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

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.