(PDF) Diagnosis and Treatment of Sexually Transmitted Infections: A Review

Guideline Adherence Is Suboptimal For Chlamydia, Gonorrhea Treatment

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Disparities Identified In Treatment Of Chlamydia And Gonorrhea In Primary Care

Background and goal: Prompt treatment of chlamydia and gonorrhea following a confirmed diagnosis is essential to prevent complications and reduce transmission. Adherence to the Centers for Disease Control (CDC) treatment guidelines in primary care settings remains a concern. This study aimed to quantify the overall treatment rate for chlamydia and gonorrhea and identify factors associated with treatment delays and disparities. 

Study approach: Researchers analyzed electronic health record data from the PRIME registry, which includes information from over 2,000 primary care clinicians across the United States. The study included patients diagnosed with chlamydia or gonorrhea between 2018 and 2022 and assessed whether they received appropriate antibiotic treatment within 30 days of diagnosis.

Main results: 6,678 cases of chlamydia and 2,206 cases of gonorrhea confirmed by a positive test were identified.

75.3% of chlamydia cases and 69.6% of gonorrhea cases were treated within 30 days.

More than 80% of treated patients received antibiotics within 7 days of diagnosis.

Only 14% of chlamydia cases were treated with the recommended doxycycline and only 38.7% of gonorrhea cases were treated with the recommended ceftriaxone.

Women, young adults (ages 10-29), and suburban residents were more likely to receive treatment.

Time to treatment of chlamydia was longer for patients aged 50-59 years and for non-Hispanic Black patients.

Why it matters: Many patients with chlamydia and gonorrhea in primary care settings do not receive the recommended treatment. This gap in care may contribute to ongoing STI transmission and adverse health outcomes, particularly among marginalized populations. 

Source:

Journal reference:

Hao, S., et al. (2025). Treatment of Chlamydia and Gonorrhea in Primary Care and Its Patient-Level Variation: An American Family Cohort Study. The Annals of Family Medicine. Doi.Org/10.1370/afm.240164.

Alaska Records Spike In Rates Of Rare But Severe Complications From Gonorrhea

A flyer posted on a bulletin board at the University of Alaska Anchorage on April 20, 2024, gives information about tests for sexually transmitted infections. In the past two years, more Alaskans have been afflicted by medical problems caused by infections of the joints, heart and other body parts not usually affected by the pathogen that causes gonorrhea. (Photo by Yereth Rosen/Alaska Beacon)

Alaska has long had the distinction of having the nation's highest or nearly highest rates of gonorrhea.

Now there is another troublesome trend among those who contract the sexually transmitted infection. Cases of a rare but severe complication of gonorrhea have spiked in Alaska for reasons that are not yet fully understood, according to state health officials.

The Alaska Department of Health received 27 reports of patients with what is known as "disseminated gonococcal infection" last year, said a bulletin released by the department's epidemiology section. Those are infections in which the pathogen that causes gonorrhea passes beyond normally infected sites — the genital, rectal or mouth areas — into the bloodstream and other parts of the body.

Disseminated gonococcal infection, or DGI, can harm joints, tendons or body organs. The most serious potential effects, according to the bulletin, include endocarditis, a life-threatening infection of the heart's inner linings and valves, and meningitis, a potentially fatal inflammation of the brain and spinal cord.

The 27 cases of DGC reported last year represented 1.3% of the 2,079 reported cases of gonorrhea in Alaska in 2024, the bulletin said. That percentage is more than triple the rate in 2023, when eight DGI cases were reported among the 2,289 reported gonorrhea cases, and it is 10 times the rate in 2022, when only three DGI cases were reported out of the 2,304 reported gonorrhea cases that year, resulting in a rate of 0.13%, the bulletin said.

Additionally, Alaska's rate of DGI is far higher than the most recently reported national rates, the bulletin said.

While Alaska's rates of gonorrhea are high, that does not account for the increasing rates of the serious infections that go beyond the parts of the body usually infected by the disease, said Julia Rogers, an epidemiologist who co-authored the new bulletin.

The number of gonorrhea cases in Alaska actually decreased in recent years, dropping from 2,304 cases in 2022 to 2,079 last year, Rogers pointed out.

Rather, what might be happening is that a particular type of gonorrhea that makes patients more prone to these severe complications is spreading in Alaska, she said.

"Though the exact reason for this increase in disseminated cases is unclear at this time, several factors are likely contributing to the increase, including that certain characteristics of the new gonorrhea sequence types circulating in Alaska's population are more likely to result in disseminated infection and more likely to be asymptomatic upon initial infection (meaning they aren't detected and treated in a timely manner, allowing for severe manifestations like DGI in patients)," she said by email.

Sequences in epidemiology terms refer to genetic patterns, and different strains of pathogens have their own genetic sequences.

State health officials have been working since last fall to boost monitoring and have looked for a possible link between these cases, but they have not identified one yet, the bulletin said.

Of the 35 DGI patients identified in 2023 and 2024, most were in Anchorage, according to the epidemiology bulletin. The most common medical complication was septic arthritis, an infection of joint fluids and joint tissues, the bulletin said. Thirty-one patients were hospitalized, and most of those had to have invasive treatments, including two valve replacements, the bulletin said.

Originally published by the Alaska Beacon, an independent, nonpartisan news organization that covers Alaska state government.

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