An Evaluation of New CDC Performance Measures on Timely Treatment of Females Diagnosed with Chlamydia or Gonorrhea in STD Clinics

Background:
In 2007, the CDC added two new performance measures (PM) for STD clinics on the timely treatment (within 14 and 30 days of specimen collection) of females diagnosed with Chlamydia (CT) or Gonorrhea (GC).

Objective:
To evaluate the new PMs and to identify associated practices that impact the PMs.

Method:
From January to June of 2007, time-to-treatment for females diagnosed with CT or GC in 13 Los Angeles STD clinics was analyzed including presumptive treatment on the day of specimen collection. Presumptive treatment was recorded on a clinic intake form and considered appropriate when signs/symptoms were present, patient was a known contact to a case, or had a positive test done elsewhere.

Result:
Of the 607 CT-positive females, 87% and 92% were treated within 14 and 30 days, respectively. Over 75% were presumptively treated on the day of presentation; of those with intake forms, an estimated 98% were appropriately treated. Of those not presumptively treated, 63% had justification for presumptive treatment. Of the 194 GC positive females, 77% and 84% were treated within 14 and 30 days, respectively. Nearly 65% were presumptively treated, of which 96% were appropriate. Of those not presumptively treated, 75% had justification for presumptive treatment.

Conclusion:
Most CT/GC was treated on presentation and more could have been identified and appropriately treated presumptively. These PMs should include a category for treatment at time of specimen collection.

Implications:
Presumptive treatment provides an opportunity for earlier treatment and minimization of loss-to-follow-up. Including a category for treatment on the day of specimen collection in the PMs would also allow STD clinics to assess their policy on presumptive treatment.