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Unnecessary antibiotic use in men who have sex with men (MSM) with anogenital symptoms attending a sexual health clinic: a retrospective analysis
  1. Arthur Wong1,2,
  2. Tanya Applegate2,
  3. David Charles Boettiger2,
  4. Rick Varma1,2,
  5. Rebecca Guy2,
  6. Nicholas Medland2
  1. 1Sydney Sexual Health Centre, Sydney, New South Wales, Australia
  2. 2The Kirby Institute, Kensington, New South Wales, Australia
  1. Correspondence to Dr Arthur Wong, Sydney Sexual Health Centre, Sydney, New South Wales, Australia; awong{at}


Objectives To quantify the amount of unnecessary antibiotics, in particular ceftriaxone, given to men who have sex with men (MSM) with anogenital symptoms as part of presumptive management in an urban sexual health clinic and examine factors associated with unnecessary ceftriaxone.

Methods This is a retrospective cross-sectional analysis of electronic records from all visits involving MSM reporting symptoms of bacterial sexually transmitted infection (STI) and who received presumptive antibiotics at Sydney Sexual Health Centre. The following variables were extracted: demographic and sexual behaviour data, presenting symptoms, prior STI diagnoses, use of anoscopy, use of point-of-care microscopy, prescriptions of antibiotics and subsequent nucleic acid amplification testing (NAAT) results for chlamydia and gonorrhoea in all anatomical sites (urethra, pharynx and rectum). We defined unnecessary antibiotic as an agent prescribed to treat an STI organism that was subsequently not detected.

Results Among 1061 visits in this analysis, 41.8% yielded negative NAAT results for both chlamydia and gonorrhoea in all anatomical sites. There were 44.3% of visits which had positive gonorrhoea NAAT result in at least one anatomical site. There were 187 courses of ceftriaxone prescribed in patients who tested negative for gonorrhoea in all anatomical sites and therefore were unnecessary. Unnecessary ceftriaxone prescribing occurred in 50.2% of visits with anorectal symptoms, 19.6% of scrotal symptoms and 7.3% of urethral symptoms. Microscopy was associated with significantly less unnecessary ceftriaxone in urethral but not anorectal or scrotal presentations. In multivariable analysis, the following factors were associated with a higher likelihood of unnecessary ceftriaxone use: anorectal symptoms, scrotal symptoms, gonorrhoea in the preceding year, contact of a bacterial STI and living with HIV.

Conclusions This study highlights the significant amount of unnecessary ceftriaxone used for STI symptoms in MSM. A new pathway incorporating rapid point-of-care molecular testing in symptomatic patients may improve the precision of antibiotic prescribing and reduce unnecessary use.

  • gonorrhoea
  • chlamydia infections
  • point-of-care testing
  • drug resistance, bacterial
  • patient care management

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request by contacting first author via

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Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request by contacting first author via

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  • Handling editor Ming Jie Lee

  • X @dr_arthur_wong, @RickVarma

  • Contributors AW is the guarantor. AW, TA and RG conceived the study and designed the research plan. AW and RV are clinicians at the centre and provide clinical guidance and care for the patients. AW, TA and NM. developed the methodology and performed the statistical analysis planning. AW and DCB performed the statistical analyses on STATAAW and wrote the first draft of the manuscript with input from all authors. All authors critically reviewed the manuscript and approved the final version for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.