Each year, approximately 1.6 million cases of chlamydia and 600,000 cases of gonorrhea are diagnosed across the United States. While some individuals receive diagnoses through clinics or at-home testing, manny rely on their primary care clinicians.A recent study highlights a concerning trend: patients may not be adhering to prescribed treatments or receiving the most effective antibiotics.

The Study: Unveiling Treatment Disparities

Researchers from Stanford University and the Centers for Disease Control and Prevention (CDC) conducted a study analyzing data from the PRIME registry. This registry encompasses a representative sample of 2,000 primary care clinicians nationwide. The study aimed to assess the timeliness of treatment initiation and adherence to CDC-recommended guidelines for chlamydia and gonorrhea.

The research team examined 6,678 chlamydia cases and 2,206 gonorrhea cases diagnosed by primary care clinicians between 2018 and 2022. The findings revealed significant gaps in the treatment process.

Key Findings: Treatment Rates and Delays

• Treatment Rates: Approximately 75% of chlamydia cases and 70% of gonorrhea cases were treated within 30 days of diagnosis. However, roughly 30% of both chlamydia and gonorrhea cases went untreated.
• Reasons for Untreated Cases: This often stemmed from patients not returning for their results or failing to seek treatment after receiving their results, possibly via phone or online portals.

As the study notes, this doesn’t meen the primary care clinician didn’t offer treatment.Rather, it usually means that the patient didn’t return for their results or got their results (possibly over the phone or through a portal) but didn’t return for the treatment.

Barriers to Access: A Two-Visit Hurdle

In-office STI testing and treatment typically require two separate visits, posing challenges for individuals facing various obstacles:

• Lack of health insurance
• Transportation difficulties
• Inflexible work schedules
• Housing instability or lack of a permanent address
• Limited access to communication (e.g., no phone)

These barriers can prevent individuals from receiving timely results and necesary treatment.

Disparities Among Groups: Unequal Treatment

Treatment rates varied considerably across different demographic groups:

• Gender: Women exhibited higher treatment rates than men (78% vs. 67% for chlamydia; 79% vs. 51% for gonorrhea).
• Race/Ethnicity: Non-Hispanic White patients had the highest treatment rates (76.8% for chlamydia; 73.5% for gonorrhea).
• Location: suburban residents showed higher treatment rates (78% for chlamydia; 83% for gonorrhea) compared to urban residents.

the median time between diagnosis and treatment also varied, with shorter durations observed for non-Hispanic Whites, women, and suburban residents.

Antibiotic choices: Deviations from CDC Guidelines

Among those who received treatment, a significant portion did not receive the CDC’s recommended first-line antibiotics:

• Chlamydia: Only 14% received doxycycline, the CDC-recommended treatment.
• Gonorrhea: Only 39% received ceftriaxone, administered via injection.

Instead, azithromycin was more commonly prescribed. While the study data does not explain the rationale behind these choices, researchers suggest that the convenience of a single oral dose of azithromycin may be a factor.Though, this raises concerns about effectiveness and the growing threat of antibiotic resistance.

The Importance of Timely Treatment

The study underscores the critical need to address gaps in chlamydia and gonorrhea treatment. These infections are curable, but untreated cases can lead to severe health consequences, including infertility. Furthermore, prompt treatment is essential for preventing further transmission.

The authors emphasize the need for enhanced education for both patients and providers regarding the importance of timely treatment and adherence to recommended guidelines.