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STDs Disproven in Many ED Patients Prescribed Antibiotics

October 3rd, 2016

DETROIT – Most ED patients treated with antibiotics after presenting with symptoms of gonorrhea or chlamydia were found not to have those sexually transmitted diseases (STDs) after all, according to a new study.

A presentation at the recent 43rd Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC) in Charlotte, NC, reports that 75% of the patients tested negative for the STDs.

For the study to identify the extent of unnecessary antibiotic use, researchers from St. John Hospital & Medical Center in Detroit examined records of more than 1,103 patients who underwent STD testing in the ED. Although genital cultures are routinely collected from patients with signs and symptoms of STDs, results usually are not immediately available and antibiotics are often prescribed without a confirmatory diagnosis, according to the report.

Of 1,103 patients tested, 40% were treated with antibiotics for gonorrhea and/or chlamydia, yet 76.6% were negative for the STDs when the tests came back. Of the 60% who went untreated, on the other hand, only 7% ultimately tested positive for either or both STDs.

"We have to find the appropriate balance between getting people tested and treated for STDs, but not prescribing antibiotics to patients who don't need them," explained lead author Karen Jones, MPH, BSN, RN, infection preventionist. "There is a tricky balance between not furthering antibiotic resistance by over-prescribing, but also still getting people treatment for STDs they might have."

Also examined in the study were how certain symptoms could be associated with positive STD cultures. Results indicate the following:

  • In male patients, 60.3% with penile discharge and 57.5% with inflammation of the urethra tested positive for gonorrhea and/or chlamydia.
  • In female patients, 25% with inflammation of the cervix and 27% with cervical motion tenderness tested positive for gonorrhea and/or chlamydia.
  • Among both sexes, 35% of patients who disclosed they had more than one sex partner also tested positive for gonorrhea and/or chlamydia.

"Focusing on these clinical predictors may improve unnecessary antibiotic prescribing in patients without true disease," Jones suggested.

The presentation also discussed the dilemma faced by many emergency physicians.

“Emergency Department (ED) clinicians must decide whether to treat during the ED encounter or wait — risking disease spread and difficulty contacting patients after discharge,” study authors concluded. “Determining predictive variables for true positive and true negative STD culture results may provide clinical guidance.”