Rapid testing for Chlamydia trachomatis and Neisseria gonorrhoeae in the emergency department (ED) may lead to a significant reduction in overtreatment for women without infections with either bacteria, and a similar improvement in appropriate treatment for women who are infected when compared with the standard of care, according to a clinical trial report published in the Annals of Emergency Medicine.

In 2016, C trachomatis was the most common bacteria spread via sexually transmitted infection (STI) in the United States, with approximately 1.6 million reported cases. This was a 4.7% increase from 2015. Similarly, an 18.5% increase was reported for individuals with N gonorrhoeae infection in the United States from 2015 to 2016. However, diagnostic testing coverage for C trachomatis and N gonorrhoeae is suboptimal, especially in EDs, where the burden of bacterial infections is high.

As a result, providers who work in the ED often have to make empiric treatment decisions, which has contributed to overtreatment of up to 30% of the population who do not have a STI and undertreatment of up to 40% of patients with confirmed C trachomatis and N gonorrhoeae. The subsequent underuse and overuse of antibiotics can lead to medical complications and increased antibiotic resistance in the community. Therefore, a more reliable and rapid assay for the accurate diagnosis of these STIs could facilitate appropriate antibiotic treatment and prevent the overuse of inappropriate therapy. This randomized clinical trial assessed rapid C trachomatis and N gonorrhoeae testing on overtreatment and undertreatment of women evaluated for infection with either of these bacteria.

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Between April 2015 and May 2016, at an urban academic ED, 254 women aged 18 to 50 years undergoing pelvic examinations and C trachomatis and N gonorrhoeae testing were randomly assigned to either a control or a rapid test group. The control group received standard-of-care nucleic acid amplification tests of endocervical specimens with a 2- to 3-day turnaround. The rapid test group provided clinicians with an extra endocervical swab for GeneXpert C trachomatis and N gonorrhoeae rapid testing, in addition to the swab provided for the standard-of-care test. The primary objective of this study was to estimate overtreatment for STIs in the ED; the secondary objective was to estimate undertreatment for STIs in the ED.

In the rapid test group, 7.9% of patients had positive test results for C trachomatis and 3.9% had positive test results for N gonorrhoeae. In the control group, 10.2% of patients had positive nucleic acid amplification test results for C trachomatis and 5.5% had positive results for N gonorrhoeae. In the rapid testing group, 100% of patients with positive results for chlamydia and gonorrhea were treated vs 56% in the control group. Further, clinicians overtreated 46.5% of uninfected control patients for C trachomatis compared with 23.1% of uninfected rapid test patients and 46.7% of uninfected control patients for N gonorrhoeae compared with 25.4% of uninfected rapid test patients.

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Overall, the study investigators concluded that, “[r]apid testing for chlamydia and gonorrhea could improve accuracy of ED treatment. The magnitude of improvement could depend on the effectiveness of follow-up procedures currently in place.”


Gaydos CA, Ako MC, Lewis M, Hsieh YH, Rothman RE, and Dugas AF. Use of a rapid diagnostic for Chlamydia trachomatis and Neisseria gonorrhoeae for women in the emergency department can improve clinical management: report of a randomized clinical trial [published online November 1, 2018]. Ann Emerg Med. doi: 10.1016/j.annemergmed.2018.09.012