Antibiotic Use before Chlamydia and Gonorrhea Genital and Extragenital Screening in the Sexually Transmitted Infection Clinical Setting

ABSTRACTBackground antibiotic use (i.e., administration of antibiotics not directly related toChlamydia trachomatisorNeisseria gonorrhoeaeinfections) has been associated with a lower prevalence of genitalC. trachomatisinfection in a clinical setting. Associations with specific antibiotic types or withN. gonorrhoeaeare lacking. Here, we assessed the prevalence of antibiotic use, the different classes and agents used, and their association with a subsequent sexually transmitted infection (STI) clinicC. trachomatisandN. gonorrhoeaetest result. At our STI clinic, we systematically registered whether antibiotics were used in the past month (in 29% of the cases, the specific antibiotic agent was named). Patients were screened for urogenitalC. trachomatisandN. gonorrhoeae; a third of them were also screened for anorectal and oropharyngealC. trachomatisandN. gonorrhoeae. The proportion of antibiotics used and their association withC. trachomatisandN. gonorrhoeaeprevalence were assessed for heterosexual men, men who have sex with men (MSM), and women. During 14,775 clinic consultations, antibiotic use was reported by 12.2% (95% confidence interval [CI], 11.7% to 12.7%), i.e., 14.8% of women, 8.6% of heterosexual men, and 11.6% of MSM. The most reported antibiotics were penicillins, tetracyclines, and macrolides, respectively. The prevalence was 11.0% (95% CI, 10.3% to 11.3%) forC. trachomatisand 1.9% (95% CI, 1.7% to 2.1%) forN. gonorrhoeae. Only tetracycline use was associated with a lowerC. trachomatisprevalence (3%). Overall antibiotic use was associated with lower anorectalC. trachomatisprevalence in MSM only (odds ratio, 0.4; 95% CI, 0.2 to 0.8). STI clinic visitors commonly report recent antibiotic use. Even in a country with low antibiotic consumption, tetracycline use impactedC. trachomatisprevalence, while there was a notable absence of association with azithromycin.