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Epidemiologic and prophylactic treatment of gonorrhea: a decision analysis review.

Abstract：

:This review of the treatment of patients exposed to gonorrhea uses decision analysis techniques to estimate and compare the probabilities of disease and treatment risks for epidemiologic treatment, for treatment contingent on results of gram stains and culture, and for treatment contingent on culture results alone. Epidemiologic treatment refers to antibiotics administered when a diagnosis is considered likely on clinical, laboratory, or epidemiological grounds, but before the results of confirmatory laboratory tests are known. A series of diagrams depict the various events associated with the 3 methods for men and women seeking treatment because of exposure to gonorrhea who are or are not infected. Estimated probabilities or ranges of probabilities are assigned for the various chance events, including initial infection, laboratory test results, return for treatment, and outcomes of disease or treatment, that divide patients into subgroups. Where possible, published sources were used to obtain estimates of the conditional probabilities; otherwise data reported to the Venereal Disease Control Division (VDCD) of the US Centers for Disease Control by 7 US Public Health Service venereal disease clinics were used. By the use of culture alone, 12-30% of women and 4-13% of men seeking treatment for exposure would be infected but remain untreated, and treatment would be delayed until the return visit for all infected persons. By the use of gram-stained smears and cultures, 4-20% of women and 2-5% of men would but infected by remain untreated. 10-41% of women and 4-15% of men would be treated for their infection, but treatment would be delayed until culture results were received and the patients returned. The VDCD considers the gram stain plus culture approach hazardous because of the large percentage of infected women who remain untreated. The adverse effects of treating uninfected persons are mild or rare. Therefore the risks of the alternative methods are judged to exceed the risks of routine epidemiologic treatment for individuals exposed to gonorrhea.

journal_name

Sex Transm Dis

journal_title

Sexually transmitted diseases

authors

Johnson RE

doi

10.1097/00007435-197904000-00022

subject

Has Abstract

pub_date

1979-04-01 00:00:00

pages

159-67

issue

2 Suppl

eissn

0148-5717

issn

1537-4521

journal_volume

pub_type

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Epidemiologic and prophylactic treatment of gonorrhea: a decision analysis review.