Decreasing Chlamydial Reinfections in a Female Urban Population

Abstract

Background: Chlamydia is the most reported bacterial sexually transmitted infection (STI). The rates of chlamydia rose by 19% between 2011 and 2018. The STI National Strategic Plan (2021-2025, encourages coordinated solutions to address STIs and reduce disparities in disadvantaged populations.

Effect of the COVID-19 Pandemic on Chlamydial Infection Treatment in Women Discharged From an Urban Safety-Net Emergency Unit

“…The increase in offered EPT from 2019 to 2020 was likely influenced by a healthcare improvement initiative that was implemented at the system level mid-August 2019 4,9 . Because the intervention occurred halfway through the pre-COVID year, it is difficult to generalize the findings through the context of pre–COVID-19 and during COVID-19.…”

“…18 The increase in offered EPT from 2019 to 2020 was likely influenced by a healthcare improvement initiative that was implemented at the system level mid-August 2019. 4,9 Because the intervention occurred halfway through the pre-COVID year, it is difficult to generalize the findings through the context of pre-COVID-19 and during COVID-19. Despite the increase in EPT, rates of repeat infections remained consistent between 2019 and 2020, which may be due to the large proportion of pregnant patients in both cohorts, as previous studies have conflicting findings between the effectiveness of EPT in the pregnant patient population versus the general female population.…”

“…Despite the increase in EPT, rates of repeat infections remained consistent between 2019 and 2020, which may be due to the large proportion of pregnant patients in both cohorts, as previous studies have conflicting findings between the effectiveness of EPT in the pregnant patient population versus the general female population. 4,9 In addition, there are different follow-up recommendations on repeat testing between the populations, which further confounds the mixed groups in relation to this secondary outcome. 18 In the future, it is paramount to identify the high-risk populations at the clinical site in which the patient is being seen, as it may be beneficial for clinicians to be more partial to treating high-risk patients empirically rather than waiting for confirmatory results.…”

“…If the patient was successfully reached, the nurse followed a standardized script to (1) notify the patient of their positive result, (2) offer the patient a prescription for antibiotic treatment (if not already treated), and (3) offer EPT prescriptions for anyone the patient had sexual contact with up to 60 days before the CT diagnosis (EPT protocol was added in August 2019). 9 If a prescription for partner treatment was offered but not given, the note included the reason not accepted. For patients concomitantly infected with CT and Neisseria gonorrhoeae, the nurse offered a referral to the county health services where the patient's partner could receive treatment for both infections.…”

2021 CDC Update: Treatment and Complications of Sexually Transmitted Infections (STIs)

“…Alternative regimens include azithromycin 1 g PO × 1 or levofloxacin 500 mg PO daily × 7. Although rates of adherence to doxycycline's longer course, compared to azithromycin's single dose, have perennially been called into question [35,36], doxycycline appears to have a higher efficacy rate, even with suboptimal compliance to treatment [37,38]. Indeed, doxycycline is effective against urogenital, rectal, and oropharyngeal infections.…”