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A Cost-Effectiveness Evaluation of Testing and Treatment of Chlamydia trachomatis Infection Among Asymptomatic Women Infected With Neisseria gonorrhoeae



Background Because patients infected with Neisseria gonorrhoeae are frequently coinfected with Chlamydia trachomatis, routine dual treatment of patients with N gonorrhoeae infection is frequently practiced and has long been recommended.

Goal The goal of this study was to examine the cost-effectiveness of routine dual treatment of women with N gonorrhoeae infection, with or without separate testing for C trachomatis, compared with an alternative of testing for both infections and restricting treatment for C trachomatis to women testing positive for C trachomatis.

Study Design A decision analysis compared the cost-effectiveness of these options using cases of pelvic inflammatory disease prevented as the outcome. Parameter values were taken from the literature.

Results Routine dual treatment is not an effective or cost-effective replacement for testing for C trachomatis, but it can increase the number of cases of C trachomatis treated when combined with testing. Dual treatment results in more overtreatment of C trachomatis infection than treatment based on test results.

Conclusions Testing for both infections is more cost-effective than routine presumptive treatment for C trachomatis. Providing both presumptive treatment and testing for C trachomatis can also be cost-effective in some settings.

Testing asymptomatic women for Chlamydia trachomatis and Neisseria gonorrhoeae is often more cost-effective than testing for N gonorrhoeae alone and routinely treating for both infections the women who test positive for N gonorrhoeae.

From the *Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta; and †Rollins School of Public Health, Emory University, Atlanta, Georgia

Reprint requests: Thomas L. Gift, PhD, Centers for Disease Control and Prevention, Mail Stop E-44, 1600 Clifton Road NE, Atlanta, GA 30333.

Received for publication August 21, 2001,

revised November 27, 2001, and accepted November 28, 2001.

© Copyright 2002 American Sexually Transmitted Diseases Association