Use of a Rapid Diagnostic for Chlamydia Trachomatis and Neisseria Gonorrhoeae for Women in the Emergency Department Can Improve Clinical Management: Report of a Randomized Clinical Trial

Methodology: 3/5          
Usefulness: 2.5/5

Gaydos CA et al. Ann Emerg Med. 2019 Jul;74(1):36-44. doi: 10.1016/j.annemergmed.2018.09.012. Epub 2018 Nov 2.

Question and Methods: RCT of women receiving pelvic testing for CT/NG comparing standard of care test (NAAT) vs. POC test (GeneXpert). Treatment was at the discretion of the clinician

Findings:

• CT undertreatment rate difference –46.2%; 95% CI -73.3% to -19.2%
• NG undertreatment rate difference –57.1%; 95% CI -93.8% to -20.5%
• CT Overtreatment rate difference –23.4%; 95% CI –35.3% to –11.5%
• NG Overtreatment rate difference –21.3%; 95% CI –33.1% to –9.5%

Limitations: Single urban inner city ED with small sample sizes; patients in rapid test group not required to wait for results; patients treated at clinician discretion.

Interpretation: Point of care testing for STI may optimize treatment and be of particular benefit in certain populations but more research is needed.

By: Dr. Lindsay Cheskes