Gonorrhea case-finding among asymptomatic men seeking ambulatory care: a cost effectiveness analysis

Case-finding for gonorrhea in asymptomatic men is generally not performed in primary care settings and often not performed when men are seen for other reasons in clinics for sexually transmitted diseases. We performed a cost-effectiveness analysis of case-finding among asymptomatic men seeking ambulatory care, using culture of the first-voided urine and treatment of culture-positive patients with tetracycline. The analysis demonstrated that care-finding is increasingly cost-effective as the probability of asymptomatic gonorrhea becomes greater. Over a reasonable expected range of the probability of asymptomatic gonorrhea (0.1-15%) in such settings, the additional cost to avert one additional day of morbidity ranged from $47,000 to $260; the additional cost to avert one additional case of residual asymptomatic infection ranged from $26,000 to $140; and the additional cost to avert one additional case of pelvic inflammatory disease in a contact ranged from $250,000 to $1,400. We conclude that the cost-effectiveness of case-finding for gonorrhea among asymptomatic men compares favorably with that of other medical interventions when the probability of infection is relatively high (perhaps greater than or equal to 5%). In order to make use of such information, physicians in ambulatory care settings require better information about the probability of gonorrhea in asymptomatic men who differ in their medical histories and socioeconomic and ethnic backgrounds.