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Non-empirical management of asymptomatic chlamydia and gonorrhoea reduces unnecessary antibiotic use fivefold: a before and after study
  1. Rafeeqah Rasul1,
  2. Ruthy McIver2,
  3. Prital Patel3,
  4. Rosalind Foster2,3,
  5. Anna McNulty1,2
  1. 1School of Population Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
  2. 2Sydney Sexual Health Centre, Sydney, New South Wales, Australia
  3. 3The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Ruthy McIver, Sydney Sexual Health Centre, Sydney, New South Wales, Australia; ruthymciver{at}gmail.com

Abstract

Objectives In 2019, informed by favourable patient and provider acceptability surveys and concerns about antimicrobial resistance, Sydney Sexual Health Centre stopped routinely providing empirical antibiotic treatment to asymptomatic contacts of Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoea (gonorrhoea). We aimed to assess if this policy change had any negative impact on patient outcomes.

Methods A retrospective file review of people who presented as asymptomatic contacts of chlamydia and gonorrhoea cases before and after the policy change was conducted. Data on infection type, test results and treatment were extracted. For contacts who tested positive and were treated non-empirically, additional data were reviewed including sexual activity and symptom or complication development between testing and treatment, time from testing to notification and treatment and loss to follow-up.

Results Of 1194 asymptomatic sexual contacts of chlamydia or gonorrhoea, most tested negative to both infections (814, 68%). All contacts with a positive result who were not treated empirically were notified of their result and 173 (99%) were treated within a mean time of 5 days. More contacts were overtreated in 2018 (n=355, 58%) under the empirical treatment model compared with 2019 (n=58, 11%, p≤0.001). There was no significant difference in the proportion of contacts who tested positive and were treated (p=0.111) or developed symptoms (p=0.413) before and after the policy change and no contacts who were treated non-empirically developed complications of pelvic inflammatory disease, epididymitis or proctitis between testing and treatment.

Conclusion In this population, a switch from empirically treating all asymptomatic contacts to treating only those who tested positive significantly reduced antibiotic overuse with minimal adverse outcomes. Our findings support results-directed treatment for asymptomatic sexual contacts of chlamydia and gonorrhoea.

  • antimicrobial resistance
  • chlamydia infections
  • gonorrhea
  • sexual health

Data availability statement

No data are available. Data not available due to ethical restrictions.

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Data availability statement

No data are available. Data not available due to ethical restrictions.

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Footnotes

  • Handling editor Joseph D Tucker

  • Contributors All authors provided critical feedback to shape the research, analysis and manuscript. AMcN and RF conceived of the research idea and supervised the project. AMcN, RF, RMcI and PP developed the study protocol. RR collected the data. PP and RMcI completed the statistical analysis. RMcI and RR wrote the manuscript with input from all authors. AMcN is the guarantor of this project.

  • Funding PP is supported by the NSW Ministry of Health Prevention Research Support Programme.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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