The vast majority of ER patients who get antibiotics for a suspected STD actually don’t have the disease, a new study shows. Experts worry that such over prescription of these medications may be contributing to the rise of antibiotic resistant bacteria.
To get a closer look at how often antibiotics were being unnecessarily prescribed for STDs in the ER, researchers examined the records of more than 1,100 patients who came in with symptoms indicative of gonorrhea or chlamydia.
Cultures turned out to be negative in more than 75 percent of patients who got antibiotics during their visit, according to the study presented at the annual conference of the Association for Professionals in Infection Control and Epidemiology.
“At our hospital, it takes upwards of 48 hours to get results back,” said the study’s lead author, Karen Jones, an infection preventionist at St. John Hospital & Medical Center in Detroit. “So the decision to write a prescription is based on the clinical symptoms and the history of the patient.”
STD infections are on the rise, according to the Centers for Disease Control and Prevention, which estimates that there are 20 million new cases each year.
Without quickly available test results, doctors have to weigh the risks of sending an infected patient back home without a prescription against the possibility that antibiotics will be given to patients who don’t need them which could increase the risk that antibiotic resistant bugs will develop, Jones said.
Jones also scrutinized the data to see if there were any symptoms that correlated with positive STD tests. There weren’t any that were foolproof. In other words, no single symptom could definitively be used to determine whether someone actually had an STD.
Out of 1,103 patients who came to the ER because they feared they had an STD, 440 were treated. Of the 440, just 25 percent turned out to have a positive test.
Currently, ER doctors are stuck between a rock and a hard place, said Dr. Richard Rothman, professor of emergency medicine and vice chair of research at the Johns Hopkins University School of Medicine.
If ER doctors don't treat for an STD, an infected patient can pass it to someone else or mild symptoms may develop into serious complications, like infertility, chronic pelvic pain and ectopic pregnancy.
“So, historically the result has been that many doctors, if they have any suspicion that a patient may have an infection, just go ahead and treat," said Rothman. "But that results in overtreatment and the potential spread of antibiotic resistant bugs.”
The current conundrum may be resolved eventually.
There are much faster tests in development which will give an answer within 45 minutes to an hour, Rothman said.
In the meantime, Rothman has advice:
Practice safe sex if you’re not sure about your partner. (Do you really need to be reminded?)
If you’re concerned about a potential infection go to the doctor and follow-up for test results in a day or two.
Request the new rapid and sensitive tests, if available.