From the Journals

Survey: Most physicians who treat STIs in their offices lack key injectable drugs



The majority of physicians surveyed who treat sexually transmitted infections (STIs) in their offices reported that they did not have on-site availability of the two primary injectable drugs for syphilis and gonorrhea, according to researchers from the Centers for Disease Control and Prevention.

injection, arm Severin Schweiger/ThinkStock

This lack of drug availability for immediate treatment is significant because STIs are on the rise in the United States. The numbers of reported cases of Neisseria gonorrhoeae and Treponema pallidum infections dramatically increased between 2013 and 2017, at 75% higher for gonorrhea and 153% higher for syphilis (primary and secondary), according to a research letter in the November issue of Emerging Infectious Diseases.

Optimal, same-day treatment of bacterial STIs with a highly effective regimen is critical for national STI control efforts and can help mitigate the development of drug resistance, the researchers stated. The recommended first-line treatment for uncomplicated gonorrhea is intramuscular ceftriaxone (250 mg), and for primary and secondary syphilis, it’s intramuscular penicillin G benzathine (2.5 million units), instead of using oral antimicrobial drug alternatives, which have been known to facilitate the development of drug resistance.

William S. Pearson, PhD, of the CDC and colleagues examined the on-site availability of the two injectable therapeutic agents among physicians who treated STIs in their office. They used the 2016 Physician Induction File of the National Ambulatory Medical Care Survey to assess the number of physicians who treat patients with STIs and had injectable antimicrobial drugs available on site. A total of 1,030 physicians (46.2% unweighted response rate), which represents an estimated 330,581 physicians in the United States, completed the Physician Induction File in 2016.

In this survey, physicians who reported evaluating or treating patients for STIs were asked which antimicrobial drugs they had available on site for same-day management of gonorrhea and syphilis, including intramuscular ceftriaxone and penicillin G benzathine at the recommended doses.

The researchers used this information to determine national estimates of reported on-site, same-day availability for these antimicrobial drugs and stratified results by patient-centered medical homes (PCMH) designation and U.S. region. They used multiple logistic regression models to determine if PCMH designation and region were predictive of on-site availability of the two medications.

An estimated 45.2% (149,483) of office-based physicians indicated that they evaluate patients for STIs in their offices. Of these, 77.9% reported not having penicillin G benzathine available on site, and 56.1% reported not having ceftriaxone.

Geographic differences in drug availability were not statistically significant. In addition, physicians in offices not designated PCMHs were more likely than those in offices designated as PCMHs to report lacking on-site availability of ceftriaxone (odds ratio, 2.03) and penicillin G benzathine (OR, 3.20).

“The costs of obtaining and carrying these medications, as well as issues of storage and shelf-life, should be explored to determine if these factors are barriers. In addition, the implications of prescribing alternative treatments or delaying care in situations when medications are not readily available on site should be further explored. Mitigating the lack of medication availability to treat these infections will help public health officials stop the rise in STI disease,” the researchers concluded.

The authors are all employees of the CDC and did not provide other disclosures.

SOURCE: Pearson WS et al. Emerg Infect Dis. 2019. doi: 10.3201/eid2511.190764.

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