Clinical Factors Associated With Accurate Presumptive Treatment of Neisseria gonorrhoeae Infections in Men Who Have Sex with Men and Transgender Women

• Published in: Clinical infectious diseases Vol. 73; no. 9; pp. e3156 - e3162
• Main Authors: Anker, Bryan, Jaffar, Samia, Patani, Henna, Bristow, Claire C, Sukhija-Cohen, Adam C
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 02.11.2021
• Subjects: Online only; sexually transmitted infections; gonorrhea; men who have sex with men; presumptive treatment
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciaa1828

Abstract Background Neisseria gonorrhoeae (N. gonorrhoeae) infections have increased among men who have sex with men and are high among transgender women. Presumptive treatment guidelines may lead to inaccurate treatments and possible antibiotic resistance. Using patient data from AIDS Healthcare Foundation sexually transmitted infection (STI) testing clinics in California and Florida, we identified clinical factors associated with accurate presumptive N. gonorrhoeae treatment. Methods Multivariable logistic regression analyses were conducted using patient visit data from 2013 to 2017. A sample of 42 050 patient encounters were analyzed. The primary outcome variable included accurate versus inaccurate presumptive treatment. Risk ratios were generated for particular symptoms, high-risk sexual behavior, and history of N. gonorrhoeae. Results Twelve percent (5051/42 050) of patients received presumptive N. gonorrhoeae treatment, and 46% (2329/5051) of presumptively treated patients tested positive for N. gonorrhoeae infection. Patients presenting with discharge or patients presenting with dysuria were more likely to receive accurate presumptive treatment. Conclusions Providers should continue to follow the Centers for Disease Control and Prevention guidelines and consider presumptive N. gonorrhoeae treatment based on specific symptoms. As the STI epidemic continues to rise in the United States, along with increased antibiotic resistance, it is imperative to accurately test, diagnose, and treat populations at risk for N. gonorrhoeae and other STIs. Antibiotic-resistant Neisseria gonorrhoeae is a growing public health concern. Presumptive treatment may lead to inaccurate treatments and contribute to antibiotic resistance. We identified clinical factors associated with accurate presumptive treatment in effort to inform clinical decision making.