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.
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.
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.
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.
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.