High frequencies of negative pretreatment results following presumptive antibiotic treatment for chlamydia and gonorrhea.

Introduction: The purpose of this study was to determine the frequencies of negative test results among all patients aged 18 years and older receiving presumptive antibiotic treatment for chlamydia and/or gonorrhea at the Sexually Transmitted Disease Clinic of the Palm Beach County Health Department. The treatment algorithms were based on guidelines of the Centers for Disease Control and Prevention.

Methods: Clinic logs were retrospectively reviewed for a consecutive case series of all 1209 patients treated from November 1, 2007 to October 31, 2008. Urogenital specimens were collected and analyzed. Laboratory results were obtained from the Health Management System of the Palm Beach County Health Department.

Results: Of the 1209 patients, 556 (46%) were treated for chlamydia, 30 (2.5%) for gonorrhea, and 623 (51.5%) for both. The frequencies of negative results were 68% for chlamydia or gonorrhea, 70.9% for chlamydia, 86.6% for gonorrhea, and 65.2% for chlamydia + gonorrhea.

Conclusions: These data indicate that implementation of the Centers for Disease Control and Prevention guidelines by the Sexually Transmitted Disease Clinic of the Palm Beach County Health Department results in presumptive treatment of more than two-thirds of patients with negative nucleic acid amplification test results for chlamydia, gonorrhea, or both. They also suggest the potential value of developing treatment algorithms to maximize treatment of patients with positive test results and minimize treatment of those with negative test results. One possible strategy to explore is the future utility of new testing and treatment methodologies in development.