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

Lancet Reg Health West Pac. 2024 Jan 12:44:101005. doi: 10.1016/j.lanwpc.2023.101005. eCollection 2024 Mar.

Authors

Lenka A Vodstrcil^{1

2

3}, Kay Htaik^{1

2}, Erica L Plummer^{1

2}, Vesna De Petra⁴, Melodi G Sen⁴, Deborah A Williamson^{5

6}, Jason J Ong^{1

2}, Jason Wu², Monica Owlad², Gerald Murray^{7

8

9}, Eric P F Chow^{1

2

3}, Christopher K Fairley^{1

2}, Catriona S Bradshaw^{1

2

3}

Affiliations

¹ Central Clinical School, Monash University, Melbourne, Victoria, Australia.
² Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
³ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
⁴ Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity at the University of Melbourne, Melbourne, Victoria, Australia.
⁵ Department of Microbiology, Royal Melbourne Hospital, Melbourne, Australia.
⁶ Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
⁷ Murdoch Children's Research Institute, Parkville, Victoria, Australia.
⁸ Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.
⁹ Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia.

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.

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