A large national study found that most patients in U.S. primary care may not receive Centers for Disease Control and Prevention–recommended antibiotics for chlamydia and gonorrhea.
Investigators reviewed electronic health records from 2018 to 2022, identifying 6,678 confirmed chlamydia cases and 2,206 gonorrhea cases from over 2,000 clinicians. Among these, 75.3% of chlamydia cases and 69.6% of gonorrhea cases were treated within 30 days of a positive test.
However, just 14% of chlamydia cases were treated with doxycycline, the recommended antibiotic. Azithromycin, no longer a first-line treatment because of its reduced efficacy, was used in 83.9% of treated cases.
For gonorrhea, 38.7% of patients received the recommended antibiotic ceftriaxone. Azithromycin alone—discouraged as a result of resistance concerns—was the most common regimen, used in 59.5% of treated cases.
“Guideline adherence remains suboptimal for chlamydia and gonorrhea treatment across primary care practices. Efforts are needed to develop interventions to improve quality of care for these sexually transmitted infections [STI],” said lead study author Shiying Hao, of the Center for Population Health Sciences at Stanford University, Calif., and colleagues.
Time to treatment also varied. Among treated patients, 85% received antibiotics within 7 days of a positive test, with a median time of 3 days. Nearly 20% were treated on the same day as their test result.
Women were more likely compared with men to receive treatment. For chlamydia, 78.4% of women were treated compared with 67.2% of men. For gonorrhea, treatment rates were 78.9% among women versus 51.4% among men.
Patients aged 10 to 29 years had the highest treatment rates. Suburban residents were more likely to be treated compared with those in urban or rural areas.
Treatment delays were more common among certain groups. Patients with chlamydia aged 50 to 59 years experienced a 61% longer time to treatment compared with those aged 20 to 29 years. Non-Hispanic Black patients also had longer delays compared with non-Hispanic White patients.
Coinfection was associated with higher treatment rates. Among gonorrhea cases, 76.4% of patients with a chlamydia coinfection received treatment versus 60.1% without coinfection.
The investigators cited multiple factors potentially contributing to treatment gaps, including delays in test result availability, prescribing patterns, and patient-related concerns such as medication adherence or preferences.
The findings highlight the need for improved STI management in primary care, clinician education, and guideline implementation to ensure appropriate and timely treatment.
Full disclosures are available in the study publication.
Source: Annals of Family Medicine