LOS ANGELES — Physicians mostly fail to follow up with adolescent patients they treat for a chlamydia infection, as recommendations state they should, according to a study conducted with the records from five Northern California pediatric clinics.
Only 10% of 122 patients testing positive for a Chlamydia trachomatis infection at the clinics received appropriate retesting, and many also did not appear to have been counseled about safer sex, did not notify their partners, or were not tested for other STDs, Loris Hwang, M.D., and her colleagues said in a poster presentation at the annual meeting of the Society for Adolescent Medicine.
Antibiotic resistance is not considered a problem with chlamydia, so treatment generally is successful and a follow-up visit is not necessary to test for cure. Rather, the reason for follow-up is because those who get infected tend to return to the same “sexual networks” where they got the infection in the first place, said Dr. Hwang of the University of California, San Francisco.
Because the study was conducted at clinics that were all part of the Kaiser Permanente system, an HMO where return visits would presumably be fairly easy for patients, “the situation is probably worse in other clinics,” Dr. Hwang said in an interview.
Guidelines for chlamydia treatment from the Centers for Disease Control and Prevention recommend that patients have one follow-up visit for retesting at 3–4 months following a treatment visit, and then another within 12 months. Retesting at less than 3 weeks from treatment is specifically not recommended because nonculture tests can remain positive for that amount of time.
There were 122 individuals in the study, and 97% received appropriate antibiotics; of those, 22% were retested within 3 weeks of treatment. An additional 17% were retested after 3 weeks but before 3 months. And, 10% received retesting at some time after 3 months and before 12 months.
The remaining patients either had another visit but were not retested, were advised to return but did not, or had no records about a follow-up visit.
Regarding the other recommendations in the CDC guidelines, Dr. Hwang and her colleagues found that the physicians tended to do better with the female patients than the males.
Eighty-three percent of the study's 96 adolescent women were counseled on safer sex, compared with 62% of the study's 26 adolescent men. Thirty-eight percent of the women were screened for other sexually transmitted diseases, compared with 31% of the men. And, partners were notified or treated for 57% of the females, but only 31% of the men.