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

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

3 Citations (Scopus)

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. Funding: ARC ITRP Hub-grant; NHMRC.

Original language	English
Article number	101005
Number of pages	15
Journal	The Lancet Regional Health - Western Pacific
Volume	44
DOIs	https://doi.org/10.1016/j.lanwpc.2023.101005
Publication status	Published - Mar 2024

Keywords

Antimicrobial stewardship
Chlamydia trachomatis
Empiric treatment
Mycoplasma genitalium
Near to patient testing
Neisseria gonorrhoeae
Point of care testing
Sexually transmitted infections
Syndromic management

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.lanwpc.2023.101005Licence: CC BY

Cite this

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, Article 101005. https://doi.org/10.1016/j.lanwpc.2023.101005

@article{2de45dd3a9b64de89f4c5648a9ab2f31,

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

keywords = "Antimicrobial stewardship, Chlamydia trachomatis, Empiric treatment, Mycoplasma genitalium, Near to patient testing, Neisseria gonorrhoeae, Point of care testing, Sexually transmitted infections, Syndromic management",

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 Information: ARC ITRP Hub-grant; NHMRC. Publisher Copyright: {\textcopyright} 2024 The Authors",

year = "2024",

month = mar,

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

language = "English",

volume = "44",

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. https://doi.org/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. / Vodstrcil, Lenka A.; Htaik, Kay; Plummer, Erica L. et al.
In: The Lancet Regional Health - Western Pacific, Vol. 44, 101005, 03.2024.

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

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.

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. Funding: ARC ITRP Hub-grant; NHMRC.

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. Funding: ARC ITRP Hub-grant; NHMRC.

KW - Antimicrobial stewardship

KW - Chlamydia trachomatis

KW - Empiric treatment

KW - Mycoplasma genitalium

KW - Near to patient testing

KW - Neisseria gonorrhoeae

KW - Point of care testing

KW - Sexually transmitted infections

KW - Syndromic management

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U2 - 10.1016/j.lanwpc.2023.101005

DO - 10.1016/j.lanwpc.2023.101005

M3 - Article

C2 - 38292654

AN - SCOPUS:85182386046

SN - 2666-6065

VL - 44

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

Abstract

Keywords

UN SDGs

Access to Document

Other files and links

Could rapid testing reduce high STI rates?

Cite this

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

Abstract

Keywords

UN SDGs

Access to Document

Other files and links

Press/Media

Could rapid testing reduce high STI rates?

Cite this