Factors Associated with Delayed Chlamydia Treatment, Massachusetts, 2015

Background: We examined factors associated with delayed chlamydia treatment to inform health services planning.

Methods: All laboratory-confirmed chlamydia cases reported to the Massachusetts Department of Public Health in 2015 were categorized as metropolitan or non-metropolitan (micropolitan, small town, rural) by home address using US Census census tract data. We sampled all non-metropolitan cases and an equivalent number of metropolitan/unknown address cases at random, and conducted clinician phone interviews through May 2016. Cases were excluded if: prior infection in 2015, not Massachusetts resident, homeless, incarcerated, clinician unavailable for interview, or treatment information unavailable. Adjusted odds (aOR) of treatment delay (defined as ≥4 days from specimen collection to antibiotic initiation) were calculated using multivariate logistic regression in SAS 9.3.  

Results: There were 224 metropolitan and 200 non-metropolitan cases. Overall, mean age was 25.8 years, 172 (40.6%) were male, 230 (54.3%) were non-Hispanic white, 58 (13.7%) were reported contacts to chlamydia cases, 164 (38.7%) were symptomatic, and 214 (50.5%) were treated by physicians. Of males, 52 (30.2%) reported sex with only men or men and women (MSM/MSMW); of females, 46 (18.2%) were pregnant. Mean test turnaround time was 2.8 days (range 0-15 days), mean travel distance was 12.8 miles, and 179 (42.2%) had delayed treatment. Among men, asymptomatic vs. contact (aOR=14.4), test turnaround time ≥3 days (aOR=3.8), and MSM/MSMW vs. MSW (aOR=3.4) were associated with delayed treatment. Among women, asymptomatic or symptomatic vs. contact (aOR=16.1 and 11.3, respectively), and test turnaround time ≥3 days (aOR=8.7) were associated with delayed treatment. Delayed treatment was not associated with age, race, pregnancy status (in women), treating facility, provider type, metropolitan status, or distance traveled, in either men or women.

Conclusions: Nearly one-third of male chlamydia cases reported same-sex engagement. There were extrinsic and intrinsic factors associated with delayed treatment. Shorter laboratory test turnaround time may result in fewer treatment delays.