Low Rate of Test of Cure for Pharyngeal Gonococcal Infections at STD Clinics

Patients treated at a sexually transmitted disease (STD) clinic for pharyngeal gonococcal infections had a low test of cure rate, according to a study published in the Journal of the American Sexually Transmitted Diseases Association.

The aim of this cross-sectional analysis was to assess the test of cure rates among patients with pharyngeal gonococcal infections who received treatment at STD clinics. The researchers completed a review of electronic medical records of the STD Surveillance Network (SSuN) to analyze patients diagnosed with pharyngeal gonococcal infections, gonorrhea treatment practices, and the rate of patients completing a test of cure. Multiple positive tests over a short period of time were classified as the same infection, and antibiotic regimens were categorized as ceftriaxone 250 mg and azithromycin 1 g, ceftriaxone plus either azithromycin at 1 gm, >1 g, or <1 g, or other regimens.

Between January 1, 2016 and June 30, 2018, researchers found that 72,369 unique patients were tested for pharyngeal gonorrhea. Overall, the median age was 30 years, 33.3% were non-Hispanic black, 31.5% were non-Hispanic white, 14.8% were Hispanic, and 4.8% were Asian. Further, 10.3% were also diagnosed with HIV. Of the study population, 10.5% tested positive for ≥1 pharyngeal infection. Roughly half of the patients did not have a positive gonorrhea test at another anatomic site, and treatment would not have occurred if extragenital testing did not occur.

Treatment for infections included 76.4% receiving ceftriaxone 250 mg and azithromycin 1 gm, 9.8% receiving ceftriaxone plus either azithromycin at >1 gm or <1 gm, and 13.8% receiving other regimens. A test of cure was completed on 8.5% of patients who completed the treatment protocol, and 4.3% still had positive pharyngeal gonorrhea results.

Limitations of this study included the inability to collect data if follow-up occurred at a different clinic, the potential that an antibiotic was prescribed for a separate infection unrelated to pharyngeal gonococcal infection, and the inability to assess why the test of cure rate was so low.

The researchers concluded that “almost 50% of the patients with pharyngeal infections did not have a gonococcal infection concurrently diagnosed at another anatomic site” and “[l]ess than 10% returned for a [test of cure], highlighting the need to understand factors that can lead to improved compliance.”

Reference

Llata E, Braxton J, Asbel L, et al. Pharyngeal gonococcal infections: a cross-sectional study in a network of sexually transmitted disease clinics; STD Surveillance Network (SSuN)—January 2016 to June 2018 [published online Oct. 28, 2019]. Sex Transm Dis. doi: 10.1097/OLQ.0000000000001073