The name of the article I chose was “Presumptive and Follow-up Treatment for Gonorrhea and Chlamydia Among Patients Attending Public Health Department Clinics in Virginia, 2016” by Pugsley, River A. PhD, MPH, Peterman, Thomas A. MD, MSc. It was published to the Journal of American Sexually transmitted diseases in 2019. This article is based on a retrospective cross-sectional analysis of data from patient visits with valid CT/GC laboratory test results who attended local health department clinics in Virginia in 2016. The point of the study was to calculate how often patients with positive CT/GC tests were treated on the same day as the initial testing visit or during a follow-up visit within 1 to 30 days of the specimen collection date. They also calculated how many patients with negative tests were treated presumptively. Of 63,889 patient visits with valid laboratory results from 131 local health department clinics, 13% had a positive CT or GC test result: 17% of the STD clinic patients and 7% of the FP clinic patients. Overall, 45% of patients with positive tests were treated presumptively whereas 10% of patients with negative tests were treated presumptively. Among the 9443 patients presumptively treated, 41% had positive test results. It concluded that resumptive treatment for persons with positive tests was significantly more common among patients diagnosed in STD clinics compared with FP clinics, as was presumptive treatment for persons with negative tests.  The study further concluded that there is some concern that presumptive treatment for CT/GC may result in over-treatment and potentially lead to antibiotic resistance, adverse effects, and waste of limited health department resources. 

     Although presumptive treatment for CT/GC in this clinic population resulted in some apparent over-treatment, it may be warranted as untreated patients did not always return quickly, or at all, for follow-up treatment, thus increasing the risk of under-treatment, potential for medical complications, and further transmission of infection. Among infected patients not presumptively treated, 26% remained untreated after 30 days. In addition, it states that the threat of antibiotic resistance due specifically to presumptive treatment is small, particularly when applied to public health department settings which dispense only a fraction of these very common antibiotics. Factoring in costs, the financial cost of presumptive treatment in Virginia’s health department clinics was just US $2 per patient for dual therapy with ceftriaxone and azithromycin in 2016. The cost of treating uninfected patients is far outweighed by the benefit from prompt treatment and the reduced need for follow-up clinic visits.  Despite the findings of this study further research is needed to see if presumptive treatment reduces the likelihood of partner notification. Patients may be less likely to tell a partner about a presumed infection than a diagnosed infection. This study has some limitations for example, the lack of information about patient symptoms and exposure status in the administrative dataset is a major limitation of this study, as they were missing key information about provider rationale in deciding whether to treat presumptively. All procedures performed during the clinic visits were captured by this data system, but results of physical examinations and other medical observations were not. Similarly, they defined presumptive treatment as treatment administered on the same day as specimen collection for CT/GC laboratory testing, not based on actual clinician documentation. In terms of the measurement of under-treatment, they did not look beyond a 30-day window after testing, and it is possible that patients received treatment at facilities.