Many STD-Negative Patients Receive Unnecessary Antibiotics

More than three-quarters of patients given antibiotics to treat a suspected sexually transmitted disease (STD) like gonorrhea or chlamydia don’t actually test positively for the disease.

New study results highlighted the important role that retail clinicians and other health care professionals can play in antimicrobial stewardship.

“I think pharmacists are essential partners in antibiotic stewardship with valued knowledge and experience,” study author Karen Jones, MPH, BSN, RN, CIC, an infection preventionist at St. John Hospital & Medical Center, toldContemporary Clinic.“Antibiotics are prescribed in situations outside of the inpatient setting, such as this study suggests, and their expertise is appreciated.”

Jones spent nearly 15 years as an emergency department (ED) nurse and saw patients as they were getting tested and treated, but she wasn’t usually aware of the testing outcome because of the lengthy time period it took to get results.

“There are many challenges from a health care provider’s point of view in the ED—it’s busy and often chaotic,” Jones said. “Testing and sending the patient home without treatment isn’t always the best option when considering the time spent trying to contact patients afterward (since the information is not always accurate or patients may not want to be contacted), and there could be additional risk of disease spread if treatment is delayed.”

In the study, 76.6% of patients treated for a suspected STD had cultures that tested negative forNeisseria gonorrheaandChlamydia trachomatis.

Around 1100 patients’ genital cultures were tested over a 2-month period in the study. The ages of the patients ranged from 14 to 67 years, and the majority of the subjects were women and African-American.

Around one-third of the subjects had previously been diagnosed with an STD, while around 13% stopped by the ED because of “possible exposure” and didn’t show any symptoms.

The researchers found that 40% of the subjects were treated with antibiotics for gonorrhea or chlamydia, and 60% were not. Around 13% eventually tested positive for 1 or both of those STDs.

In addition to the three-quarters of patients who didn’t test positive but were given antibiotics, the researchers also found that 7% of patients not treated did test positive for gonorrhea and/or chlamydia.

Men who had STD cultures taken were more likely to test positive for an STD than women. Dysuria, vaginal discharge, vaginal bleeding, or nausea and/or vomiting weren’t associated with a positive test result.

Notably, around 21% of patients who presented with “STD check/possible exposure” actually tested positive for one or both of the STDs.

The high percentage of patients receiving unnecessary antibiotics is problematic for several reasons, including wasted medical costs, antibiotic use complications, and antibiotic resistance. The researchers suggested that focusing on clinical predictors could help curb unnecessary antibiotic prescribing. Health care providers should conduct a detailed history and physical exam, and a decision-making algorithm may be useful in addressing treatment of suspected STDs.

“Educating patients to seek primary health care providers in non-emergent settings when appropriate (such as STD testing) must be done through public health initiatives; partnering with the local public health department will allow patients better linkage to health care,” the researchers added.

Untreated STDs can cause serious reproductive health issues, like infertility, fetal health issues, and some cancers. Health care providers must balance treating a potential STD in the ED and risking unnecessary antimicrobial use versus not treating an infection promptly and losing the patient in the aftermath of discharge.