NASPAG/JPAG roundtable discussion annual clinical meeting 2003–Philadelphia, PA

Cervicitis: To Treat or Not To Treat? The Role of Patient Preferences and Decision Analysis

“…Due to re-infection by untreated partners [26,27], we estimated that with empiric treatment of cervicitis patients and test-based treatment of their partners, 21 teenagers would develop PID. Based on 5% false-negative test results [29,30], treatment delays, loss to follow-up, and re-infection by untreated partners [8,9,22,23,26,27], we estimated that with nonempiric treatment, 46 teenagers would develop PID.…”

“…The utility of empirically treating cervicitis patients and their sexual partners for CT and GC might be questioned more frequently if the consequences of not treating these sexually transmitted diseases (STDs) were less dire. However, with the annual treatment costs of pelvic inflammatory disease (PID) approximately 2 billion dollars in the United States [7], concerns about the consequences of under-diagnosis and under-treatment usually overshadow concerns about the consequences of overdiagnosis and over-treatment [1][2][3][4]8].…”

“…In comparison with most other groups, they have higher sexually transmitted disease (STD) prevalence rates, are especially vulnerable to the adverse reproductive consequences of untreated STDs, and are generally perceived as noncompliant with follow-up [1,8]. However, taken together, the low positive predictive value of mucopurulent cervicitis for treatable infections [2][3][4][5][6], the futility of treating index cases if their sexual networks are not treated [9 -11], the adverse psychological effects of being diagnosed with an STD [12][13][14][15][16][17], and the serious public health problem created by the indiscriminate use of antibiotics [18], raise serious concerns about the wisdom of empirically treating this common gynecologic problem as an STD.…”

“…Pelvic inflammatory disease (PID), the most common sequelae of CT and GC cervicitis, develops in 10 -40% of untreated women, but only 3-5% of treated women [8,22,23]. Almost half of women who develop PID also develop costly complications ranging from chronic pelvic pain to ectopic pregnancy and infertility [7,[22][23][24][25].…”

“…We demonstrate how empiric and nonempiric treatment affect the ratio of physical to psychological sequelae incurred and the ratio of physical sequelae prevented to psychological sequelae caused. Because GC is isolated from teenage cervicitis patients far less commonly than CT [1,8], we limited our analysis to CT-related morbidity.…”