Rescreening for gonorrhea: an evaluation of compliance methods and results.

Abstract

To evaluate the cost-effectiveness of a routine rescreening (RS) culture several weeks after treatment for gonorrhea, as well as the specific efforts to ensure return visits, we followed 438 consecutive patiehts, 347 men and 91 women. Return visit compliance rates were 70 per cent for a test-of-cure culture, 27 per cent for a six-week RS, and 15 per cent at 12 weeks. The program detected seven cases of gonorrhea at $796 per case. In our clinic, RS is not a costeffective way to control gonorrhea. (Am J Public Health 69:1178-1180, 1979.)The Venereal Disease Control Division of the Center for Disease Control (CDC) in Atlanta, GA, has recommended that additional efforts be made to follow-up patients treated for gonorrhea.* It is reasoned that patients who acquire gonorrhea at least once are those most likely to acquire gonorrhea again. To systematically evaluate the costs and benefits from intensified follow-up efforts, the Denver (Colorado) Metro Health Clinic (DMHC) conducted a prospective study of a sequence of methods for motivating patients to return for test-of-cure (TOC) and rescreening (RS) cultures. We also sought to better define patient characteristics associated with compliance behavior. MethodsFrom January 15 to April 7, 1976, 347 16, 1979. complicated anogenital gonorrhea were instructed to return for a TOC in three to five days and RS in six and 12 weeks.To obtain patient compliance, four motivational methods were used in a sequence determined by anticipated costeffectiveness (Figure 1). The clinician informed the patient about the complications of gonorrhea, initiated a contactcard system,' and explained the rationale for a TOC. When the patient returned for a TOC, the clinician explained the rationale for RS. At each visit, the patient was given an appointment card with the date entered for the next follow-up culture.We attributed any non-contact case detected duning a designated follow-up period to the most recently used motivational method. We did not attribute a gonorrhea case to RS efforts if the patient returned with symptoms before a scheduled appointment or at any time as a result of contact investigation.We compared the cost-effectiveness of each method based upon the unit cost of bringing a new case of previously undetected gonorrhea to treatment. Costs included clinician labor related to follow-up visits; secretarial labor in telephoning and filling out and posting letters; field investigator's labor and supervision; and the additional clinic visits generated at a 1976 average of $12.75 per visit. Indirect costs were not included.Gonorrhea was diagnosed by CDC recommended culture techniques.2 Patients were assigned by a random card system to receive the CDC recommended treatment schedule3 of procaine penicillin G, tetracycline hydrochloride, or spectinomycin. Women were not offered tetracycline and patients with a history of penicillin allergy received tetracycline (men) or spectinomycin (women).tCorrelations were made between TOC compliance behavior and sex, race, sexual ...

Chlamydial and gonococcal reinfection among men: a systematic review of data to evaluate the need for retesting

“…[31][32][33][34] However, there is no recent compilation of the literature about gonococcal reinfection in men and no review has been published to date about chlamydial reinfection in men. We Abbreviations: EPT, expedited partner treatment; NAAT, nucleic acid amplification test; STI, sexually transmitted infection ÀRepeat chlamydia/gonorrohea defined as either chlamydial or gonococcal infection in men coinfected with chlamydia and gonorrhoea at baseline.…”