https://links.lww.com/OLQ/A785

(1)

Rates of appropriate treatment and follow-up testing after a gonorrhea and/or chlamydia infection in an urban network of federally qualified health center systems

Laura McWhirter, Yingbo Lou, Sarah Reingold, Sarah Warsh, Tara Thomas-Gale, Christine Haynes, Deborah Rinehart, Karen A. Wendel, Holly M. Frost

Supplementary Tables

Supplemental Table 1: Electronic health record (EPIC, Verona, WI) fields used for electronic abstraction of data.

Factor^a Data Acquisition

Substance Use History Social History-Substance Use (Collected by medical assistants at each visit)

Adolescent and Title X Note Macros (Assessed by providers at all wellness visits and family planning visits) Encounter ICD10CM

Alcohol History Social History- Alcohol Use

Adolescent Note Macro Encounter ICD10CM

Sexual Orientation (ever) Social History-Sexually Orientation (Collected by medical assistants at each visit)

Adolescent and Title X Note Macros (Assessed by providers at all wellness visits and family planning visits)

Sexual Activity Social History-Sexually Active

Adolescent and Title X Note Macros Internal Prenatal Registry

Laboratory Data- Positive Pregnancy Test Prescription Data

Encounter ICD10CM

Condom Use Social History- Birth Control (Collected by medical

assistants at each visit)

Adolescent and Title X Note Macros (Assessed by providers at all wellness visits and family planning visits)

Pregnancy History (ever) Encounter ICD10CM

Internal Prenatal Registry

Laboratory Data- Positive Pregnancy Test

Anxiety History ICD10CM

(2)

Depression History ICD10CM

Gonorrhea and Chlamydia Testing CPT Codes: 87591

Human Immunodeficiency Virus Testing CPT Codes: 86689, 86701, 86702, 86703, 87389, 87534, 87535, 87536, 87537, 87538, 87539

Syphilis Testing CPT Codes: 86780, 86593, 86780, 86592

a Unless otherwise indicated clinical factors were determined for the date of the index episode or within 1 year prior.

(3)

Supplementary Table 2: Appropriate antibiotic therapy for gonorrhea and chlamydia infections based on CDC- recommended treatment

^a,b,c

Antibiotic therapy for gonorrhea

infection Antibiotic therapy for chlamydia

infection Ceftriaxone and Azithromycin Azithromycin Cefixime and Azithromycin Doxycycline Gentamicin and Azithromycin

Ceftriaxone and Doxycycline Cefixime and Doxycycline Cefpodoxime and Azithromycin

a Workowski KA, Bolan GA; CDC. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64(No. RR-3).

bWorkowski KA, Bachmann LH, Chan PA, et al.. Sexually transmitted infections treatment guidelines, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(4):1-187

c First-line treatment recommendations changed after the study period for chlamydia.

(4)

Supplementary Table 3: Factors associated with receipt of antibiotic treatment within 14 days of positive lab result

Gonorrhea Chlamydia

Factor Unadjusted OR

(95% CI) P Adjusted OR

(95%CI) P Unadjusted OR

(95% CI) P Adjusted OR (95%

CI) P

Age 1.09 (0.99, 1.21) 0.09 1.13 (1.00, 1.27) 0.05 1.06 (1.00, 1.11) 0.03 1.05 (0.99, 1.12) 0.08 Gender-Male 2.04 (0.97, 4.27) 0.06 2.00 (0.93, 4.30) 0.07 1.17 (0.83, 1.65) 0.37 1.16 (0.81, 1.66) 0.43 Race

White Reference Reference Reference Reference

Black 1.15 (0.52, 2.53) 0.66 1.20 (0.52, 2.77) 0.67 0.86 (0.55, 1.32) 0.63 0.89 (0.57, 1.39) 0.61 Other 0.71 (0.22, 2.24) 0.34 0.67 (0.20, 2.28) 0.52 0.98 (0.49, 1.94) 0.79 0.97 (0.49, 1.95) 0.94 Ethnicity- Hispanic 1.38 (0.66, 2.87) 0.19 1.42 (0.65, 3.06) 0.38 0.84 (0.58, 1.22) 0.47 0.90 (0.61, 1.32) 0.59 Preferred Language

Non-English Reference Reference Reference Reference

English 0.37 (0.11, 1.23) 0.11 0.37 (0.11, 1.26) 0.11 0.87 (0.59, 1.28) 0.47 0.86 (0.58, 1.28) 0.45 Insurance

Public/Medicaid Reference Reference Reference Reference

Commercial 0.89 (0.35, 2.23) 0.90 0.87 (0.33, 2.28) 0.77 1.56 (0.96, 2.53) 0.06 1.33 (0.80, 2.19) 0.27 Self-pay 0.70 (0.37, 1.33) 0.42 0.64 (0.32, 1.26) 0.20 0.95 (0.69, 1.31) 0.15 0.84 (0.61, 1.17) 0.31 History of alcohol use 0.74 (0.16, 3.45) 0.70 0.88 (0.17, 4.58) 0.88 1.06 (0.41, 2.73) 0.90 1.06 (0.41, 2.76) 0.91 History of tobacco use 1.16 (0.47, 2.84) 0.74 1.07 (0.40, 2.86) 0.90 0.74 (0.45, 1.20) 0.22 0.74 (0.44, 1.26) 0.27 History of anxiety/

depression 0.96 (0.49, 1.89) 0.91 1.09 (0.53, 2.27) 0.81 0.77 (0.54, 1.11) 0.16 0.82 (0.56, 1.19) 0.30 Sexual orientation-

LGBTQ+ 0.79 (0.40, 1.56) 0.49 1.06 (0.51, 2.19) 0.87 1.00 (0.67, 1.50) 0.99 1.06 (0.70, 1.62) 0.78 Documented condom

use 1.12 (0.65, 1.91) 0.69 1.25 (0.70, 2.24) 0.45 1.26 (0.97, 1.63) 0.08 1.44 (1.09, 1.90) 0.01 Prior history of

chlamydia 0.77 (0.41, 1.44) 0.41 0.68 (0.34, 1.37) 0.28 0.87 (0.58, 1.31) 0.51 0.91 (0.59, 1.42) 0.69 Prior history of

gonorrhea 1.59 (0.36, 6.98) 0.54 1.60 (0.33, 7.84) 0.56 0.81 (0.39, 1.66) 0.56 0.85 (0.39, 1.87) 0.69 History of syphilis^a <0.001 (0.00, >100) 0.99 - - 0.14 (0.04, 0.57) 0.01 0.16 (0.04, 0.71) 0.02 Testing location

Non-pediatric setting Reference Reference Reference Reference

(5)

Pediatric clinic 0.92 (0.43, 1.96) 0.82 1.01 (0.43, 2.38) 0.98 0.61 (0.44, 0.85) 0.00 0.66 (0.46, 0.94) 0.02

aNot included in multivariable model given low number of cases

(6)

Supplementary Table 4: Factors associated with HIV and syphilis testing following a positive gonorrhea test

Factor HIV Syphilis

Unadjusted OR (95% CI)

P Adjusted OR (95% CI)

P Unadjusted OR (95% CI)

P Age 1.10 (1.02, 1.18) 0.01 1.12 (1.03, 1.22) 0.01 1.08 (1.00, 1.15) 0.04 1.10 (1.01, 1.19) 0.03 Gender - male 0.91 (0.60, 1.39) 0.67 0.77 (0.49, 1.22) 0.27 0.71 (0.47, 1.09) 0.12 0.61 (0.38, 0.95) 0.03 Race/Ethnicity

White Reference Reference Reference Reference

Black 1.19 (0.68, 2.08) 0.31 1.40 (0.76, 2.56) 0.28 1.37 (0.79, 2.39) 0.08 1.64 (0.90, 3.00) 0.11 Hispanic 1.28 (0.76, 2.13) 0.12 1.61 (0.93, 2.79) 0.09 1.29 (0.78, 2.14) 0.11 1.65 (0.95, 2.85) 0.07 Other 0.64 (0.26, 1.59) 0.16 0.76 (0.29, 1.97) 0.57 0.56 (0.22, 1.42) 0.08 0.64 (0.24, 1.69) 0.36 Primary Language

Public Reference Reference Reference Reference

Private 1.11 (0.59, 2.09) 0.97 1.04 (0.53, 2.05) 0.91 1.17 (0.62, 2.19) 0.7 1.19 (0.61, 2.33) 0.61 Other 1.20 (0.75, 1.93) 0.62 1.18 (0.71, 1.94) 0.52 1.06 (0.67, 1.69) 0.95 1.10 (0.67, 1.79) 0.71 History of alcohol use 1.43 (0.42, 4.80) 0.57 1.87 (0.50, 6.91) 0.35 1.17 (0.37, 3.74) 0.79 1.48 (0.43, 5.17) 0.54 History of tobacco use 1.05 (0.58, 1.89) 0.87 0.74 (0.38, 1.44) 0.38 1.26 (0.70, 2.26) 0.44 0.95 (0.49, 1.85) 0.89 History of anxiety/

depression 0.62 (0.39, 0.98) 0.04 0.54 (0.33, 0.89) 0.02 0.71 (0.45, 1.13) 0.15 0.60 (0.37, 0.99) 0.05 Sexual orientation

LGBTQ+

1.02 (0.62, 1.67) 0.94 1.15 (0.68, 1.97) 0.6 1.24 (0.76, 2.02) 0.4 1.35 (0.79, 2.31) 0.27 Documented condom use 1.30 (0.90, 1.88) 0.16 1.49 (0.99, 2.24) 0.06 1.26 (0.87, 1.81) 0.22 1.39 (0.93, 2.09) 0.11 History of chlamydia 1.19 (0.75, 1.87) 0.46 0.93 (0.55, 1.56) 0.77 1.24 (0.79, 1.94) 0.36 0.90 (0.54, 1.52) 0.71 History of gonorrhea 3.53 (1.18, 10.54) 0.02 3.28 (0.98, 10.96) 0.05 4.18 (1.40, 12.48) 0.01 3.73 (1.12, 2.37) 0.03 Testing location

(7)

Supplementary Table 5: Factors associated with HIV and syphilis testing following a positive chlamydia test

Factor HIV Syphilis

Unadjusted OR (95% CI)

P Adjusted OR (95%

CI)

P Unadjusted OR (95% CI)

P Age 1.07 (1.04, 1.11) <.001 1.10 (1.06, 1.14) <.001 1.06 (1.02, 1.09) <.001 1.08 (1.04, 1.12) <.001 Gender - male 1.30 (1.04, 1.62) 0.02 1.35 (1.07, 1.70) 0.01 1.10 (0.88, 1.36) 0.42 1.11 (0.89, 1.40) 0.36 Race/Ethnicity

White (baseline) Reference Reference Reference Reference

Black 1.18 (0.89, 1.57) 0.28 1.20 (0.89, 1.60) 0.23 1.21 (0.91, 1.60) 0.35 1.24 (0.93, 1.66) 0.14 Hispanic 1.12 (0.88, 1.42) 0.54 1.17 (0.92, 1.49) 0.21 1.12 (0.89, 1.43) 0.82 1.17 (0.92, 1.50) 0.2 Other 0.99 (0.64, 1.53) 0.61 0.96 (0.62, 1.50) 0.87 1.10 (0.71, 1.71) 0.98 1.09 (0.70, 1.69) 0.72 Primary Language

Public (baseline) Reference Reference Reference Reference

Private 1.16 (0.88, 1.54) 0.29 1.04 (0.78, 1.40) 0.77 1.11 (0.84, 1.46) 0.63 1.04 (0.78, 1.39) 0.78 Other 0.99 (0.80, 1.24) 0.5 1.03 (0.82, 1.29) 0.83 1.07 (0.86, 1.33) 0.89 1.13 (0.90, 1.41) 0.29 History of alcohol use 1.30 (0.70, 2.42) 0.41 1.13 (0.60, 2.14) 0.7 1.15 (0.62, 2.12) 0.65 1.02 (0.55, 1.91) 0.94 History of tobacco use 1.56 (1.08, 2.26) 0.02 1.25 (0.85, 1.83) 0.26 1.53 (1.07, 2.19) 0.02 1.27 (0.87, 1.84) 0.22 History of anxiety/

depression 1.26 (0.97, 1.63) 0.08 1.27 (0.97, 1.66) 0.08 1.20 (0.93, 1.56) 0.15 1.19 (0.91, 1.55) 0.19 Sexual orientation

LGBTQ+

1.16 (0.89, 1.52) 0.28 1.28 (0.96, 1.69) 0.09 1.21 (0.92, 1.59) 0.17 1.29 (0.98, 1.70) 0.07 Documented condom

use 1.12 (0.94, 1.33) 0.22 1.20 (1.00, 1.45) 0.05 1.06 (0.89, 1.26) 0.51 1.12 (0.93, 1.34) 0.24 History of chlamydia 1.13 (0.85, 1.49) 0.4 0.99 (0.73, 1.33) 0.94 1.16 (0.88, 1.53) 0.29 1.03 (0.77, 1.39) 0.84 History of gonorrhea 1.54 (0.90, 2.62) 0.11 1.37 (0.78, 2.41) 0.28 1.48 (0.88, 2.49) 0.14 1.33 (0.76, 2.31) 0.31 History of syphilis 1.47 (0.35, 6.16) 0.6 1.23 (0.28, 5.39) 0.79 1.74 (0.42, 7.32) 0.45 1.49 (0.34, 6.53) 0.6 Testing location

(8)

Supplementary Table 6: Factors associated with gonorrhea and chlamydia retesting within 60 days-6 months following a positive gonorrhea test

Factor Unadjusted OR

(95% CI) P Adjusted OR

(95% CI) P

Age 0.94 (0.88, 1.01) 0.11 0.93 (0.86, 1.02) 0.12

Gender - male 0.22 (0.13, 0.36) <.001 0.19 (0.11, 0.33) <.001 Race/Ethnicity

White Reference Reference

Black 1.46 (0.83, 2.57) 0.17 1.42 (0.76, 2.65) 0.27

Hispanic 1.25 (0.74, 2.10) 0.58 1.26 (0.72, 2.23) 0.42

Other 0.94 (0.37, 2.38) 0.54 0.87 (0.32, 2.36) 0.79

Primary Language

Non-English Reference Reference

English 1.26 (0.70, 2.27) 0.44 1.16 (0.61, 2.21) 0.66 Insurance

Public Reference Reference

Private 0.73 (0.38, 1.38) 0.78 0.90 (0.45, 1.81) 0.77

Other 0.64 (0.40, 1.03) 0.29 0.66 (0.39, 1.12) 0.13

History of alcohol use 0.44 (0.12, 1.64) 0.22 0.36 (0.09, 1.46) 0.15 History of tobacco use 1.28 (0.72, 2.28) 0.41 1.47 (0.75, 2.85) 0.26 History of anxiety/

depression 1.03 (0.65, 1.64) 0.89 0.78 (0.47, 1.29) 0.33 Sexual orientation

LGBTQ+ 1.11 (0.68, 1.81) 0.67 0.98 (0.57, 1.69) 0.95

Documented condom use 1.11 (0.77, 1.61) 0.56 1.27 (0.84, 1.93) 0.26 History of chlamydia 1.21 (0.77, 1.89) 0.41 1.08 (0.63, 1.84) 0.78 History of gonorrhea 1.80 (0.77, 4.18) 0.17 1.36 (0.51, 3.67) 0.54 Testing location

Non-pediatric setting Reference Reference

Pediatric clinic 1.18 (0.70, 1.99) 0.54 0.93 (0.50, 1.72) 0.82

(9)

Supplementary Table 7: Factors associated with gonorrhea and chlamydia retesting within 60 days-6 months following a positive chlamydia test

Factor Unadjusted OR (95%

CI) P Adjusted OR (95%

CI) P

Age 0.94 (0.91, 0.97) <.001 0.94 (0.91, 0.98) <.001

Gender - male 0.33 (0.25, 0.43) <.001 0.30 (0.23, 0.39) <.001 Race/Ethnicity

White Reference Reference

Black 1.09 (0.81, 1.45) 0.11 1.12 (0.83, 1.52) 0.45

Hispanic 1.11 (0.87, 1.42) 0.03 1.07 (0.82, 1.38) 0.63

Other 0.63 (0.39, 1.01) 0.02 0.62 (0.38, 1.02) 0.06

Primary Language

Non-English Reference Reference

English 0.96 (0.75, 1.24) 0.78 0.93 (0.71, 1.21) 0.58

Insurance

Public Reference Reference

Private 0.83 (0.62, 1.11) 0.32 1.06 (0.78, 1.44) 0.71

Other 0.92 (0.74, 1.16) 0.91 0.98 (0.77, 1.24) 0.86

History of alcohol use 1.06 (0.57, 1.97) 0.86 1.02 (0.53, 1.95) 0.95 History of tobacco use 1.17 (0.82, 1.67) 0.39 1.30 (0.88, 1.90) 0.18 History of anxiety/ depression 1.61 (1.24, 2.08) <.001 1.39 (1.06, 1.81) 0.02 Sexual orientation LGBTQ+ 1.18 (0.90, 1.55) 0.24 0.93 (0.70, 1.24) 0.62 Documented condom use 1.51 (1.26, 1.80) <.001 1.56 (1.28, 1.89) <.001 History of chlamydia 1.04 (0.79, 1.39) 0.77 0.93 (0.68, 1.27) 0.66 History of gonorrhea 0.83 (0.49, 1.42) 0.5 0.73 (0.41, 1.31) 0.3 History of syphilis 0.93 (0.22, 3.91) 0.92 0.84 (0.19, 3.67) 0.82 Testing location

Non-pediatric setting Reference Reference

Pediatric clinic 1.05 (0.82, 1.34) 0.69 0.92 (0.70, 1.22) 0.57

(10)

Supplemental Table 8: Rates of laboratory follow-up for patients with chlamydia treated on the same day as the test vs.

between 2-14 days after testing.

Same day

N (%) 2-14 days

N (%) P^a

HIV No 317 (47.7) 522 (43.8) 0.11

Yes 347 (52.3) 668 (56.1)

GC/CT^b No 450 (67.8) 663 (55.7) <0.01

Yes 214 (28.9) 527 (44.3)

Syphilis No 353 (53.2) 565 (47.5) 0.02

Yes 311 (46.8) 625 (52.5)

a Chi-squared test, significance defined as p<0.05.

b Gonorrhea and chlamydia retest between 60 days to 6 months after infection.

(11)

Supplemental Table 9: Rates of laboratory follow-up for patients with gonorrhea treated on the same day as the test vs.

between 2-14 days after testing.

Same day

N (%) 2-14 days

N (%) P^a

HIV No 317 (46.0) 522 (35.4) 0.03

Yes 347 (54.0) 668 (64.6)

GC/CT^b No 102 (68.0) 137 (50.6) <0.01

Yes 48 (32.0) 134 (49.4)

Syphilis No 82 (54.7) 99 (36.5) <0.01

Yes 68 (45.3) 172 (63.5)

a Chi-squared test, significance defined as p<0.05.

b Gonorrhea and chlamydia retest between 60 days to 6 months after infection.