(P139) IT ISN’T WHAT YOU KNOW, IT IS WHO YOU KNOW. EPIDEMIOLOGIC TREATMENT OF CONTACTS TO CHLAMYDIA TRACHOMATIS AND/OR NEISSERIA GONORRHOEAE IN SEXUALLY TRANSMITTED INFECTION CLINIC PATIENTS FROM 5 U.S. CITIES, STI SURVEILLANCE NETWORK, JANUARY 2021-JUNE 2023

Wednesday, September 18, 2024

4:15 PM - 5:15 PM EST

Primary Author(s)

Eloisa Llata, MD MPH

Medical Epidemiologist
CDC
Decatur, Georgia, United States

Co-Author(s)(s)

Christina M. Schumacher, PhD, MHS (she/her/hers)

Assistant Professor
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States
JB

Jamie Black, MPH

Indiana Department of Health
Jennifer Tang, MS (she/her/hers)

Data Analyst
NYC Health Department, United States
LA

Lenore Asbel, MD

Philadelphia Department of Public Health
Roxanne P. Kerani, PhD, MPH (she/her/hers)

Research Associate Professor
University of Washington
Seattle, Washington, United States

Background:
Treatment of sex partners of persons diagnosed with chlamydia (CT) or gonorrhea (GC) without a confirmed infection likely results in overuse of antibiotics, contributing to antimicrobial resistance. We characterized treatment practices among CT and GC contacts in six STI clinics participating in the STI Surveillance Network.

Methods:
We conducted a cross-sectional analysis of clinic visits of patients reporting being CT and/or GC contacts from 1/1/2021-6/30/2023. Visits were evaluated by sex and sex of sex partners (women, men who have sex with men [MSM], men who have sex with women only [MSW]), symptoms, and same-day CT/GC testing and treatment with an antimicrobial appropriate for each diagnosed pathogen. Overtreatment (contacts who were tested/treated but subsequently tested negative) was the primary outcome.

Results:
Of 114,997 visits, 6,306 (6%) CT contact and 4,013 (4%) GC contact visits were identified. Among CT contact visits, 2,002 (32%) were among MSM, 2,977 (47%) among MSW and 1,327 (21%) among women. Among GC contact visits, 2,343 (58%) were among MSM, 986 (25%) among MSW and 684 (17%) among women. In 65% of the CT and 68% of the GC contact visits, same-day test results were subsequently negative, regardless of same-day treatment. Symptomatic contacts were tested and treated (93%, 95% confidence Interval (CI) 92-94%) more often than those without symptoms (88%, 95% CI 86-88%). CT overtreatment did not differ across the three groups (MSM 53%, 95% CI 51-55%); MSW 50%, 95% CI 48-51%; women 51%, 95% CI 48-53%). However, GC overtreatment was higher among MSM (39%, 95% CI 37-41%) vs. MSW (15%, 95% CI 14-16%) and women (14%, 95% CI 12-15%).

Conclusion:
Overtreatment occurred in more than half of CT contact visits. Although GC overtreatment was less common, over a third of MSM were overtreated. Implementation of sensitive point-of-care tests may be useful in balancing individual clinical care while optimizing antimicrobial use.