Near-to-patient-testing to inform targeted antibiotic use for sexually transmitted infections in a public sexual health clinic: the NEPTUNE cohort study

Lenka A Vodstrcil; Kay Htaik; Erica L Plummer; Vesna De Petra; Melodi G Sen; Deborah A Williamson; Jason J Ong; Jason Wu; Monica Owlad; Gerald Murray; Eric P F Chow; Christopher K Fairley; Catriona S Bradshaw

doi:10.1016/j.lanwpc.2023.101005

Near-to-patient-testing to inform targeted antibiotic use for sexually transmitted infections in a public sexual health clinic: the NEPTUNE cohort study

Lenka A Vodstrcil^*, Kay Htaik, Erica L Plummer, Vesna De Petra, Melodi G Sen, Deborah A Williamson, Jason J Ong, Jason Wu, Monica Owlad, Gerald Murray, Eric P F Chow, Christopher K Fairley, Catriona S Bradshaw^*

^*Corresponding author for this work

School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Empiric treatment of sexually transmitted infections can cause unnecessary antibiotic use. We determined if near-to-patient-testing (NPT) for Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium (MG) improved antibiotic-use for a range of clinical presentations.

Methods: Clients attending with non-gonococcal urethritis (NGU), proctitis, as STI-contacts, or for an MG-test-of-cure (MG-TOC) between March and December 2021 were recruited. Participants received near-to-patient-testing (NPT-group) for the three STIs using the GeneXpert® System (Cepheid), and concurrent routine-testing by transcription-mediated-amplification (TMA; Aptima, Hologic). Antibiotic-use among NGU or proctitis cases in the NPT-group was compared to clinic-controls undergoing routine-testing only. The proportion in the NPT-group who notified partners <24 hrs of their STI-specific result was calculated.

Findings: Among 904 consults by 808 NPT-participants, ≥1 STI was detected in 63/252 (25.0%) with NGU, 22/51 (43.1%) with proctitis, and 167/527 (31.7%) STI-contacts. MG was detected among 35/157 (22.3%) MG-TOC consults. Among NGU and proctitis cases, fewer in the NPT-group received empiric treatment compared to clinic-controls (29.4% [95% CI: 24.3-34.9%] vs 83.8% [95% CI: 79.2-87.8%], p < 0.001), resulting in more NPT-group cases appropriately treated (STI-specific drug/no drug appropriately; 80.9% [95% CI: 76.0-85.1%] vs 33.0% [95% CI: 27.7-38.6%], p < 0.001) and fewer mistreated (incorrect drug/treated but pathogen-negative; 17.8% [13.7-22.6%] vs 61.4% [55.6-66.9%], p < 0.001). Of 167/264 in the NPT-group with an STI who responded regarding partner-notification, 95.2% notified all/some partners; 85.9% notified them <24 hrs of the STI-specific result.

Interpretation: Near-to-patient-testing significantly improved antibiotic use and a high proportion of individuals rapidly notified partners of STI-specific results, highlighting the broad benefits of timely diagnostic strategies for STIs in clinical decision making and partner notification.

Original language	English
Article number	101005
Pages (from-to)	1-15
Number of pages	15
Journal	The Lancet Regional Health. Western Pacific
Volume	44
Early online date	12 Jan 2024
DOIs	https://doi.org/10.1016/j.lanwpc.2023.101005
Publication status	Published - Mar 2024

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Vodstrcil, L. A., Htaik, K., Plummer, E. L., De Petra, V., Sen, M. G., Williamson, D. A., Ong, J. J., Wu, J., Owlad, M., Murray, G., Chow, E. P. F., Fairley, C. K., & Bradshaw, C. S. (2024). Near-to-patient-testing to inform targeted antibiotic use for sexually transmitted infections in a public sexual health clinic: the NEPTUNE cohort study. The Lancet Regional Health. Western Pacific, 44, 1-15. Article 101005. https://doi.org/10.1016/j.lanwpc.2023.101005

@article{9ee4b8c88102465f9ac72a45345b3561,

title = "Near-to-patient-testing to inform targeted antibiotic use for sexually transmitted infections in a public sexual health clinic: the NEPTUNE cohort study",

abstract = "Background: Empiric treatment of sexually transmitted infections can cause unnecessary antibiotic use. We determined if near-to-patient-testing (NPT) for Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium (MG) improved antibiotic-use for a range of clinical presentations. Methods: Clients attending with non-gonococcal urethritis (NGU), proctitis, as STI-contacts, or for an MG-test-of-cure (MG-TOC) between March and December 2021 were recruited. Participants received near-to-patient-testing (NPT-group) for the three STIs using the GeneXpert{\textregistered} System (Cepheid), and concurrent routine-testing by transcription-mediated-amplification (TMA; Aptima, Hologic). Antibiotic-use among NGU or proctitis cases in the NPT-group was compared to clinic-controls undergoing routine-testing only. The proportion in the NPT-group who notified partners <24 hrs of their STI-specific result was calculated.Findings: Among 904 consults by 808 NPT-participants, ≥1 STI was detected in 63/252 (25.0\%) with NGU, 22/51 (43.1\%) with proctitis, and 167/527 (31.7\%) STI-contacts. MG was detected among 35/157 (22.3\%) MG-TOC consults. Among NGU and proctitis cases, fewer in the NPT-group received empiric treatment compared to clinic-controls (29.4\% [95\% CI: 24.3-34.9\%] vs 83.8\% [95\% CI: 79.2-87.8\%], p < 0.001), resulting in more NPT-group cases appropriately treated (STI-specific drug/no drug appropriately; 80.9\% [95\% CI: 76.0-85.1\%] vs 33.0\% [95\% CI: 27.7-38.6\%], p < 0.001) and fewer mistreated (incorrect drug/treated but pathogen-negative; 17.8\% [13.7-22.6\%] vs 61.4\% [55.6-66.9\%], p < 0.001). Of 167/264 in the NPT-group with an STI who responded regarding partner-notification, 95.2\% notified all/some partners; 85.9\% notified them <24 hrs of the STI-specific result. Interpretation: Near-to-patient-testing significantly improved antibiotic use and a high proportion of individuals rapidly notified partners of STI-specific results, highlighting the broad benefits of timely diagnostic strategies for STIs in clinical decision making and partner notification.",

author = "Vodstrcil, \{Lenka A\} and Kay Htaik and Plummer, \{Erica L\} and \{De Petra\}, Vesna and Sen, \{Melodi G\} and Williamson, \{Deborah A\} and Ong, \{Jason J\} and Jason Wu and Monica Owlad and Gerald Murray and Chow, \{Eric P F\} and Fairley, \{Christopher K\} and Bradshaw, \{Catriona S\}",

note = "Funding: ARC ITRP Hub-grant; NHMRC.",

year = "2024",

month = mar,

doi = "10.1016/j.lanwpc.2023.101005",

language = "English",

volume = "44",

pages = "1--15",

journal = "The Lancet Regional Health. Western Pacific",

issn = "2666-6065",

publisher = "Elsevier",

}

Vodstrcil, LA, Htaik, K, Plummer, EL, De Petra, V, Sen, MG, Williamson, DA, Ong, JJ, Wu, J, Owlad, M, Murray, G, Chow, EPF, Fairley, CK & Bradshaw, CS 2024, 'Near-to-patient-testing to inform targeted antibiotic use for sexually transmitted infections in a public sexual health clinic: the NEPTUNE cohort study', The Lancet Regional Health. Western Pacific, vol. 44, 101005, pp. 1-15. https://doi.org/10.1016/j.lanwpc.2023.101005

TY - JOUR

T1 - Near-to-patient-testing to inform targeted antibiotic use for sexually transmitted infections in a public sexual health clinic

T2 - the NEPTUNE cohort study

AU - Vodstrcil, Lenka A

AU - Htaik, Kay

AU - Plummer, Erica L

AU - De Petra, Vesna

AU - Sen, Melodi G

AU - Williamson, Deborah A

AU - Ong, Jason J

AU - Wu, Jason

AU - Owlad, Monica

AU - Murray, Gerald

AU - Chow, Eric P F

AU - Fairley, Christopher K

AU - Bradshaw, Catriona S

N1 - Funding: ARC ITRP Hub-grant; NHMRC.

PY - 2024/3

Y1 - 2024/3

N2 - Background: Empiric treatment of sexually transmitted infections can cause unnecessary antibiotic use. We determined if near-to-patient-testing (NPT) for Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium (MG) improved antibiotic-use for a range of clinical presentations. Methods: Clients attending with non-gonococcal urethritis (NGU), proctitis, as STI-contacts, or for an MG-test-of-cure (MG-TOC) between March and December 2021 were recruited. Participants received near-to-patient-testing (NPT-group) for the three STIs using the GeneXpert® System (Cepheid), and concurrent routine-testing by transcription-mediated-amplification (TMA; Aptima, Hologic). Antibiotic-use among NGU or proctitis cases in the NPT-group was compared to clinic-controls undergoing routine-testing only. The proportion in the NPT-group who notified partners <24 hrs of their STI-specific result was calculated.Findings: Among 904 consults by 808 NPT-participants, ≥1 STI was detected in 63/252 (25.0%) with NGU, 22/51 (43.1%) with proctitis, and 167/527 (31.7%) STI-contacts. MG was detected among 35/157 (22.3%) MG-TOC consults. Among NGU and proctitis cases, fewer in the NPT-group received empiric treatment compared to clinic-controls (29.4% [95% CI: 24.3-34.9%] vs 83.8% [95% CI: 79.2-87.8%], p < 0.001), resulting in more NPT-group cases appropriately treated (STI-specific drug/no drug appropriately; 80.9% [95% CI: 76.0-85.1%] vs 33.0% [95% CI: 27.7-38.6%], p < 0.001) and fewer mistreated (incorrect drug/treated but pathogen-negative; 17.8% [13.7-22.6%] vs 61.4% [55.6-66.9%], p < 0.001). Of 167/264 in the NPT-group with an STI who responded regarding partner-notification, 95.2% notified all/some partners; 85.9% notified them <24 hrs of the STI-specific result. Interpretation: Near-to-patient-testing significantly improved antibiotic use and a high proportion of individuals rapidly notified partners of STI-specific results, highlighting the broad benefits of timely diagnostic strategies for STIs in clinical decision making and partner notification.

AB - Background: Empiric treatment of sexually transmitted infections can cause unnecessary antibiotic use. We determined if near-to-patient-testing (NPT) for Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium (MG) improved antibiotic-use for a range of clinical presentations. Methods: Clients attending with non-gonococcal urethritis (NGU), proctitis, as STI-contacts, or for an MG-test-of-cure (MG-TOC) between March and December 2021 were recruited. Participants received near-to-patient-testing (NPT-group) for the three STIs using the GeneXpert® System (Cepheid), and concurrent routine-testing by transcription-mediated-amplification (TMA; Aptima, Hologic). Antibiotic-use among NGU or proctitis cases in the NPT-group was compared to clinic-controls undergoing routine-testing only. The proportion in the NPT-group who notified partners <24 hrs of their STI-specific result was calculated.Findings: Among 904 consults by 808 NPT-participants, ≥1 STI was detected in 63/252 (25.0%) with NGU, 22/51 (43.1%) with proctitis, and 167/527 (31.7%) STI-contacts. MG was detected among 35/157 (22.3%) MG-TOC consults. Among NGU and proctitis cases, fewer in the NPT-group received empiric treatment compared to clinic-controls (29.4% [95% CI: 24.3-34.9%] vs 83.8% [95% CI: 79.2-87.8%], p < 0.001), resulting in more NPT-group cases appropriately treated (STI-specific drug/no drug appropriately; 80.9% [95% CI: 76.0-85.1%] vs 33.0% [95% CI: 27.7-38.6%], p < 0.001) and fewer mistreated (incorrect drug/treated but pathogen-negative; 17.8% [13.7-22.6%] vs 61.4% [55.6-66.9%], p < 0.001). Of 167/264 in the NPT-group with an STI who responded regarding partner-notification, 95.2% notified all/some partners; 85.9% notified them <24 hrs of the STI-specific result. Interpretation: Near-to-patient-testing significantly improved antibiotic use and a high proportion of individuals rapidly notified partners of STI-specific results, highlighting the broad benefits of timely diagnostic strategies for STIs in clinical decision making and partner notification.

UR - https://www.scopus.com/pages/publications/85182386046

U2 - 10.1016/j.lanwpc.2023.101005

DO - 10.1016/j.lanwpc.2023.101005

M3 - Article

C2 - 38292654

SN - 2666-6065

VL - 44

SP - 1

EP - 15

JO - The Lancet Regional Health. Western Pacific

JF - The Lancet Regional Health. Western Pacific

M1 - 101005

ER -

Near-to-patient-testing to inform targeted antibiotic use for sexually transmitted infections in a public sexual health clinic: the NEPTUNE cohort study

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