(note: empiric treatment = treatment administered based on symptoms, before a confirmed diagnosis. Empiric treatment is important for STI treatment when consequences of untreated disease far outweigh any downside of treating, and the opportunity to see patient a second time is uncertain)
Chlamydia trachomatis is the most common sexually transmitted infection (STI). If left untreated, the infection can result in complications such as infertility in women and urethral strictures in men. Most clinicians treat the infection based on symptoms and patient history (empiric treatment). However, a new study found that only a minority of patients with STI symptoms seen at a safety-net clinic serving homeless and underserved youth and adults were treated empirically with antibiotics. This was particularly true for women with symptoms, who had significantly lower odds of receiving treatment. [in other words, people at increased risk of HIV infection!]
Researchers identified 737 men and 485 women who received at least one lab test for Chlamydia at a primary care safety-net clinic in Portland, Oregon. Manual chart review was conducted to collect patient demographics, STI symptoms, laboratory testing, empiric treatment, and follow-up. Within the group, 488 patients had reported symptoms of a STI, while 49 reported a known STI exposure. Among patients presenting with STI symptoms, 37.1 percent received empiric treatment with antibiotics. The treatment rate rose to 91.8 percent for patients with known STI exposures and 90.9 percent for those who had both STI symptoms and exposure. Out of 75 patients with positive Chlamydia laboratory tests, 46 had empiric treatment before confirming infection. Among 515 patients with either STI symptoms or exposure, 281 were empirically treated.
Patients less likely to receive empiric antibiotic treatment included women, homeless individuals or those with unstable housing, and non-Hispanics. Patients who were non-white with positive lab tests and no empiric treatment were significantly associated with no documented follow-up. Follow-up was also a problem for those with housing issues. The researchers recommend that clinicians make decisions on empiric treatment that take into account how quickly followup can be undertaken, particularly in women. The study was supported in part by the Agency for Healthcare Research and Quality (HS21068).”
See “Patterns of empiric treatment of Chlamydia trachomatis infections in an underserved population,” by Lauren Faricy, M.D., Tanya Page, M.D., Micha Ronick, M.D., and others in the June 2012 Family Medicine 44(6), pp. 408-415.
For more information on why this is a problem, please see The Role of STD Detection and Treatment in HIV Prevention – CDC Fact Sheet,
http://www.cdc.gov/std/hiv/stdfact-std-hiv.htm (e.g., “Individuals who are infected with STDs are at least two to five times more likely than uninfected individuals to acquire HIV infection if they are exposed to the virus through sexual contact. In addition, if an HIV-infected individual is also infected with another STD, that person is more likely to transmit HIV through sexual contact than other HIV-infected persons.”)