Empiric Treatment for Gonorrhea Among Patients with Cervicitis: Evaluation of a Recommendation in the CDC 2006 Sexually Transmitted Diseases Treatment Guidelines

Background:
The Centers for Disease Control and Prevention (CDC) 2006 Sexually Transmitted Diseases (STD) Treatment Guidelines recommend that when providing presumptive treatment for cervicitis, in addition to medication for chlamydia (CT), concurrent therapy for gonorrhea (GC) is indicated if GC prevalence is >5% in the patient population. All women seen for an STD evaluation at New York City (NYC) Department of Health and Mental Hygiene (DOHMH) Bureau of Sexually Transmitted Disease Control (BSTDC) clinics are tested for CT and GC using nucleic acid amplification tests.

Objective:
To determine if there is a subset of patients for whom empiric treatment for cervicitis should include medication for both CT and GC.

Method:
Clinic electronic medical record data from June 2006–June 2007 were analyzed. Overall and age-specific GC prevalence was measured among all females, and among females diagnosed with cervicitis on the day of visit.

Result:
Among females attending BSTDC clinics, GC prevalence was 2.8% (ages <15, 10.6%; 15-19, 3.7%; 20-24, 3.1%; 25-29, 1.9%; 30-34, 2.1%). Among 6191 females with cervicitis, 193 (3.1%) had a positive GC test. Highest rates of GC co-infection were 17.7% (3/17) in 10-14 year old females with cervicitis, followed by 6.2% (68/1103) in 15-19 year olds, and 3.1% (66/2100) in 20-24 year olds.

Conclusion:
The overall GC prevalence in BSTDC clinics is lower than the cut point recommended for empiric treatment for GC. For the few females aged <15 years who attend BSTDC clinics and are diagnosed with cervicitis on the day of visit, prevalence of GC is high and empiric treatment may be warranted for that age group.

Implications:
Programs may need to modify CDC STD Treatment Guidelines recommendations to make appropriate treatment decisions regarding their STD clinic patients, and to make practical implementation feasible. The risks of unnecessary GC treatment should be considered.