The CDC recommended treatment for gonorrhea is a single dose of 500 mg of IM ceftriaxone.
Yet, despite rising cases of chlamydia and gonorrhea, which affected 2.4 million individuals in 2021, a surprising percentage of patients are not treated appropriately.
A report in Sexually Transmitted Diseases pointed out that in a recent study of individuals aged 15 to 60 years, measuring and comparing treatment rates for the STIs has found that nearly one in five patients with chlamydia and one in four patients with gonorrhea did not receive CDC recommended treatment for their infection.
The problem was especially acute in the private healthcare setting, according to the Regenstrief Institute–led researchers. The study advised that males, younger patients, individuals identifying as black or multiracial, people with HIV, and those with both chlamydia and gonorrhea—a higher percentage of whom often are treated in public health clinics—were more likely to receive CDC-recommended treatment.
“Using data from multiple sources, including medication orders from electronic health records and Medicaid claims, we determined that treatment rates were higher than previous studies which relied upon less robust data from a single source,” said lead author Brian Dixon, PhD, MPA, interim director of the Regenstrief Institute’s Center for Biomedical Informatics. “Although we found higher treatment rates, they still are too low. Almost 20 percent of individuals with chlamydia and about a quarter of individuals with gonorrhea are not being treated, illustrating we have to work to encourage CDC recommended treatment, especially by private providers. Treatment is critical to addressing the nationwide epidemic of rising STI rates.”
The CDC-funded study of a single metropolitan area used data from multiple sources, including electronic health records and Medicaid claims, which were linked and integrated. Overall, 52,946 chlamydia cases and 25,699 gonorrhea cases were identified in the nine-county Indianapolis metropolitan area.
The researchers defined cases observed during 2016-2020 based on positive laboratory results. Also considered were the characteristics of providers and patients and whether public or private healthcare providers were involved.
The results indicated that 82.2% and 63.0% of initial Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) episodes, respectively, received CDC-recommended treatment. “The public STI clinic treated more than 90% of CT and GC cases consistently across the 5-year period,” according to the authors.
On the other hand, they wrote, “Private providers were significantly less likely to treat first episodes for CT (79.6%) and GC (53.3%; P < 0.01).”
The study noted that other factors associated with a higher likelihood of recommended treatment included being male, being HIV positive, and identifying as black or multiracial. Among GC cases, 10.8% received nonrecommended treatment, while all CT cases with treatment occurred per guidelines in those circumstances.
“Although these treatment rates are higher than previous studies, there remain significant gaps in STI treatment that require intervention from public health,” according to the researchers.
“Our analysis of chlamydia and gonorrhea treatment rates, which sheds light on what proportion of patients receive treatment and who is more likely to receive treatment, is likely to be similar to treatment in other parts of the U.S.,” Dr. Dixon added. “We hope this knowledge will help us target public health efforts to stem the rising tide of STIs.”
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