Annals of Emergency Medicine

Use of a Rapid Diagnostic for Chlamydia trachomatisand Neisseria gonorrhoeaefor Women in the Emergency Department Can Improve Clinical Management: Report of a Randomized Clinical Trial

Charlotte A. Gaydos, MA, DrPHcgaidos@jhemi.edu

Study objective

In emergency departments (EDs), diagnosis and treatment of Chlamydia trachomatisand Neisseria gonorrhoeaeare challenging. We conducted a randomized clinical trial to assess rapid C trachomatisand N gonorrhoeaetesting on overtreatment and undertreatment of women evaluated for C trachomatisand N gonorrhoeae.

Methods

Women undergoing pelvic examinations and C trachomatisand N gonorrhoeaetesting (n=254) were randomized to control or rapid test groups. The control group received standard-of-care C trachomatisand N gonorrhoeaenucleic acid amplification tests of endocervical specimens, with 2- to 3-day turnaround times. For the rapid test group, clinicians collected an extra endocervical swab for GeneXpert C trachomatisand N gonorrhoeaerapid testing, in addition to the standard-of-care nucleic acid amplification test swab. Rapid results were immediately provided, and all patients were treated according to providers’ clinical judgment.

Results

In the rapid test group, 7.9% of patients had positive test results for C trachomatis; 3.9% had positive test results for N gonorrhoeae. In the control standard-of-care group, 10.2% of patients had positive nucleic acid amplification test results for C trachomatis; 5.5% had positive results for N gonorrhoeae. Undertreatment for both C trachomatisand N gonorrhoeaein the ED was 0% for the rapid test group and 43.8% for the control standard-of-care group. Clinicians overtreated 46.5% of uninfected standard-of-care control patients for C trachomatiscompared with 23.1% of uninfected rapid test patients. For patients uninfected with N gonorrhoeae, clinicians overtreated 46.7% of standard-of-care control patients compared with 25.4% of rapid test patients. The length of stay did not differ significantly between groups.

Conclusion

RapidC trachomatisand N gonorrhoeaetesting in the ED led to a significant reduction in overtreatment for women without infections compared with the standard-of-care control group. Additionally, in the rapid test group there wassignificant improvement in appropriate treatment for patients with infections.

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