents and adults. Key issues addressed include whether to change the dosage of ceftriaxone and azithromycin used in the recommended dual treatment regimen, whether to continue to list dual treatment with cefixime and azithromycin as an alternative treatment regimen, and management of gonococcal infections in persons with severe cephalosporin allergy or suspected treatment failure.

Identifying Relationships Between High‐Risk Sexual Behaviors and Screening Positive for Chlamydia and Gonorrhea in School‐Wide Screening Events

This article describes a school-wide sexually transmitted infection (STI) screening to identify adolescent high-risk sexual behaviors, STI history/incidence, and presence of chlamydia and gonorrhea, and examines relationships between high-risk behaviors and screening positive for chlamydia and gonorrhea in an alternative high school setting. School-wide chlamydia and gonorrhea education and screening was provided to 869 adolescents; 226 males and 282 females 14-20 years (mean age = 17.07) consented to urine screening. Relationships were examined between screening positive, history of STIs, and high-risk sexual behaviors. A majority (69%) of the adolescents consented to screening: 17.76% (92) had a history of STI; 8.83% (46) tested positive at screening. More females than males tested positive (p = .001). Significant relationships existed between history of STIs and ≥ 4 sexual partners (p = .0022), no condom use (p = .06), and sexual intercourse in last 3 months (p = .03). School-Based Health Center (SBHC) screening was well accepted by students and staff. Sexually transmitted infection history was correlated with all identified high-risk sexual behaviors supporting the need for in-depth assessment, counseling, and testing of adolescents wherever they present for care. This study also provides an example of the role SBHCs can play in the national strategy to control chlamydia and gonorrhea in adolescents.

Evaluation of Self-Collected Vaginal Swab, First Void Urine, and Endocervical Swab Specimens for the Detection of Chlamydia Trachomatis and Neisseria Gonorrhoeae in Adolescent Females

Objective To assess the concordance of self-obtained vaginal swabs (SVS), first void urine samples (FVU) and provider-collected endocervical swabs (PES) for the detection of Chlamydia trachomatis (CT) and Neisseria gonorrhea (NG) in adolescents. Methods A total of 342 adolescent women and 1080 baseline and semi-annual visits were analyzed. FVU, SVS and PES were collected at each biannual visit. All specimens were tested by BDProbeTec ET ™ Amplified DNA Assay. Sensitivity, specificity, positive predictive value (PPV) negative predictive value (NPV) and kappa coefficient were calculated to evaluate the ability to identify possible infected cases using samples from three anatomic sites and the test agreement between any two of these three specimen types. Positive results from at least two of the three specimens collected from same subject at the same study visit was considered true positive. Results The positivity rates for CT and NG were 26.6 and 11.7 per 100 women respectively. The sensitivities of SVS, FVU and PES for detecting CT were 97.3%, 89.2% and 90.1% respectively. For the detection of NG, the sensitivities of the three sampling methods were 100%, 88.6% and 95.5% respectively. The specificities were between 94.7% and 99.7% for both CT and NG. Kappa coefficients of CT test results were 0.89, 0.88 and 0.83 for specimen pairs SVS vs PES, SVS vs FVU and PES vs FVU respectively. For the detection of NG, kappa coefficients were 0.91, 0.87 and 0.91 for these three pairs (all P < 0.0001). Kappa > 0.75 is considered excellent agreement between specimens. Conclusion There were strong agreements among SVS, PES and FVU specimens on the detection of CT and NG infections in adolescent females using nucleic acid amplification test. SVS represented as high as or more sensitive an approach for detecting both CT and NG compared to PES. Although FVU was the least sensitive sampling method, it is also the least invasive method. Thus SVS and FVU may provide a reliable alternative to endocervical specimens for CT and NG screening.

Adolescent sexuality and reproductive health: where are we in 2004?

Adolescent sexuality and reproductive health: where are we in 2004?

Treatment of Gonorrhea in Adolescents

From the Venereal Disease Control Division, Bureau of State Services, Center for Disease Control, Atlanta, Georgia

Gonorrhea in Adolescents

Over a four-year period a group of 209 young women committed to a state institution for deliquent youths was screened for infection with Neisseria gonorrhoeae by multiple bacteriologic cultures and by gonococcal complement-fixation tests. In this selected population of sexually active young women with a relatively high prevalence of gonorrhea, the gonoccal complement fixation test proved too insensitive to justify primary reliance on it for the identification of cases of actual disease. Only 25 (38%) of infected women had reactive sera. The specificity of the test was somewhat better; in two cases unexpected sero-positivity led to the identification, and treatment of previously-missed asymptomatic disease.