Introduction The impact of testing asymptomatic patients for sexually transmitted infections without a clinical examination (CE), i.e., Express Testing (ET), on treatment completion has varied, in part due to differences in presumptive treatment practices. Our objective was to determine whether patients diagnosed with gonorrhoea (GC) through ET were as likely to return for treatment within 30 days compared to those who had a CE but were not presumptively treated for GC at the date of visit in two publically funded U.S. urban STD clinics.

Methods We analysed STD clinic records of patients diagnosed with GC and who did not receive presumptive GC treatment at the initial visit from January 2014-July 2016. Treatment completion was defined as receiving dual therapy regimen (ceftriaxone plus azithromycin or doxycycline) within 30 days of being tested for GC. We used logistic binomial regression to compare treatment completion rates by visit type (ET vs. CE).

Results Between January 2014-July 2016, 1893 persons were diagnosed with GC, 74% of whom were presumptively treated at the initial visit. Among the 395 men and 234 women not presumptively treated, 54% and 68% completed treatment within 30 days, respectively. Among women, CE vs. ET was not associated with treatment completion [Adjusted relative risk (aRR): 1.14, 95% CI:(0.95–1.37)], adjusting for year, clinic, age, and presumptive azithromycin treatment. Men diagnosed through CE vs. ET were 24% less likely to complete treatment [aRR:0.76, (0.65–0.91)], adjusting for the same factors. Men presumptively treated with azithromycin treatment alone were 46% less likely to complete treatment [aRR:0.54, (0.41–0.70)].

Conclusion Among patients who did not receive presumptive treatment at the initial visit, ET vs. CE had no effect on GC treatment completion among women and increased treatment completion among men. Men presumptively treated with azithromycin were significantly less likely to return for recommended GC treatment, suggesting that ET may reduce incorrect presumptive diagnoses leading to under-treatment of GC patients.