Improving antimicrobial stewardship in an urban STI clinic: from syndromic management to targeted antibiotic treatment of male urethritis using point-of-care chlamydia and gonorrhea testing

Background The Centers for Disease Control and Prevention (CDC) has identified drug-resistant Neisseria gonorrhoeae as an urgent public health threat, highlighting the importance of antimicrobial stewardship. This study evaluated the implementation of point-of-care (POC) nucleic acid amplification (NAA) testing for chlamydia and gonnorhea among males presenting with urethritis at an urban public sexually transmitted infections (STI) clinic. Methods POC urine NAA testing was performed for males presenting with symptoms of urethritis and/or urethral discharge, as well as asymptomatic males reporting STI exposure. Patients with with laboratory-confirmed infections were treated according to CDC STI treatment guidelines: for chlamydia, patients were treated with doxycycline 100 mg orally twice daily for 7 days; for gonorrhea, patients were treated with a single 500-mg intramuscular dose of ceftriaxone. Patients testing negative for both infections were managed for non-gonococcal urethritis with doxycycline, or in select cases, received no empiric therapy. Reductions in antibiotic use were compared with standard syndromic management. Results A total of 385 POC tests were analysed. Gonorrhea was detected in 40 patients (10.4%), chlamydia in 29 (7.5%), and both infections in five (1.3%), while 311 (80.8%) were negative. Forty-seven patients received ceftriaxone, representing an absolute reduction of 338 doses (87.8% relative reduction). Doxycycline was dispensed to 193 patients, representing an absolute reduction of 192 doses (49.9% relative reduction). Conclusions Implementation of POC NAA testing for chlamydia and gonorrhea in male patients presenting with urethritis improved antimicrobial stewardship by significantly reducing unnecessary empiric use of antibiotics in an urban STI clinic setting.