The Relationship Between Directly Observed Therapy for Chlamydia Infections and Retesting Rates in an Adolescent Population

BACKGROUND

Chlamydia trachomatis is the most common reportable sexually transmitted infection in the United States, with >60% of reported cases occurring in individuals aged 15 to 24 years. US practice guidelines recommend directly observed therapy (DOT) for the treatment of chlamydia in adolescents, but almost no research has been done to evaluate whether DOT results in improved outcomes.

METHODS

We conducted a retrospective cohort study of adolescents who sought care at 1 of 3 clinics within a large academic pediatric health system for a chlamydia infection. The study outcome was return for retesting within 6 months. Unadjusted analyses were performed using χ2 , Mann-Whitney U , and t tests, and adjusted analyses were performed using multivariable logistic regression.

RESULTS

Of the 1970 individuals included in the analysis, 1660 (84.3%) received DOT and 310 (15.7%) had a prescription sent to a pharmacy. The population was primarily Black/African American (95.7%) and female (78.2%). After controlling for confounders, individuals who had a prescription sent to a pharmacy were 49% (95% confidence interval, 31%-62%) less likely than individuals who received DOT to return for retesting within 6 months.

CONCLUSIONS

Despite clinical guidelines recommending the use of DOT for chlamydia treatment in adolescents, this is the first study to describe the association between DOT and an increase in the number of adolescents and young adults who return for sexually transmitted infection retesting within 6 months. Further research is needed to confirm this finding in diverse populations and explore nontraditional settings for the provision of DOT.

A Joinpoint Regression Analysis of Syphilis and Gonorrhea Incidence in 15-19-Year Old Adolescents between 2005 and 2017: A Regional Study

Background and Objectives: Surveillance of syphilis and gonorrhea in Romania is case-based and makes use of European case definitions. Adolescence is a period characterized by vulnerabilities and opportunities, a period when health decisions, including those related to sexually transmitted infections, may have a lifetime impact. The present study investigates the trends recorded in the incidence of syphilis and gonorrhea in 15-19 year-old adolescents in the central and northwestern regions of Romania. Materials and Methods: An observational study was conducted and this included surveillance data for syphilis and gonorrhea in the period 2005-2017 (n = 939). The distribution of demographic and epidemiological variables in adolescents with syphilis and gonorrhea was evaluated, as well as the tendency of the incidence of syphilis and gonorrhea in the studied population. Joinpoint regression analysis was used to characterize the incidence trend for syphilis and gonorrhea. Results: Between 2005 and 2017, 773 cases of syphilis and 166 cases of gonorrhea were reported. The incidence of syphilis and gonorrhea decreased. Most cases of syphilis have been found out by active detection. Most cases of gonorrhea have been found out by passive detection. The age distribution in the group diagnosed with syphilis was similar to that in the group diagnosed with gonorrhea. There was a higher frequency of syphilis in females and gonorrhea was more common in males. Syphilis was more common in rural areas. Gonorrhea was more common in urban areas. Conclusions: There was a decreasing tendency in the incidence of syphilis and gonorrhea in adolescents aged 15-19 during the studied period.