Evaluation of diagnostic practices and treatment compliance for Chlamydia trachomatis and Neisseria gonorrhoeae in male patients at STD clinics in Southern China

Evaluation of diagnostic practices and treatment compliance for Chlamydia trachomatis and Neisseria gonorrhoeae in male patients at STD clinics in Southern China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of diagnostic practices and treatment compliance for Chlamydia trachomatis and Neisseria gonorrhoeae in male patients at STD clinics in Southern China Mingzhou Xiong, Zichao Pang, Xiangyi He, Mengqi Gao, Peizhen Zhao, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8094254/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Apr, 2026 Read the published version in BMC Infectious Diseases → Version 1 posted 13 You are reading this latest preprint version Abstract Objectives To evaluate the diagnostic accuracy and adherence to national treatment guidelines for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) among male patients attending sexually transmitted disease (STD) clinics (MSPs) in southern China. Methods A survey was conducted in Guangdong Province in 2022. MSPs who completed standard clinical procedures provided informed consent and an additional urine sample for CT/NG testing at the reference laboratory. Information of reference laboratory-confirmed CT/NG cases were extracted from hospital information systems. Clinic-reported test results were compared to reference laboratory findings. Treatment records were reviewed to assess compliance with national STD treatment guidelines. Results Among 5,354 participants, the reference laboratory confirmed 96 CT-positive and 71 NG-positive cases. In clinical settings, 22 (22.9%) CT-positive and 7 (9.9%) NG-positive patients were not tested for the relevant pathogen. Of those tested, clinics identified only 24 (32.4%) CT-positive and 38 (59.4%) NG-positive cases. True-positive proportions for CT were 60.0% (NAAT), 31.3% (antigen detection), and 0% (culture). For NG, the corresponding proportions were 100.0% (NAAT), 59.5% (Gram stain smear), and 57.7% (culture). Among CT-positive patients, 27 received treatment, but only 5 (22.7%) received guideline-recommended regimens. Of 38 NG-positive patients who received treatment, only 16 (42.1%) were treated appropriately. Conclusions Diagnostic performance and adherence to recommended treatment regimens for CT and NG among MSPs in southern China remain inadequate. Efforts are needed to expand testing coverage, upgrade diagnostic tools, and improve compliance with national treatment guidelines to reduce the burden of CT and NG infections in this population. Chlamydia trachomatis Neisseria gonorrhoeae Laboratory test Treatment Cross-sectional study Figures Figure 1 Introduction Chlamydia and gonorrhea, caused by Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), respectively, are among the most prevalent sexually transmitted infections (STIs) worldwide. In 2020, the World Health Organization estimated 128.5 million new cases of chlamydia and 82.4 million of gonorrhea among individuals aged 15–49 years[1, 2]. Without treatment, both infections can lead to infertility, other serious reproductive health issues, and heightened vulnerability to HIV. Co-infections are frequently observed in high-risk groups, with prevalence ranging from under 4% to as high as 60% across various studies[3–6]. In China, the disease burden is particularly significant. Gonorrhea ranked as the fourth most commonly reported Class A/B notifiable infectious disease in 2021, with 127,803 new cases (9.1 per 100,000 population)[7]. The incidence of chlamydia in 2019 was 55.32 per 100,000 [8]. Although laboratory testing is essential for definitive diagnosis, many infections remain undetected. Asymptomatic cases are common, resulting in low healthcare utilization. Even among symptomatic individuals, diagnoses may be missed due to the absence of test prescriptions, patient refusal, or false-negative results. In Shenzhen, China, over 75% of patients with NG were not tested during their most recent STD clinic visit, and only 37.7% had confirmed positive results[9]. Data on chlamydia underdiagnosis in China are limited. Similarly, despite annual CT screening recommendations for adolescents in the United States, only 7.8% undergo screening without targeted intervention[10]. The underdiagnosis of chlamydia and gonorrhea exacerbates individual health risks and facilitates continued transmission within populations. Inappropriate treatment prescribing remains a significant concern. A national survey involving physicians from 126 cities across 22 provinces in China found that 62.2% did not follow the National Sexually Transmitted Disease (STD) Treatment Guidelines for managing uncomplicated gonorrhea[11]. Similarly, a study in 15 municipal cities within Guangdong Province reported that only 30.7% of gonorrhea patients received guideline-compliant therapy in hospital settings[12]. Non-adherence to recommended regimens increases the risk of treatment failure and promotes the development of gonococcal antimicrobial resistance. However, national data on chlamydia treatment adherence are currently lacking. Guangdong Province, located in southern China, is the most populous region in the country and bears the highest burden of chlamydia and gonorrhea infections[8, 13]. Male STD clinic patients (MSPs)—a population typically characterized by high sexual activity and presentation for high-risk behaviors or reproductive health issues—show disproportionately high infection rates for both CT and NG[14, 15]. Against this backdrop, we conducted a cross-sectional study in southern China to: (1) assess the diagnostic accuracy of clinical evaluations compared with laboratory-confirmed results for CT and NG, and (2) determine the proportion of MSPs receiving treatment regimens aligned with national STD guidelines. Methods Study sites and population A cross-sectional study was conducted in Guangdong Province, China, between April 1 and October 31, 2022. Seven cities—Shenzhen, Jiangmen, Zhuhai, Foshan, Maoming, Yunfu, and Qingyuan—were randomly selected from 21 municipalities. In each city, one dermatology hospital and two general hospitals were designated as study sites. A minimum of 250 participants was recruited per hospital (Fig. 1 ). Eligibility was limited to men aged 18 years or older who had not used antibiotics in the previous two weeks and were seeking care for STDs or sexual health concerns at participating clinics (including departments of dermatology and venereology, andrology, or urology). Written informed consent was obtained from all participants. Exclusion criteria included follow-up visits for previously diagnosed STDs, inability to communicate effectively, or failure to provide a urine sample. Laboratory testing and data collection In accordance with the Chinese guidelines Diagnosis for Gonorrhoea (WS 268–2019) and Diagnosis of Genital Chlamydia Trachomatis Infection (WS/T 513–2016), a laboratory-confirmed positive result is required for the diagnosis of NG and CT infections. Following routine clinical care, eligible participants were informed of the study’s objectives and procedures by their attending physicians. Regardless of whether NG or CT testing had been conducted during the clinic visit, each participant was asked to provide an additional urine sample. These samples were submitted to the STD Laboratory at the Dermatology Hospital of Southern Medical University, which served as the reference center. Nucleic acid amplification testing (NAAT) for NG and CT was performed using the Roche Cobas 4800 Molecular System (Branchburg, NJ, USA), which functioned as the reference standard for this study. At participating sites, NG and CT testing was conducted in accordance with national diagnostic protocols. For NG, methods included Gram stain microscopy (restricted to symptomatic male patients), culture, and NAAT. For CT, testing included antigen detection, culture, and NAAT. We developed a structured information collection form (Supplementary File 1) for this study to collect data on demographic characteristics, clinical symptoms, site-specific test results, and prescribed treatments. All the data were retrieved daily from the Hospital Information System (HIS) for all participants who tested positive for NG or CT at the reference laboratory. Outcome measures The following indicators were employed to evaluate study outcomes: 1) Untested Proportion: Defined as the proportion of participants who tested positive for CT or NG at the reference laboratory but were not tested at the clinical site. 2) True-Positive Proportion: Defined as the proportion of participants who tested positive for NG or CT at both the reference laboratory and the clinic. 3) Recommended Treatment Proportion: Defined as the proportion of participants who received treatment consistent with national guidelines. In accordance with these guidelines, the following treatment regimens were recommended: 1) For NG infection: Ceftriaxone 1 g administered intramuscularly or intravenously as a single dose, or spectinomycin 2 g intramuscularly as a single dose (4 g for cervicitis). 2) For CT infection: Azithromycin 1 g orally on day 1, followed by 0.5 g once daily for two additional days (total of 3 days), or doxycycline 100 mg orally twice daily for 10–14 days. Data analysis The database was created using EpiData 3.0, and all entries were double-entered and cross-verified for accuracy. Statistical analyses were conducted using R software (version 4.2.0). The true-positive proportion of clinic-based CT and NG testing was determined by comparison with reference laboratory results. Between-group differences were examined using t-tests and Chi-square (χ²) tests. Prescriptions were evaluated for adherence to national guidelines, considering dosage, frequency, duration, and route of administration (intramuscular, intravenous, or oral). Statistical significance was defined as a p -value < 0.05. Results Participant demographics Of the 5,500 MSPs enrolled, 5,354 provided urine specimens and were included in the analysis. The remaining 146 were excluded—120 for not submitting a urine sample and 26 for declining informed consent. Reference laboratory testing confirmed 82 CT-positive, 57 NG-positive, and 14 CT/NG co-infections, yielding a total of 153 cases for final analysis. Among participants, 34.6% were aged 15–29 years, 58.2% were married, and 24.4% held a bachelor’s degree. The majority were employed as manual laborers (37.9%) or in business-related roles (26.1%). Table 1. Demographic characteristics of study participants by infection type. Variable Total (n=153) (n , % ) Infectious types (n, %) p -value CT -positive ( n= 82) N G-positve ( n= 57) Co-positive (n=14) Age (years) 0.542 15-29 53 (34.6) 34 (41.5) 15 (26.3) 4 (28.6) 30-39 35 (22.9) 20 (24.4) 12 (21.1) 3 (21.4) 40-49 34 (22.2) 15 (18.3) 15 (26.3) 4 (28.6) 50-59 23 (15.0) 9 (11.0) 11 (19.3) 3 (21.4) ≥ 60 8 (5.2) 4 (4.9) 4 (7.0) 0 (0.0) Marriage status 0.620 Married 89 (58.2) 44 (53.7) 35 (61.4) 10 (71.4) Unmarried 57 (37.3) 35 (42.7) 18 (31.6) 4 (28.6) Divorced 3 (2.0) 2 (2.4) 1 (1.8) 0 (0.0) Widowed 2 (1.3) 1 (1.2) 1 (1.8) 0 (0.0) Missing 2 (1.3) 0 (0.0) 2 (3.6) 0 (0.0) Education level 0.150 Primary school 6 (3.9) 1 (1.2) 4 (7.0) 1 (7.1) Middle school 31 (20.3) 20 (24.4) 10 (17.5) 1 (7.1) High school/Technical 39 (25.5) 19 (23.2) 13 (22.8) 7 (50.0) Junior college 24 (15.7) 10 (12.2) 11 (19.3) 3 (21.4) Bachelor’s or higher 37 (24.2) 24 (29.3) 12 (21.1) 1 (7.1) Missing 16 (10.5) 8 (9.7) 7 (12.3) 1 (7.1) Occupation 0.236 Worker 58 (37.9) 37 (45.1) 16 (24.6) 5 (35.7) Businessperson 40 (26.1) 21 (25.6) 14 (28.1) 5 (35.7) Farmer 18 (11.8) 9 (11.0) 8 (14.0) 1 (7.1) Homemaker/Unemployed 15 (9.8) 8 (9.8) 6 (10.5) 1 (7.1) Other* 10 (6.5) 3 (3.6) 5 (8.8) 2 (14.2) Missing 12 (7.8) 4 (4.9) 8 (14.0) 0 (0.0) Note: *Other occupations include students, retirees, and freelance workers. Clinic-based testing for CT and NG Of the 96 patients confirmed positive for CT (including CT/NG co-infections), 22 (22.9%) were not tested for CT at the clinic. Among the 74 who underwent testing, only 24 were correctly identified, resulting in a true-positive proportion of 32.4%. By diagnostic method, true-positive proportions were 60.0% for NAAT, 31.3% for antigen detection, and 0% for culture. Among the 71 NG-positive patients (including co-infections), 7 (9.9%) were not tested in the clinical setting. Of the 64 tested, 38 were correctly identified, yielding a true-positive proportion of 59.4%. NAAT achieved a true-positive proportion of 100.0%, compared to 59.5% for Gram stain smear and 57.7% for culture. Table 2. Medication selection and clinical application of prescriptions by test result concordance. Group Clinic+/Reference+ (A) Clinic-/Reference+ (B) Untested (C) True-positive (%) (A/A+B) False-negative (%) (B/A+B) Untested (%) (C/A+B+C) CT-positive 24 50 22 32.4 67.6 22.9 Test method Nucleic acid test 3 2 – 60.0 40.0 – Antigen detection 21 46 – 31.3 68.7 – Culture 0 2 – 0.0 100 – NG-positive 38 26 7 59.4 40.6 9.9 Test method Nucleic acid test 1 0 – 100.0 0 – Gram stain 22 15 – 59.5 40.5 – Culture 15 11 – 57.7 42.3 – Total 62 76 29 44.9 55.1 17.4 Clinic-based treatment for CT and NG Among the 27 CT-positive patients treated in clinics (28.1%), only 5 (22.7%) received regimens aligned with national guidelines. Inappropriate treatments included the wrong drug (1 case), incorrect dosage (1 case), and improper duration (20 cases). The remaining 69 patients (71.9%) did not receive CT treatment: 1 was correctly diagnosed but untreated, 46 had false-negative results, and 22 were not tested for CT. Of the 38 NG-positive patients treated in clinics (53.5%), 16 (42.1%) received guideline-compliant therapy. The rest were treated with the wrong drug (1 case), incorrect dosage (2 cases), or inadequate duration (19 cases). Among the 33 untreated NG-positive patients (46.5%), 1 was diagnosed but not treated, 25 had false-negative results, and 7 were not tested for NG. All 14 patients co-infected with CT and NG received treatment for both infections. However, only 1 (7.1%) received appropriate CT therapy, while 8 (57.1%) received recommended NG treatment. Table 3. Medication selection and prescription compliance among clinically treated patients. Variable CT infected patients NG infected patients Diagnosed with CT (n=24, %) Not diagnosed with CT (n=50, %) Untested (n=22, %) Total (n=96, %) Diagnosed with NG (n=38, %) Not diagnosed with NG (n=26, %) Untested (n=7, %) Total (n=71, %) Treated 23 (95.8) 4 (8.0) 0 (0.0) 27 (28.1) 37 (97.4) 1 (3.8) 0 (0.0) 38 (53.5) Untreated 1 (4.2) 46 (92.0) 22 (100.0) 69 (71.9) 1 (2.6) 25 (96.2) 7 (100.0) 33 (46.5) Guideline-compliant 4 (17.4) 1 (25.0) 0 (0.0) 5 (22.7) 15 (40.5) 1 (100.0) 0 (0.0) 16 (42.1) Non-compliant 19 (82.6) 3 (75.0) 0 (0.0) 22 (77.3) 22 (59.5) 0 (0.0) 0 (0.0) 22 (57.9) Inappropriate drug 1 (5.3) 0 (0.0) 0 (0.0) 1 (4.5) 1 (2.7) 0 (0.0) 0 (0.0) 1 (2.7) Incorrect dosage 1 (5.3) 0 (0.0) 0 (0.0) 1 (4.5) 2 (9.1) 0 (0.0) 0 (0.0) 2 (9.1) Inadequate duration 17 (89.5) 3 (100.0) 0 (0.0) 20 (91.0) 19 (86.4) 0 (0.0) 0 (0.0) 19 (86.4) Discussion This study assessed the diagnostic accuracy of CT and NG testing, as well as adherence to recommended treatment protocols, in hospitals across southern China. Findings revealed that nearly two-thirds of CT cases and half of NG cases among male patients were either not tested or yielded false-negative results, leading to substantial underdiagnosis. Moreover, the majority of confirmed cases did not receive guideline-concordant treatment. These results underscore the urgent need to improve testing coverage, enhance diagnostic accuracy, and ensure adherence to national treatment guidelines in STD clinics across the region. Our data indicate limited diagnostic capacity for CT and NG. Despite seeking care, only 25.0% (24/96) of CT-positive and 53.5% (38/71) of NG-positive men were identified. This is consistent with a Shenzhen-based study in which only 22 of 161 NG-infected men were correctly diagnosed[9]. Testing remains a critical entry point for diagnosis, yet 22.9% of CT-positive and 9.9% of NG-positive patients in our study were not tested. Contributing factors include physician oversight and the low sensitivity of commonly used diagnostic methods. In most primary hospitals, CT testing relies on antigen detection, while NG diagnosis depends on Gram stain and culture. Although the theoretical sensitivities of these methods range from 82–87% (CT) antigen, 89–98% (Gram stain), and 72–100% (culture), their real-world performance is considerably lower[16]. In this study, antigen detection missed approximately 70% of CT cases, and Gram stain and culture detected fewer than 60% of NG cases. NAAT, the most sensitive and specific method, is endorsed by the World Health Organization and widely adopted in high-income countries[17]. However, its use in China remains limited due to cost and technical constraints [18]. Even in Shenzhen—one of China’s most developed cities—only 40.4% of hospitals offered NAAT for NG and 45.6% for CT, with corresponding patient screening rates of 25.5% and 43.2%[19]. In Fujian Province, NAAT availability was even lower, at 20.9% for NG and 24.4% for CT[20]. Antimicrobial resistance (AMR) in bacteria is a pressing global health challenge, and strict adherence to treatment guidelines is essential to curb its progression[21]. In our survey, only 40.5% of male patients with NG infection received guideline-compliant therapy. This proportion closely mirrors findings from Guangdong (36.2% in men)[12] and a national survey (37.8% across sexes)[11], underscoring the considerable risk of accelerating NG resistance in China. Adherence rates abroad appear higher. In New Zealand, 61% of patients received recommended therapy, and U.S. studies reported rates ranging from 48.6% to 82.5%[22–25]. In contrast, England showed poor compliance: only 50–52% of cases were treated, and just 5–11% received the recommended dual therapy[26]. In our survey, most non-compliant cases involved incorrect treatment courses, whereas earlier studies noted physicians in Jiangsu Province (79.1%) and nationwide (65.7%) often prescribed higher-than-recommended dosages for NG[27]. The divergence in prescribing patterns requires further investigation. Far less is known about AMR in CT because the bacterium is difficult to culture in vitro[28]. As a result, resistance-related treatment failures are rarely documented. Nonetheless, our findings are concerning: only 17.4% of CT patients received treatment consistent with national guidelines. Finally, no patients in our survey were treated without laboratory confirmation of CT or NG infection. This emphasizes the need to expand targeted testing among high-risk populations to reduce treatment gaps. This study has several limitations. It focused solely on male patients, excluding data on CT and NG testing and treatment in females. Although 5,354 men were tested at STD clinics, only 153 CT and/or NG infections were detected, limiting the analytical power of the study. The small number of cases may affect the reliability and generalizability of the results. Additionally, the study did not examine the causes of misdiagnosis or treatment non-adherence, which should be addressed in future research. Conclusion In South China, both the accuracy of laboratory testing and adherence to treatment guidelines for CT and NG among men who have sex with men (MSM) remain suboptimal. Targeted efforts are needed to expand testing, adopt more sensitive and accessible diagnostics, and improve treatment compliance to reduce the disease burden in this population. Declarations Ethics approval and consent to participate Ethics approval was obtained from the Ethics Review Committee of Dermatology Hospital of Southern Medical University (2022019) and performed by the principles of the Declaration of Helsinki. During the recruitment phase, all participants were informed of the study details and signed the informed consent form. Data sharing No additional data available. Competing interests There have no competing interests in this research. Funding This research has been funded by Guangdong Basic and Applied Basic Research Foundation (No. 2022A1515110895) and Guangdong University Youth Innovation Talent Project (No. 2021KQNCX011). Author Contribution MX and CW were responsible for the study conception and design and critically reviewed the final manuscript. ZP curated the data with input from XH. MX conducted the data analysis and drafted the manuscript with inputs from MG, MY. SH, PZ, and JL provided iterative reviews and critical comments. All the authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Acknowledgement We would like to thank all the investigators and physicians at the selected hospitals who contributed to the completion of this study. Data Availability All data relevant to the study are included in the article or uploaded as supplementary information. References Chlamydia [ https://www.who.int/news-room/fact-sheets/detail/chlamydia ] Gonorrhoea (Neisseria gonorrhoeae infection) [ https://www.who.int/news-room/fact-sheets/detail/gonorrhoea-(neisseria-gonorrhoeae-infection) ] Seo Y, Choi KH: Characterization and Trend of Co-Infection with Neisseria gonorrhoeae and Chlamydia trachomatis from the Korean National Infectious Diseases Surveillance Database . 2021, 39 (1):107–115. Barati Sedeh F, Thomsen SF, Larsen HK, Westh H, Salado-Rasmussen K: Sex-associated Risk Factors for Co-infection with Chlamydia trachomatis and Neisseria gonorrhoea among Patients Presenting to a Sexually Transmitted Infection Clinic . Acta dermato-venereologica 2021, 101 (1):adv00356. 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Supplementary Files SupplementaryFile1.docx Cite Share Download PDF Status: Published Journal Publication published 01 Apr, 2026 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 28 Jan, 2026 Reviews received at journal 13 Jan, 2026 Reviews received at journal 05 Jan, 2026 Reviewers agreed at journal 31 Dec, 2025 Reviewers agreed at journal 30 Dec, 2025 Reviews received at journal 29 Dec, 2025 Reviewers agreed at journal 29 Dec, 2025 Reviewers agreed at journal 27 Dec, 2025 Reviewers invited by journal 16 Dec, 2025 Editor assigned by journal 11 Dec, 2025 Editor invited by journal 02 Dec, 2025 Submission checks completed at journal 02 Dec, 2025 First submitted to journal 02 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8094254","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":561768650,"identity":"f59899fd-a566-4c99-a1b2-0c35abb16d50","order_by":0,"name":"Mingzhou 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University","correspondingAuthor":false,"prefix":"","firstName":"Zichao","middleName":"","lastName":"Pang","suffix":""},{"id":561768652,"identity":"64463c4a-82b8-4e56-b873-6123c551582f","order_by":2,"name":"Xiangyi He","email":"","orcid":"","institution":"Guangdong Provincial Key Laboratory of Tropical Diseases Research, School of Public Health, Southern Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiangyi","middleName":"","lastName":"He","suffix":""},{"id":561768653,"identity":"b5c226d0-a9f2-4818-bf30-5196e49e3cdb","order_by":3,"name":"Mengqi Gao","email":"","orcid":"","institution":"Dermatology Hospital of Southern Medical University","correspondingAuthor":false,"prefix":"","firstName":"Mengqi","middleName":"","lastName":"Gao","suffix":""},{"id":561768654,"identity":"aca91912-dad4-43d4-9c61-c41df329af6e","order_by":4,"name":"Peizhen Zhao","email":"","orcid":"","institution":"Dermatology Hospital of Southern Medical 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12:29:38","extension":"html","order_by":23,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":122326,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8094254/v1/2c2afb8d667ba82219aa5e5e.html"},{"id":98778031,"identity":"97a471ea-7714-4934-b07c-ecbdfe61c8d0","added_by":"auto","created_at":"2025-12-22 12:28:50","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":140902,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of study design and participant inclusion.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8094254/v1/e7dc1b2196ac88a34015268f.png"},{"id":106344406,"identity":"76bc2797-03ae-40e2-b68e-f832658cd323","added_by":"auto","created_at":"2026-04-07 16:14:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2367472,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8094254/v1/eb2dd711-1d22-49cf-af9a-8b94a4ce6af4.pdf"},{"id":98780695,"identity":"904ccd4e-ae8b-41cd-9569-1fe1c9aabec2","added_by":"auto","created_at":"2025-12-22 12:31:34","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":24419,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8094254/v1/8f14beeadf5b030cd6b4cc97.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of diagnostic practices and treatment compliance for Chlamydia trachomatis and Neisseria gonorrhoeae in male patients at STD clinics in Southern China","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChlamydia and gonorrhea, caused by \u003cem\u003eChlamydia trachomatis\u003c/em\u003e (CT) and \u003cem\u003eNeisseria gonorrhoeae\u003c/em\u003e (NG), respectively, are among the most prevalent sexually transmitted infections (STIs) worldwide. In 2020, the World Health Organization estimated 128.5\u0026nbsp;million new cases of chlamydia and 82.4\u0026nbsp;million of gonorrhea among individuals aged 15\u0026ndash;49 years[1, 2]. Without treatment, both infections can lead to infertility, other serious reproductive health issues, and heightened vulnerability to HIV. Co-infections are frequently observed in high-risk groups, with prevalence ranging from under 4% to as high as 60% across various studies[3\u0026ndash;6]. In China, the disease burden is particularly significant. Gonorrhea ranked as the fourth most commonly reported Class A/B notifiable infectious disease in 2021, with 127,803 new cases (9.1 per 100,000 population)[7]. The incidence of chlamydia in 2019 was 55.32 per 100,000 [8].\u003c/p\u003e \u003cp\u003eAlthough laboratory testing is essential for definitive diagnosis, many infections remain undetected. Asymptomatic cases are common, resulting in low healthcare utilization. Even among symptomatic individuals, diagnoses may be missed due to the absence of test prescriptions, patient refusal, or false-negative results. In Shenzhen, China, over 75% of patients with NG were not tested during their most recent STD clinic visit, and only 37.7% had confirmed positive results[9]. Data on chlamydia underdiagnosis in China are limited. Similarly, despite annual CT screening recommendations for adolescents in the United States, only 7.8% undergo screening without targeted intervention[10]. The underdiagnosis of chlamydia and gonorrhea exacerbates individual health risks and facilitates continued transmission within populations.\u003c/p\u003e \u003cp\u003eInappropriate treatment prescribing remains a significant concern. A national survey involving physicians from 126 cities across 22 provinces in China found that 62.2% did not follow the National Sexually Transmitted Disease (STD) Treatment Guidelines for managing uncomplicated gonorrhea[11]. Similarly, a study in 15 municipal cities within Guangdong Province reported that only 30.7% of gonorrhea patients received guideline-compliant therapy in hospital settings[12]. Non-adherence to recommended regimens increases the risk of treatment failure and promotes the development of gonococcal antimicrobial resistance. However, national data on chlamydia treatment adherence are currently lacking.\u003c/p\u003e \u003cp\u003eGuangdong Province, located in southern China, is the most populous region in the country and bears the highest burden of chlamydia and gonorrhea infections[8, 13]. Male STD clinic patients (MSPs)\u0026mdash;a population typically characterized by high sexual activity and presentation for high-risk behaviors or reproductive health issues\u0026mdash;show disproportionately high infection rates for both CT and NG[14, 15]. Against this backdrop, we conducted a cross-sectional study in southern China to: (1) assess the diagnostic accuracy of clinical evaluations compared with laboratory-confirmed results for CT and NG, and (2) determine the proportion of MSPs receiving treatment regimens aligned with national STD guidelines.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy sites and population\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted in Guangdong Province, China, between April 1 and October 31, 2022. Seven cities\u0026mdash;Shenzhen, Jiangmen, Zhuhai, Foshan, Maoming, Yunfu, and Qingyuan\u0026mdash;were randomly selected from 21 municipalities. In each city, one dermatology hospital and two general hospitals were designated as study sites. A minimum of 250 participants was recruited per hospital (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEligibility was limited to men aged 18 years or older who had not used antibiotics in the previous two weeks and were seeking care for STDs or sexual health concerns at participating clinics (including departments of dermatology and venereology, andrology, or urology). Written informed consent was obtained from all participants. Exclusion criteria included follow-up visits for previously diagnosed STDs, inability to communicate effectively, or failure to provide a urine sample.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eLaboratory testing and data collection\u003c/h3\u003e\n\u003cp\u003eIn accordance with the Chinese guidelines Diagnosis for \u003cem\u003eGonorrhoea\u003c/em\u003e (WS 268\u0026ndash;2019) and Diagnosis of \u003cem\u003eGenital Chlamydia Trachomatis Infection\u003c/em\u003e (WS/T 513\u0026ndash;2016), a laboratory-confirmed positive result is required for the diagnosis of NG and CT infections. Following routine clinical care, eligible participants were informed of the study\u0026rsquo;s objectives and procedures by their attending physicians. Regardless of whether NG or CT testing had been conducted during the clinic visit, each participant was asked to provide an additional urine sample. These samples were submitted to the STD Laboratory at the Dermatology Hospital of Southern Medical University, which served as the reference center. Nucleic acid amplification testing (NAAT) for NG and CT was performed using the Roche Cobas 4800 Molecular System (Branchburg, NJ, USA), which functioned as the reference standard for this study. At participating sites, NG and CT testing was conducted in accordance with national diagnostic protocols. For NG, methods included Gram stain microscopy (restricted to symptomatic male patients), culture, and NAAT. For CT, testing included antigen detection, culture, and NAAT.\u003c/p\u003e \u003cp\u003eWe developed a structured information collection form (Supplementary File 1) for this study to collect data on demographic characteristics, clinical symptoms, site-specific test results, and prescribed treatments. All the data were retrieved daily from the Hospital Information System (HIS) for all participants who tested positive for NG or CT at the reference laboratory.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eOutcome measures\u003c/h3\u003e\n\u003cp\u003eThe following indicators were employed to evaluate study outcomes: 1) Untested Proportion: Defined as the proportion of participants who tested positive for CT or NG at the reference laboratory but were not tested at the clinical site. 2) True-Positive Proportion: Defined as the proportion of participants who tested positive for NG or CT at both the reference laboratory and the clinic. 3) Recommended Treatment Proportion: Defined as the proportion of participants who received treatment consistent with national guidelines. In accordance with these guidelines, the following treatment regimens were recommended: 1) For NG infection: Ceftriaxone 1 g administered intramuscularly or intravenously as a single dose, or spectinomycin 2 g intramuscularly as a single dose (4 g for cervicitis). 2) For CT infection: Azithromycin 1 g orally on day 1, followed by 0.5 g once daily for two additional days (total of 3 days), or doxycycline 100 mg orally twice daily for 10\u0026ndash;14 days.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe database was created using EpiData 3.0, and all entries were double-entered and cross-verified for accuracy. Statistical analyses were conducted using R software (version 4.2.0). The true-positive proportion of clinic-based CT and NG testing was determined by comparison with reference laboratory results. Between-group differences were examined using t-tests and Chi-square (χ\u0026sup2;) tests. Prescriptions were evaluated for adherence to national guidelines, considering dosage, frequency, duration, and route of administration (intramuscular, intravenous, or oral). Statistical significance was defined as a \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eParticipant demographics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 5,500 MSPs enrolled, 5,354 provided urine specimens and were included in the analysis. The remaining 146 were excluded\u0026mdash;120 for not submitting a urine sample and 26 for declining informed consent. Reference laboratory testing confirmed 82 CT-positive, 57 NG-positive, and 14 CT/NG co-infections, yielding a total of 153 cases for final analysis.\u003c/p\u003e\n\u003cp\u003eAmong participants, 34.6% were aged 15\u0026ndash;29 years, 58.2% were married, and 24.4% held a bachelor\u0026rsquo;s degree. The majority were employed as manual laborers (37.9%) or in business-related roles (26.1%).\u0026nbsp;\u003c/p\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"608\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 608px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e \u003cstrong\u003eDemographic characteristics of study participants by infection type.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=153)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n\u003c/strong\u003e\u003cstrong\u003e, %\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfectious types (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCT\u003c/strong\u003e\u003cstrong\u003e-positive\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003en=\u003c/strong\u003e\u003cstrong\u003e82)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003cstrong\u003eG-positve (\u003c/strong\u003e\u003cstrong\u003en=\u003c/strong\u003e\u003cstrong\u003e57)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCo-positive\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=14)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.542\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e15-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e53 (34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e34 (41.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e15 (26.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e4 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e30-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e35 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e20 (24.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e12 (21.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e3 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e40-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e34 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e15 (18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e15 (26.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e4 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e50-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e23 (15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e9 (11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e11 (19.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e3 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026ge; 60\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e8 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e4 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e4 (7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarriage status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.620\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e89 (58.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e44 (53.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e35 (61.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e10 (71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e57 (37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e35 (42.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e18 (31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e4 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e3 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e2 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e1 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e2 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.150\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e6 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e1 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e4 (7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eMiddle school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e31 (20.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e20 (24.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e10 (17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eHigh school/Technical\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e39 (25.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e19 (23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e13 (22.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e7 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e24 (15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e10 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e11 (19.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e3 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e37 (24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e24 (29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e12 (21.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e16 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e8 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e7 (12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.236\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eWorker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e58 (37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e37 (45.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e16 (24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e5 (35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eBusinessperson\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e40 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e21 (25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e14 (28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e5 (35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e18 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e9 (11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e8 (14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eHomemaker/Unemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e15 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e8 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e6 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eOther*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e3 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e5 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e2 (14.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e12 (7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e4 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e8 (14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNote: *Other occupations include students, retirees, and freelance workers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinic-based testing for CT and NG\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ethe 96 patients confirmed positive for CT (including CT/NG co-infections), 22 (22.9%) were not tested for CT at the clinic. Among the 74 who underwent testing, only 24 were correctly identified, resulting in a true-positive proportion of 32.4%. By diagnostic method, true-positive proportions were 60.0% for NAAT, 31.3% for antigen detection, and 0% for culture.\u003c/p\u003e\n\u003cp\u003eAmong the 71 NG-positive patients (including co-infections), 7 (9.9%) were not tested in the clinical setting. Of the 64 tested, 38 were correctly identified, yielding a true-positive proportion of 59.4%. NAAT achieved a true-positive proportion of 100.0%, compared to 59.5% for Gram stain smear and 57.7% for culture.\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"125%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" style=\"width: 716px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2. Medication selection and clinical application of prescriptions by test result concordance.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cimg width=\"1\" src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1766072632.png\" alt=\"image\"\u003e\u003cstrong\u003eClinic+/Reference+ (A)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinic-/Reference+ (B)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUntested\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(C)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTrue-positive (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(A/A+B)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFalse-negative (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(B/A+B)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUntested (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(C/A+B+C)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCT-positive\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e32.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e67.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e22.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest method\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eNucleic acid test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e60.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cimg width=\"1\" src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1766072632.png\" alt=\"image\"\u003e40.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eAntigen detection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e31.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e68.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eCulture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNG-positive\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e59.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e40.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest method\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eNucleic acid test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eGram stain\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e59.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e40.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eCulture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e57.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e42.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e44.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e55.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eClinic-based treatment for CT and NG\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 27 CT-positive patients treated in clinics (28.1%), only 5 (22.7%) received regimens aligned with national guidelines. Inappropriate treatments included the wrong drug (1 case), incorrect dosage (1 case), and improper duration (20 cases). The remaining 69 patients (71.9%) did not receive CT treatment: 1 was correctly diagnosed but untreated, 46 had false-negative results, and 22 were not tested for CT. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOf the 38 NG-positive patients treated in clinics (53.5%), 16 (42.1%) received guideline-compliant therapy. The rest were treated with the wrong drug (1 case), incorrect dosage (2 cases), or inadequate duration (19 cases). Among the 33 untreated NG-positive patients (46.5%), 1 was diagnosed but not treated, 25 had false-negative results, and 7 were not tested for NG.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll 14 patients co-infected with CT and NG received treatment for both infections. However, only 1 (7.1%) received appropriate CT therapy, while 8 (57.1%) received recommended NG treatment.\u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"762\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" style=\"width: 762px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3. Medication selection and prescription compliance among clinically treated patients.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCT infected patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 320px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNG infected patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003eDiagnosed with CT\u003c/p\u003e\n \u003cp\u003e(n=24,\u0026nbsp;%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eNot diagnosed with CT\u003c/p\u003e\n \u003cp\u003e(n=50,\u0026nbsp;%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eUntested\u003c/p\u003e\n \u003cp\u003e(n=22,\u0026nbsp;%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(n=96, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eDiagnosed with NG\u003c/p\u003e\n \u003cp\u003e(n=38,\u0026nbsp;%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eNot diagnosed with NG\u003c/p\u003e\n \u003cp\u003e(n=26,\u0026nbsp;%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eUntested\u003c/p\u003e\n \u003cp\u003e(n=7,\u0026nbsp;%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(n=71, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e23 (95.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e4 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e27 (28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e37 (97.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e38 (53.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUntreated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e1 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e46 (92.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e22 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e69 (71.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e25 (96.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e7 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e33 (46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eGuideline-compliant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e4 (17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e5 (22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e15 (40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e16 (42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eNon-compliant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e19 (82.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e3 (75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e22 (77.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e22 (59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e22 (57.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eInappropriate drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e1 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e1 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e1 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eIncorrect dosage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e1 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e1 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e2 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e2 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eInadequate duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e17 (89.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e3 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e20 (91.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e19 (86.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e19 (86.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the diagnostic accuracy of CT and NG testing, as well as adherence to recommended treatment protocols, in hospitals across southern China. Findings revealed that nearly two-thirds of CT cases and half of NG cases among male patients were either not tested or yielded false-negative results, leading to substantial underdiagnosis. Moreover, the majority of confirmed cases did not receive guideline-concordant treatment. These results underscore the urgent need to improve testing coverage, enhance diagnostic accuracy, and ensure adherence to national treatment guidelines in STD clinics across the region.\u003c/p\u003e \u003cp\u003eOur data indicate limited diagnostic capacity for CT and NG. Despite seeking care, only 25.0% (24/96) of CT-positive and 53.5% (38/71) of NG-positive men were identified. This is consistent with a Shenzhen-based study in which only 22 of 161 NG-infected men were correctly diagnosed[9]. Testing remains a critical entry point for diagnosis, yet 22.9% of CT-positive and 9.9% of NG-positive patients in our study were not tested. Contributing factors include physician oversight and the low sensitivity of commonly used diagnostic methods. In most primary hospitals, CT testing relies on antigen detection, while NG diagnosis depends on Gram stain and culture. Although the theoretical sensitivities of these methods range from 82\u0026ndash;87% (CT) antigen, 89\u0026ndash;98% (Gram stain), and 72\u0026ndash;100% (culture), their real-world performance is considerably lower[16]. In this study, antigen detection missed approximately 70% of CT cases, and Gram stain and culture detected fewer than 60% of NG cases. NAAT, the most sensitive and specific method, is endorsed by the World Health Organization and widely adopted in high-income countries[17]. However, its use in China remains limited due to cost and technical constraints [18]. Even in Shenzhen\u0026mdash;one of China\u0026rsquo;s most developed cities\u0026mdash;only 40.4% of hospitals offered NAAT for NG and 45.6% for CT, with corresponding patient screening rates of 25.5% and 43.2%[19]. In Fujian Province, NAAT availability was even lower, at 20.9% for NG and 24.4% for CT[20].\u003c/p\u003e \u003cp\u003e Antimicrobial resistance (AMR) in bacteria is a pressing global health challenge, and strict adherence to treatment guidelines is essential to curb its progression[21]. In our survey, only 40.5% of male patients with NG infection received guideline-compliant therapy. This proportion closely mirrors findings from Guangdong (36.2% in men)[12] and a national survey (37.8% across sexes)[11], underscoring the considerable risk of accelerating NG resistance in China. Adherence rates abroad appear higher. In New Zealand, 61% of patients received recommended therapy, and U.S. studies reported rates ranging from 48.6% to 82.5%[22\u0026ndash;25]. In contrast, England showed poor compliance: only 50\u0026ndash;52% of cases were treated, and just 5\u0026ndash;11% received the recommended dual therapy[26]. In our survey, most non-compliant cases involved incorrect treatment courses, whereas earlier studies noted physicians in Jiangsu Province (79.1%) and nationwide (65.7%) often prescribed higher-than-recommended dosages for NG[27]. The divergence in prescribing patterns requires further investigation. Far less is known about AMR in CT because the bacterium is difficult to culture in vitro[28]. As a result, resistance-related treatment failures are rarely documented. Nonetheless, our findings are concerning: only 17.4% of CT patients received treatment consistent with national guidelines. Finally, no patients in our survey were treated without laboratory confirmation of CT or NG infection. This emphasizes the need to expand targeted testing among high-risk populations to reduce treatment gaps.\u003c/p\u003e \u003cp\u003eThis study has several limitations. It focused solely on male patients, excluding data on CT and NG testing and treatment in females. Although 5,354 men were tested at STD clinics, only 153 CT and/or NG infections were detected, limiting the analytical power of the study. The small number of cases may affect the reliability and generalizability of the results. Additionally, the study did not examine the causes of misdiagnosis or treatment non-adherence, which should be addressed in future research.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e In South China, both the accuracy of laboratory testing and adherence to treatment guidelines for CT and NG among men who have sex with men (MSM) remain suboptimal. Targeted efforts are needed to expand testing, adopt more sensitive and accessible diagnostics, and improve treatment compliance to reduce the disease burden in this population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval was obtained from the Ethics Review Committee of Dermatology Hospital of Southern Medical University (2022019) and performed by the principles of the Declaration of Helsinki. During the recruitment phase, all participants were informed of the study details and signed the informed consent form.\u003c/p\u003e\n\u003ch2\u003eData sharing\u003c/h2\u003e\n\u003cp\u003eNo additional data available.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThere have no competing interests in this research.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis research has been funded by Guangdong Basic and Applied Basic Research Foundation (No. 2022A1515110895) and Guangdong University Youth Innovation Talent Project (No. 2021KQNCX011).\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eMX and CW were responsible for the study conception and design and critically reviewed the final manuscript. ZP curated the data with input from XH. MX conducted the data analysis and drafted the manuscript with inputs from MG, MY. SH, PZ, and JL provided iterative reviews and critical comments. All the authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eWe would like to thank all the investigators and physicians at the selected hospitals who contributed to the completion of this study.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eAll data relevant to the study are included in the article or uploaded as supplementary information.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eChlamydia\u003c/strong\u003e [\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/chlamydia\u003c/span\u003e\u003c/span\u003e]\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eGonorrhoea (Neisseria gonorrhoeae infection)\u003c/strong\u003e [\u003cspan class=\"ExternalRef\"\u003e\u003cspan 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\u003cstrong\u003e94\u003c/strong\u003e(4):298\u0026ndash;303.\u003c/li\u003e\n \u003cli\u003eBoyajian AJ, Murray M, Tucker M, Neu N: \u003cstrong\u003eIdentifying variations in adherence to the CDC sexually transmitted disease treatment guidelines of Neisseria gonorrhoeae\u003c/strong\u003e. \u003cem\u003ePublic Health\u003c/em\u003e 2016, \u003cstrong\u003e136\u003c/strong\u003e:161\u0026ndash;165.\u003c/li\u003e\n \u003cli\u003eForster R, Ng D, Upton A, Franklin R, Thomas M: \u003cstrong\u003eTreatment of gonorrhoea in Auckland, New Zealand: marked variation in prescriber adherence to treatment guidelines\u003c/strong\u003e. \u003cem\u003eIntern Med J\u003c/em\u003e 2017, \u003cstrong\u003e47\u003c/strong\u003e(6):640\u0026ndash;648.\u003c/li\u003e\n \u003cli\u003eWeston EJ, Workowski K, Torrone E, Weinstock H, Stenger MR: \u003cstrong\u003eAdherence to CDC Recommendations for the Treatment of Uncomplicated Gonorrhea - STD Surveillance Network, United States, 2016\u003c/strong\u003e. \u003cem\u003eMMWR Morb Mortal Wkly Rep\u003c/em\u003e 2018, \u003cstrong\u003e67\u003c/strong\u003e(16):473\u0026ndash;476.\u003c/li\u003e\n \u003cli\u003eMohammed H, Sile B, Furegato M, Fifer H, Hughes G: \u003cstrong\u003ePoor adherence to gonorrhoea treatment guidelines in general practice in England\u003c/strong\u003e. \u003cem\u003eBr J Gen Pract\u003c/em\u003e 2016, \u003cstrong\u003e66\u003c/strong\u003e(648):352.\u003c/li\u003e\n \u003cli\u003eDing Jianping LX, Hu Haiyang, et al.: \u003cstrong\u003eClinical antibiotic-use survey for gonorrhea treatment in Jiangsu province\u003c/strong\u003e. \u003cem\u003eActa universitatis medicinalis Nanjing (Natural Science)\u003c/em\u003e 2014, \u003cstrong\u003e34\u003c/strong\u003e(1):4.\u003c/li\u003e\n \u003cli\u003eGiacani L, Bradshaw CS, Muzny CA, Graves KJ, Pasricha S, Jordan SJ, Allan-Blitz LT: \u003cstrong\u003eAntimicrobial Resistance in Curable Sexually Transmitted Infections\u003c/strong\u003e. \u003cem\u003eCurrent HIV/AIDS reports\u003c/em\u003e 2025, \u003cstrong\u003e22\u003c/strong\u003e(1):14.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Chlamydia trachomatis, Neisseria gonorrhoeae, Laboratory test, Treatment, Cross-sectional study","lastPublishedDoi":"10.21203/rs.3.rs-8094254/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8094254/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eTo evaluate the diagnostic accuracy and adherence to national treatment guidelines for \u003cem\u003eChlamydia trachomatis\u003c/em\u003e (CT) and \u003cem\u003eNeisseria gonorrhoeae\u003c/em\u003e (NG) among male patients attending sexually transmitted disease (STD) clinics (MSPs) in southern China.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA survey was conducted in Guangdong Province in 2022. MSPs who completed standard clinical procedures provided informed consent and an additional urine sample for CT/NG testing at the reference laboratory. Information of reference laboratory-confirmed CT/NG cases were extracted from hospital information systems. Clinic-reported test results were compared to reference laboratory findings. Treatment records were reviewed to assess compliance with national STD treatment guidelines.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 5,354 participants, the reference laboratory confirmed 96 CT-positive and 71 NG-positive cases. In clinical settings, 22 (22.9%) CT-positive and 7 (9.9%) NG-positive patients were not tested for the relevant pathogen. Of those tested, clinics identified only 24 (32.4%) CT-positive and 38 (59.4%) NG-positive cases. True-positive proportions for CT were 60.0% (NAAT), 31.3% (antigen detection), and 0% (culture). For NG, the corresponding proportions were 100.0% (NAAT), 59.5% (Gram stain smear), and 57.7% (culture). Among CT-positive patients, 27 received treatment, but only 5 (22.7%) received guideline-recommended regimens. Of 38 NG-positive patients who received treatment, only 16 (42.1%) were treated appropriately.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eDiagnostic performance and adherence to recommended treatment regimens for CT and NG among MSPs in southern China remain inadequate. Efforts are needed to expand testing coverage, upgrade diagnostic tools, and improve compliance with national treatment guidelines to reduce the burden of CT and NG infections in this population.\u003c/p\u003e","manuscriptTitle":"Evaluation of diagnostic practices and treatment compliance for Chlamydia trachomatis and Neisseria gonorrhoeae in male patients at STD clinics in Southern China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 09:48:29","doi":"10.21203/rs.3.rs-8094254/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-28T08:09:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-13T13:13:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-05T13:23:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"298691269474317562855528256233142447648","date":"2025-12-31T16:03:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"166331338227865991374558785665878232353","date":"2025-12-30T15:30:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-29T14:28:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"268236651426126568180699141333200207699","date":"2025-12-29T10:36:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"25975988689723059978610837466182744508","date":"2025-12-27T10:32:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-16T12:37:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-11T05:05:35+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-02T12:16:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-02T10:40:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-12-02T09:53:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c7e934f4-faea-4cf8-88b1-b93f29cec6d9","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T16:10:06+00:00","versionOfRecord":{"articleIdentity":"rs-8094254","link":"https://doi.org/10.1186/s12879-026-13203-y","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2026-04-01 16:00:00","publishedOnDateReadable":"April 1st, 2026"},"versionCreatedAt":"2025-12-22 09:48:29","video":"","vorDoi":"10.1186/s12879-026-13203-y","vorDoiUrl":"https://doi.org/10.1186/s12879-026-13203-y","workflowStages":[]},"version":"v1","identity":"rs-8094254","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8094254","identity":"rs-8094254","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}