Lack of STI Treatment Accuracy When Relying on Syndromic Management in an Urgent Care Setting.

Glasgow, Kimberly E

BACKGROUND Chlamydia and gonorrhea are two of the most common sexually transmitted infections and patients are increasingly seeking care for them in urgent care clinics. Providers often rely on syndromic management due to prolonged test turnaround times which can result in inappropriate treatment. METHODS This study retrospectively evaluated chlamydia and gonorrhea treatment accuracy of adults, men and women, aged 18 and older in four urgent cares in Northeast Iowa, using standard NAAT in a 6-month timeframe through medical records review. Seven hundred twenty-two visits were evaluated. RESULTS 25.8% (n=186/722) of patients were treated at the time of their visit, resulting in 68.8% (n=128/186) over-treatment and 8.2% (n=44/536) under-treatment. Logistic regression analysis found that treatment prescribed without diagnostic test results and the patient-collected vaginal swabs were predictors of inappropriate treatment. Patients who were treated in the clinic were significantly less likely to be treated appropriately compared to patients who were treated later based on test results (OR 0.04, CI 0.02-0.06). Patients that self-collected vaginal swabs had significantly lower odds of being treated appropriately (OR 0.04, CI 0.09-0.80). CONCLUSION Syndromic management leads to inaccurate treatment of chlamydia and gonorrhea at the time of the initial patient visit. Changes in practice in urgent care are needed in order to improve treatment accuracy by promoting antibiotic stewardship and decreasing forward disease transmission.