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[(the)-407.8(electronic)-407.7(medical)-404.4(record)-406.3(\(EMR\).)-403.7(In)-399.6(this)-401.9(analysis,)-406.1(pa-)]TJ 0 -1.1116 TD [(tients)-359.3(were)-358.9(considered)-360()50.8(symptomatic)44.1()-352.4(i)0(f)-353.6(they)-357(had)-355.8(urethral)]TJ T* [(discharge,)-316.2(dysuria,)-311.7(testicular)-308.5(pain,)-314.4(or)-307.4(a)-307.5(clinical)-312.3(diagnosis)-310.5(of)]TJ 0 -1.1174 TD [(urethr)-7.8(itis;)-299.6(anal)-306.4(discharge)-307.1(or)-301.7(a)-307.5(clinical)-306.6(diagnosis)-304.7(of)-301.7(proctitis;)]TJ 0 -1.1116 TD -.0159 Tc [(o)-15.9(r)-242.7(a)-254.3(c)-.9(li)-15.9(n)10.6(i).2(cal)-259(diagn)-15.9(o)10.7(sis)-258.7(o).3(f)-253.1(pha)-15.9(r)9.6(yngi)-15.9(t)10.4(i).2(s.)-255.5(Pat)-15.9(i)10.4(ents)-258.7(were)-254.3(c)-15.9(o)9.5(nsid)-15.9(e)9.5(r).3(ed)]TJ T* [(t)-15.9(o)-288.9(hav)-15.9(e)-290()52.2()-15.9(s)10.9(i).2(gns)-15.9()62.8()-305(if)-299.2(th)-15.9(e)9.5(y)-299.2(ha)-15.9(d)-290(uret)-15.9(h)10.6(ral)-305.1(o).3(r)-299.2(r).3(e)-15.9(c)8.4(tal)-299.4(p)-15.9(h)10.7(y).3(si)-15.9(c)9.4(a)-.9(l)-299.4(e)-.9(x)-15.9(a)9.5(mi-)]TJ 0 -1.1174 TD [(n)-15.9(a)9.5(tion)-425.9()-15.9(n)10.9(d).3(ings)-15.9(.)-411.9(E)-.9(x)-15.9(p)10.7(osed)-15.9(,)-412.1(a)-.9(sy)-15.9(m)9.5(p).3(tomat)-15.9(i)10.4(c)-427.1(patie)-15.9(n)9.5(ts)-425.7(were)-427.1(t)-15.9(h)10.6(ose)]TJ 0 -1.1116 TD [(w)-16(i)9.6(th)-414.5(an)-420.3(ICD-)-16(9)-404.1(c)-1(ode)-415.7(f)-16(o)10.6(r)-414.5(e)-1(x)-16(p)10.6(osur)-16(e)-405.2(t).1(o)-414.5(g)-16(o)10.6(norr)-16(h)10.6(e)-1(a)-415.7(o).2(r)-420.2(e)-1(xpos)-16(u)10.8(r).2(e)]TJ T* -.0158 Tc [(t)-15.8(o)-231.2(v)-15.8(e)9.6(nere)-15.8(a)8.5(l)-241.7(d)-15.8(i)10.7(seas)-15.8(e)9.8(,)-243.9(an)-15.8(d)-231.1(n).4(o)-247.3(s)-15.8(i)10.9(gns)-247.1(or)-247.3(sym)-15.8(p)9.6(toms.)-249.6(Incl)-15.8(u)10.7(sion)-247.3(cr)-15.8(i)10.7(t).2(e-)]TJ 0 -1.1174 TD 0 Tc [(ri)26.5(a)-307.5(w)15.3(e)15(r)0(e)-297.1(a)15(s)-306.2(follows:)-326.6(cisgender)-324.3(MSM)-327.5(aged)-323.5(18)-324.7(years)-324.4(or)-324.7(older)]TJ 0 -1.1116 TD [(who)-240.3(tested)-239.4(for)-233.6(gonorrhea)-242.6(of)-232.6(the)-240.7(urethra,)-238.2(rectum,)-238.3(and/or)-238.3(phar-)]TJ T* [(ynx)-308.6(between)-305.9(February)-310.4(and)-304(July)-303.8(2015.)-307.3(Participants)-304.8(are)-310.9(iden-)]TJ T* [(tied)-577(in)-566.8(the)-574.8(dataset)-575.7(as)-567.6(cisgender)-577.8(MSM)-569.4(based)-572.1(on)-572.4(three)]TJ 0 -1.1174 TD [(criteria:)-411.3(\(1\))-406.4(assigned)-402.5(male)-405.5(sex)-407.5(at)-406.7(birth,)-400.8(\(2\))-406.4(current)-407.5(gender)]TJ 0 -1.1116 TD [(identity)-310(of)-313.2(male,)-305.3(and)-309.7(\(3\))-308.5(gay)-309.7(or)-307.4(bisexual)-310.7(sexual)-308.4(orientation,)]TJ T* [(or)-434.1(other)-433(sexual)-435.1(orientation)-435.4(and)-430.7(a)-434.2(male)-434.3(sex)-430.5(partner)-436.3(within)]TJ 0 -1.1174 TD [(the)-304.1(past)-299.2(year.)]TJ /F10 1 Tf 8.9663 0 0 8.9663 313.0582 471.7416 Tm [(Statistical)-304.5(analysis)]TJ /F5 1 Tf 9.843 0 0 9.843 323.0361 455.3007 Tm [(Visits)-387.6(were)-387.7(the)-384.7(units)-385.7(of)-388.1(analysis.)-388.8(The)-385.8(term)-387()50.8(patient)50.8()-387(i)0(s)]TJ -1.0137 -1.1116 TD [(used)-264.6(to)-267.3(refer)-261.2(to)-267.3(unique)-261.3(visits,)-263.5(rather)-268.2(than)-264.9(unique)-261.3(individuals;)]TJ 0 -1.1174 TD [(thus,)-422.5(if)-417(a)-422.7(unique)-416.8(individual)-421.6(had)-419.2(multiple)-426.4(visits,)-419(each)-422.6(visit)]TJ 0 -1.1116 TD [(would)-409.7(be)-406.5(included)-414.6(separately)-407.4(and)-407.6(consid)-7.7(ered)-404.1(a)-411.2()50.8(patient.)47.4()]TJ T* [(Demographi)-9.8(c)-273(differences)-281.6(associated)-286.2(with)-276.2(presumptive)-280.7(treat-)]TJ 0 -1.1174 TD [(ment)-312.2(among)-307.4(those)-306.1(testing)-308.6(positive)-303.9(were)-312.8(examined)-307.4(using)-305(bi-)]TJ 0 -1.1116 TD -.0204 Tc [(v)-20.4(a)-6.5(r)-20.4(i).3(a)-20.4(t)-.9(e)-368.2(l)-20.4(og)-20.4(i)-5.5(s)-20.4(ti)-20.4(c)-358(r)-20.4(e)-6.4(g)-20.4(re)-20.4(ss)-20.4(io)-20.4(n)-362.4(\()-20.4(0.)-20.4(05)]TJ /F11 1 Tf 13.0342 0 TD 0 Tc (a)Tj /F5 1 Tf .8524 0 TD [(le)19.6(ve)19.7(l\))20.7(.)-349(A)-347.5(on)15.1(e-)19.7(ta)19.6(il)20.6(ed)]TJ /F9 1 Tf 8.173 0 TD (Z)Tj /F5 1 Tf .5472 0 TD [(-t)20.7(es)19.9(t)]TJ -22.6068 -1.1116 TD .0124 Tc [(of)-259.4(p)5.5(rop)5.5(or)5.6(tio)5.5(ns)-253.5(\(0.0)5.5(5)]TJ /F11 1 Tf 8.4956 0 TD 0 Tc (a)Tj /F5 1 Tf .7718 0 TD .0097 Tc [(le)-4.1(ve)-4.1(l\))-262.1(w)-3.8(a)1.7(s)-261.9(p)-2.9(erformed)-262.1(to)-256.3(test)-262.2(whether)]TJ -9.2674 -1.1116 TD .0121 Tc [(pat)5.1(i)-.6(ent)5.1(s)-351.7(tr)5.3(eated)-346.1(p)-.5(r)5.3(e)-1.7(s)5.4(u)-.5(mpti)5.1(vely)-346.1(had)-346.1(h)-.5(i)5.1(g)-.5(h)5.2(e)-1.7(r)-346.1(gon)5.2(or)5.3(rhea)-353(p)5.2(os)5.4(i-)]TJ 0 -1.1174 TD .0119 Tc [(tiv)5(it)4.9(y)-317.5(t)-.8(h)5(a)-1.9(n)-311.7(p)-.7(atient)4.9(s)-317.3(w)4.2(ho)-317.5(d)5(i)-.8(d)-311.7(n)-.7(o)5(t)-317.6(receiv)5(e)-318.7(p)5(res)5.2(u)-.7(mpt)4.9(i)-.8(ve)-312.9(tr)5.1(eat-)]TJ 0 -1.1116 TD [(ment.)-388.9(T)-1.9(h)5(e)-393.5(PPV)-393.2(w)4.2(as)-392.2(th)5(e)-393.5(p)-.7(r)5.1(obabi)4.9(lit)4.9(y)-392.4(t)-.8(h)5(a)-1.9(t)-392.5(a)-393.5(pati)4.9(ent)-392.5(t)4.9(reated)]TJ T* .0126 Tc [(presu)5.7(mp)5.7(tiv)5.7(el)5.6(y)-299.5(f)0(o)5.7(r)-299.5(go)5.7(no)5.7(rrh)5.7(ea)-300.7(t)5.6(e)-1.2(s)5.9(t)-.1(ed)-293.8(po)5.7(sit)5.6(i)-.1(ve)-294.9(fo)5.7(r)-299.5(g)0(o)5.7(nor)5.8(rh)5.7(ea,)]TJ 0 -1.1174 TD .0122 Tc [(cal)5.2(cu)5.3(lated)-455.4(o)-.4(v)5.3(e)-1.6(rall)-461.3(and)-455.4(b)-.4(y)-461.2(t)5.2(re)]TJ 12.487 0 TD [(atmen)5.2(t)-461.4(in)5.2(di)5.1(catio)5.2(n.)-457.9(Accu)5.2(rate)]TJ -12.487 -1.1116 TD .0119 Tc [(presu)5(mp)5(tiv)5(e)-255.3(t)4.9(reatmen)5(t)-254.3(referred)-254.1(t)4.9(o)-254.1(t)-.8(r)5.1(e)-1.9(ati)4.9(n)-.7(g)-254.1(p)5(eo)5(ple)-249.5(p)-.7(r)5.1(e)-1.9(su)5(mp)5(-)]TJ T* [(tiv)4.9(el)4.8(y,)-204.7(who)-202.4(t)-.9(hen)-202.4(t)-.9(es)5.1(ted)-208.2(p)4.9(osi)4.8(t)-.9(i)4.8(v)-.8(e)-203.6(f)-.8(o)4.9(r)-208.1(g)4.9(ono)4.9(rr)5(hea.)-204.7(To)-208.2(d)4.9(e)-2(t)4.8(e)-2(rmin)4.9(e)]TJ 0 -1.1174 TD [(the)-474.1(o)5.1(verall)-473(p)5.1(rop)5.1(or)5.2(tio)5.1(n)-472.9(o)-.6(f)-472.9(p)5.1(at)5(ien)5.1(t)-.7(s)-472.7(t)5(reated)-472.9(pr)5.2(es)5.3(umpti)5(v)-.6(ely,)]TJ 0 -1.1116 TD [(who)-415.3(t)5(es)5.3(ted)-415.3(pos)5.3(it)5(ive)-416.5(f)5.2(or)-415.3(at)-415.4(least)-415.4(o)5.1(ne)-416.5(i)5(n)-.6(f)5.2(e)-1.8(ctio)5.1(n)-415.3(s)-.4(u)5.1(s)-.4(cept)5(ibl)5(e)]TJ T* [(to)-357.8(th)5(e)-359(t)4.9(reatmen)5(t)-358(regimen,)-354.4(the)-353.2(c)-1.9(hl)4.9(amyd)5(ia)-359(p)5(o)-.7(s)5.2(i)-.9(ti)4.9(vi)4.9(ty)-357.8(amo)5(n)-.7(g)]TJ T* [(gon)4.9(or)5(rhea)-249.6(n)4.9(eg)4.9(at)4.8(ive)-243.9(p)-.8(ati)4.8(e)-2(nt)4.8(s)-248.3(w)4.1(as)-242.5(calcu)4.9(l)-.9(ated.)-245.1(D)-1.7(ata)-243.9(w)-1.7(ere)-243.9(a)-2(na-)]TJ 0 -1.1174 TD .0124 Tc [(lyzed)-294(u)-.2(si)5.4(ng)-294(SAS)-293.8(9)-.2(.4)-299.7(\()5.6(S)-.1(AS)-293.8(Ins)5.7(ti)5.4(tut)5.4(e)-300.9(I)5.6(n)-.2(c.,)-296.3(C)4.5(ary)5.5(,)-296.3(NC\))5.6(.)]TJ /F10 1 Tf 8.9663 0 0 8.9663 313.0582 223.4267 Tm 0 Tc (Ethics)Tj /F5 1 Tf 9.843 0 0 9.843 323.0361 206.9858 Tm -.0216 Tc [(The)-150.6(s)-5.2(tudy)-149.4(rece)-6.6(ived)-149.4(appr)-5.4(oval)-149.5(fro)-5.4(m)-144.9(t)-5.5(he)-150.6(Univer)-5.4(sity)-149.4(of)-149.4(C)-6.4(a)-.8(liforn)-5.4(i).2(a,)]TJ -1.0137 -1.1116 TD [(L)-6.6(o).3(s)-160.7(A)-.5(ngel)-5.5(e)-.8(s)-160.7(S).5(out)-5.5(h)-160.9(G)-.5(enera)-6.6(l)-161.1(Inst)-5.6(itution)-5.4(a)-.8(l)-161.1(R)-.7(eview)-167.6(B)-.7(oard)-160.9(\()-5.4(S).5(GIRB\))]TJ 0 -1.1174 TD -.0214 Tc [(\()-5.2(I).6(RB)-271.2(No.:)-264.5(00)-5.2(004474;)-270.3(Pro)-5.2(j).4(ect)-270.3(No.:)-264.5(16-)-5.2(000240\))-5.2(.)-266.7(A)-271(waiver)-270.1(of)-270.1(in-)]TJ 0 -1.1116 TD -.0208 Tc [(formed)-361.7(consent)-361.9(w).3(as)-361.5(granted)-361.7(b)1.1(y)-361.7(t)1(he)-362.9(IRB)-362.7(b)1.1(ecause)-362.9(the)-362.9(a)0(nalysis)]TJ T* -.0214 Tc [(w)-6.1(a)-.6(s)-246.9(l).4(i)-5.3(m)-.7(ited)-252.9(t).4(o)-247.1(s).7(e)-6.4(c)-.6(ondary)-252.9(data)-254(collect)-5.3(ed)-247.1(as)-252.7(part)-253(of)-252.9(clinical)-253(care)-6.4(.)]TJ /F3 1 Tf 8.9663 0 0 8.9663 313.0582 139.011 Tm 0 Tc (Results)Tj /F5 1 Tf 9.843 0 0 9.843 323.0361 122.57 Tm [(During)-433.8(the)-430.8(study)-425.9(period,)-431.8(there)-434.2(were)-428(9141)-430.6(visits)-432.8(among)]TJ -1.0137 -1.1174 TD [(6756)-309.7(unique)-307.4(gay,)-307.4(bisexual,)-308.4(and)-309.7(other)-306.3(MSM)-310.2(testing)-308.6(for)-308.5(gon-)]TJ 0 -1.1116 TD [(orrhea)-342.9(\(Table)-344.3(1\).)-339.7(At)-343(more)-340.8(than)-339.8(half)-339.7(of)-342(visits,)-338.3(patients)-345.4(were)]TJ T* [(30)-255.6(years)-255.3(or)-249.8(older.)-252.1(The)-253.3(sample)-257.8(was)-252.8(racially)-254.6(and)-257.9(ethnically)-251.2(di-)]TJ 0 -1.1174 TD [(verse)-295.6(with)-299.3(47%)-292.4(White,)-294.9(31%)-292.4(Hispanic,)-297.7(8%)-291.2(Black)-297(or)-290.1(African)]TJ 0 -1.1116 TD [(American,)-323.2(and)-321.2(13%)-315.4(other)-317.8(race/ethnicity)-327.1(represented)-321.9(among)]TJ T* [(the)-632.4(visits.)-626.3(At)-631(1184)-626.5(visits)-628.7(\(13%\),)-626.2(there)-630(was)-632.9(a)-624.3(positive)]TJ /F3 1 Tf 8.9663 0 0 8.9663 62.022 749.5368 Tm (140)Tj 46.9539 0 TD [(SHOVER)-305.9(ET)-300.7(AL.)]TJ ET endstream endobj 34 0 obj <>stream BHIKCA+AdvPSMP10 qE AdvPSMP10 B d]^5ObLQYu yhgbz =3K u}G][1,9ĿGA endstream endobj 37 0 obj <>stream /GS1 gs BT /F5 1 Tf 9.843 0 0 9.843 59.7543 264.9826 Tm 0 0 0 rg 0 Tc 0 Tw [(gonorrhea)-277.1(result)-278.5(at)-274.2(one)-275.2(or)-278.6(more)-277.5(anatomic)-278.7(sites.)-274.9(Presumptive)]TJ 0 -1.1116 TD [(treatment)-516.1(was)-512(provided)-511.2(at)-510.3(1677)-511.3(visits)-513.5(\(18%\))-513.4(from)-506.7(1514)]TJ T* [(unique)-382.3(individuals.)-385.7(The)-385.8(majority)-380.2(of)-382.3(presumptive)-384.3(treatment)]TJ T* [(visits)-265.8(included)-270.6(gonorrhea)-265.6(tests)-265.7(from)-264.7(all)-263.9(anato)-8(mic)-265(sites;)-267(how-)]TJ 0 -1.1174 TD [(ever,)-361.5(30)-353.5(\(2%\))-356.8(had)-355.8(no)-353.5(urethral)-356.9(test,)-360.4(108)-354.6(\(6%\))-356.8(had)-355.8(no)-353.5(rectal)]TJ 0 -1.1116 TD [(test,)-216.4(and)-211.8(87)-209.5(\(5%\))-212.8(had)-211.8(no)-215.3(pharyngeal)-210.4(test.)-216.4(Patients)-212.8(treated)-218.8(pre-)]TJ T* [(sumptively)-261.3(were)-261(signicantly)-257.6(more)-260.2(likely)-255.8(to)-255.8(test)-259.1(positive)-257.8(for)]TJ 0 -1.1174 TD [(gonorrhea)-386.6(compared)-387.9(to)-382.5(patients)-385.7(who)-384.3(were)-387.7(not)-377.8(treated)-385.8(pre-)]TJ 0 -1.1116 TD [(sumptively)-388(\()]TJ /F9 1 Tf 5.178 0 TD (P)Tj /F6 1 Tf .7833 0 TD (<)Tj /F5 1 Tf .72 0 TD [(0.01\).)-385.6(Overall,)-389(gonococcal)-384.4(infections)-393.6(were)]TJ -6.6813 -1.1116 TD [(identied)-225.6(at)-222.4(31%)-217.5(\()]TJ /F9 1 Tf 7.3494 0 TD (n)Tj /F6 1 Tf .6681 0 TD (=)Tj /F5 1 Tf .72 0 TD [(527\))-217.5(of)-221(the)-217.7(1677)-223.3(visits)-219.7(where)-221.8(presump-)]TJ -8.7375 -1.1174 TD [(tive)-218.9(treatment)-216.6(was)-218.3(provided,)-215.1(compared)-215.1(to)-215.4(9%)-216.4(\()]TJ /F9 1 Tf 18.5866 0 TD (n)Tj /F6 1 Tf .6624 0 TD (=)Tj /F5 1 Tf .72 0 TD [(657\))-217.5(of)-209.5(the)]TJ -19.9689 -1.1116 TD [(7464)-303.9(visits)-300.3(with)-299.3(no)-301.7(presumptive)-303.7(treatment.)]TJ 1.0137 -1.1116 TD [(Bivariate)-389.2(associations)-390.9(of)-382.3(demographic)-391.3(characteristics)-392.2(on)]TJ -1.0137 -1.1174 TD [(presumptive)-269.1(treatment)-262.7(among)-267.1(those)-260(testing)-262.5(positive)-269.4(for)-262.4(gon-)]TJ 0 -1.1116 TD [(orrhea)-337.2(found)-339.5(a)-330.6(signicant)-341.7(association)-338.2(between)-340.5(presumptive)]TJ T* [(treatment)-579.4(and)-568.9(age)-575.8(\()]TJ /F9 1 Tf 8.6972 0 TD (P)Tj /F6 1 Tf .7776 0 TD (<)Tj /F5 1 Tf .72 0 TD [(0.01\),)-569.9(but)-573.6(not)-573.6(sexual)-573.3(orientation)]TJ -10.1947 -1.1116 TD (\()Tj /F9 1 Tf .3341 0 TD (P)Tj /F6 1 Tf .7833 0 TD (=)Tj /F5 1 Tf .72 0 TD [(0.06\))-445.5(or)-445.7(race/ethnicity)-453.8(\()]TJ /F9 1 Tf 10.068 0 TD (P)Tj /F6 1 Tf .7833 0 TD (=)Tj /F5 1 Tf .72 0 TD [(0.10\).)-449(Specically,)-452.2(gonor-)]TJ -13.4086 -1.1174 TD [(rhea)-519.3(positive)-517(patients)-518.2(who)-516.8(were)-520.2(40)-514.8(years)-514.5(or)-514.8(older)-519.4(were)]TJ 0 -1.1116 TD [(more)-363.9(likely)-359.5(to)-359.4(be)-360.5(treated)-362.8(presumptively)-363.6(compared)-364.8(to)-359.4(those)]TJ T* [(who)-303.7(were)-301.3(younger)-302.6(than)-299.4(25)-301.7(years.)]TJ 26.5234 21.1496 TD [(Overall,)-360.2(45%)-361.5(of)-359.3(gonococcal)-361.4(infections)-364.8(were)-364.7(treated)-362.8(pre-)]TJ -1.0137 -1.1116 TD [(sumptively)-543.5(\(Table)-540.1(2\).)-541.3(Extragenital)-542.5(infections)-543.4(were)-543.2(more)]TJ T* [(common)-309.7(than)-316.7(urethral)-310.8(infections,)-316.4(and)-309.7(were)-318.6(less)-310.6(likely)-313.4(to)-313.3(be)]TJ T* [(treated)-374.3(presumptively.)-378.6(The)-374.3(proportion)-374.1(of)-370.8(infections)-382.1(treated)]TJ 0 -1.1174 TD [(differed)-327.9(by)-330.5(anatomic)-330.6(site.)-325.8(Seventy-eight)-334.8(percent)-328.1(of)-324.7(urethral)]TJ 0 -1.1116 TD [(infections,)-299.2(54%)-303.9(of)-295.9(rectal)-304.1(infections,)-304.9(and)-298.2(35%)-298.1(of)-301.7(pharyngeal)]TJ T* [(infections)-503.1(were)-508.7(treated)-506.8(presumptively.)-511.1(Presumptive)-505.1(treat-)]TJ 0 -1.1174 TD [(ment)-231.6(was)-235.5(provided)-228.9(at)-233.9(14%)-229(\()]TJ /F9 1 Tf 11.1738 0 TD (n)Tj /F6 1 Tf .6681 0 TD (=)Tj /F5 1 Tf .72 0 TD [(1150\))-230.1(of)-232.6(visits)-231.2(where)-233.3(all)-235.1(gon-)]TJ -12.5619 -1.1116 TD [(orrhea)-302.6(tests)-300.3(were)-307.1(negative.)]TJ 1.0137 -1.1116 TD [(Controlling)-221(for)-216.3(site)-224.5(of)-221(infection,)-223.4(the)-217.7(PPV)-222.7(for)-216.3(indications)-227.9(of)]TJ -1.0137 -1.1174 TD [(presumptive)-344(treatment)-349.1(were)-347.4(highest)-343(for)-343.1(genitourinary)-351(signs)]TJ 0 -1.1116 TD [(\(56%\),)-246.1(genitourinary)-247.4(symptoms)-247.2(\(29%\),)-246.1(and)-246.4(rectal)-246.5(symptoms)]TJ T* [(\(28%\))-219.6(\(Table)-223.3(3\).)-224.5(Rectal)-224.5(signs)-224.1(and)-217.6(pharyngitis)-226.6(were)-220.7(less)-224.2(com-)]TJ 0 -1.1174 TD [(mon)-217.6(and)-223.3(less)-224.2(predictive)-222.2(of)-221(infection.)-229.1(Symptoms)-218.4(or)-221(signs)-224.1(may)]TJ 0 -1.1116 TD [(be)-239.5(caused)-240.3(by)-244.1(an)-239.5(infection)-243(other)-237.2(than)-241.8(gonorrhea.)-240.2(Of)-244.9(presump-)]TJ T* [(tive)-207.4(treatment)-210.8(visits)-208.2(where)-210.3(no)-209.5(gonococcal)-205.9(infection)-214.2(was)-206.7(iden-)]TJ T* [(tied)-219.9(\()]TJ /F9 1 Tf 2.6149 0 TD (n)Tj /F6 1 Tf .6624 0 TD (=)Tj /F5 1 Tf .72 0 TD [(1150\),)-222(chlamydial)-223.5(infections)-220.9(were)-220.7(identied)-219.8(at)-222.4(172)]TJ -3.9972 -1.1174 TD [(\(15%\))-357.9(\(Table)-367.3(4\).)-356.9(Therefore,)-369.3(an)-360.5(infection)-363.9(susceptible)-361.2(to)-365.2(the)]TJ 0 -1.1116 TD [(antibiotic)-503.6(regimen)-500.9(was)-500.5(identied)-502(at)-504.6(42%)-499.7(of)-497.5(presumptive)]TJ T* [(treatment)-556.4(visits.)-551.5(At)-550.4(visits)-553.8(where)-555.8(neither)-557.4(gonococcal)-551.5(nor)]TJ ET 59.754 708.888 490.167 .28345 re f 59.754 316.8 490.167 .28345 re f 205.342 680.031 113.159 .28345 re f 343.956 680.031 113.159 .28345 re f 482.57 680.031 67.351 .28345 re f 59.754 662.4 490.167 .22675 re f BT /F8 1 Tf 9.845 0 0 9.845 109.8708 725.5557 Tm (Table)Tj /F5 1 Tf 2.9656 0 TD (1.)Tj /F8 1 Tf 1.2496 0 TD [(Patient)-301.6(Characteristics)-298.8(at)-301.3(Visits)-300.5(With)-301.2(and)-303.2(Without)-305.1(Gonorrhea)-299.5(Presumptive)]TJ 4.9523 -1.0135 TD (Treatment)Tj /F5 1 Tf 5.2518 0 TD (\()Tj /F9 1 Tf .334 0 TD (n)Tj /F6 1 Tf .6622 0 TD (=)Tj /F5 1 Tf .7198 0 TD (9141\),)Tj /F8 1 Tf 2.885 0 TD (February)Tj /F5 1 Tf 4.5665 0 TD (2015)Tj /F8 1 Tf 2.505 0 TD (July)Tj /F5 1 Tf 2.3495 0 TD (2015)Tj /F9 1 Tf -17.5924 -1.9406 TD [(Presumptive)-338.9(treatment)]TJ 2.8159 -1.0135 TD (provided)Tj 11.2637 1.0135 TD [(Presumptive)-338.9(treatment)]TJ 1.837 -1.0135 TD [(not)-337.1(provided)]TJ /F5 1 Tf 7.3837 0 0 6.5625 424.3463 690.8596 Tm (a)Tj /F9 1 Tf 9.845 0 0 9.845 505.8707 686.4943 Tm (Total)Tj /F5 1 Tf -28.165 -1.8197 TD (n)Tj /F9 1 Tf 6.8699 0 TD (%)Tj /F5 1 Tf 7.083 0 TD (n)Tj /F9 1 Tf 6.8757 0 TD (%)Tj /F5 1 Tf 5.6146 0 TD (N)Tj /F9 1 Tf 4.6587 0 TD (%)Tj /F5 1 Tf -48.2508 -1.8946 TD (Gender)Tj 1.002 -1.0135 TD [(Male)-13332.6(1677)-4916(100)-5542.7(7464)-4662.6(100)-4431.3(9141)-2595.3(100)]TJ -1.002 -1.313 TD [(Age)-339(group)]TJ /F6 1 Tf 1.002 -1.0135 TD (<)Tj /F5 1 Tf .5528 0 TD [(25)-330.2(years)-11898.5(292)-5416(17)-5541.7(1431)-5163.6(19)-4430.3(1723)-3090.5(19)]TJ -.5528 -1.0135 TD [(2529)-333.2(years)-10948.4(432)-5416(26)-5541.7(2108)-5163.6(28)-4430.3(2540)-3090.5(28)]TJ 0 -1.0077 TD [(3039)-333.2(years)-10948.4(533)-5416(32)-5541.7(2296)-5163.6(31)-4430.3(2829)-3090.5(31)]TJ 0 -1.0135 TD (40)Tj /F6 1 Tf 1.002 0 TD (+)Tj /F5 1 Tf .8811 0 TD [(years)-11898.5(420)-5416(25)-5541.7(1629)-5163.6(22)-4430.3(2049)-3090.5(22)]TJ -2.885 -1.3187 TD (Race/ethnicity)Tj 1.002 -1.0077 TD [(White)-13437.6(797)-5416(48)-5541.7(3518)-5163.6(47)-4430.3(4315)-3090.5(47)]TJ 0 -1.0135 TD [(Hispanic)-12334.5(506)-5416(30)-5541.7(2355)-5163.6(32)-4430.3(2861)-3090.5(31)]TJ T* [(Black)-336.7(or)-330.2(African)-338.5(American)-4701.1(174)-5416(10)-6042.7(553)-5663.6(7)-4930.3(727)-3590.5(8)]TJ T* [(Other)-13614.6(199)-5416(12)-5541.7(1032)-5163.6(14)-4430.3(1231)-3090.5(13)]TJ 0 -1.0077 TD [(Unknown/unreported)-8337.5(1)-5915(0.1)-6287.9(6)-5667.4(0.1)-5182.3(7)-3588.6(0.1)]TJ -1.002 -1.3187 TD [(Sexual)-336.5(orientation)]TJ 1.002 -1.0077 TD [(Gay/homosexual)-8605.5(1464)-5417(87)-5541.7(6310)-5163.6(85)-4430.3(7774)-3090.5(85)]TJ 0 -1.0135 TD [(Bisexual)-12386.5(173)-5416(10)-6042.7(956)-5162.6(13)-4430.3(1129)-3090.5(12)]TJ T* [(Other)-14115.6(35)-5916(2)-6041.7(183)-5663.6(2)-4930.3(218)-3590.5(2)]TJ T* [(Unknown/unreported)-8337.5(5)-5915(0.3)-5786.9(15)-5668.4(0.2)-4681.3(20)-3589.6(0.2)]TJ -1.002 -1.3129 TD [(Gonorrhea)-340.3(result)]TJ 7.3837 0 0 6.5625 127.1622 463.0109 Tm (b)Tj 9.845 0 0 9.845 69.6189 448.6676 Tm [(Positive,)-335.1(any)-332.4(site)-8908(527)-5416(31)-6042.7(657)-5663.6(9)-4429.3(1184)-3090.5(13)]TJ 1.002 -1.0135 TD [(Urethral)-10163.7(266/1647)-4522.8(16)-4902.5(74/7284)-5022.8(1)-4930.3(340)-3590.5(4)]TJ 0 -1.0077 TD [(Rectal)-10934.8(397/1569)-4522.8(25)-4649.1(337/7183)-4776.2(5)-4930.3(734)-3590.5(8)]TJ 0 -1.0135 TD [(Pharyngeal)-8996.7(222/1590)-4522.8(14)-4649.1(421/7228)-4776.2(6)-4930.3(643)-3590.5(7)]TJ -1.002 -1.0135 TD [(Negative)-335.1(at)-337.3(all)-332.7(sites)-334.4(tested)-4575(1150)-5417(69)-5541.7(6807)-5163.6(91)-4430.3(7957)-3090.5(87)]TJ -1.002 -1.313 TD [(Prevalence)-338.2(of)-336(signs/symptoms)]TJ 7.3837 0 0 6.5625 181.4173 400.2519 Tm (c)Tj 9.845 0 0 9.845 69.6189 385.9086 Tm [(Genitourinary)-339(signs)-7882.5(240)-5416(14)-7038.9(3)-5667.4(0.04)-3680.3(243)-3590.5(3)]TJ 0 -1.0135 TD [(Genitourinary)-339(symptoms)-5820.4(869)-5416(52)-6537.9(95)-5668.4(1)-4930.3(964)-3089.6(11)]TJ 0 -1.0077 TD [(Rectal)-339(signs)-11435.5(11)-5916(1)-7037.9(9)-5667.4(0.1)-4681.3(20)-3589.6(0.2)]TJ 0 -1.0135 TD [(Rectal)-339(symptoms)-8872.5(155)-5917(9)-6536.9(2)0(2)-5668.4(0.3)-4180.3(177)-3590.5(2)]TJ T* [(Pharyngitis)-11834.5(49)-5916(3)-6536.9(2)0(8)-5668.4(0.4)-4681.3(77)-3589.6(1)]TJ T* [(Asymptomatic,)-337.8(exposed)-6124.7(591)-5416(35)-6042.7(401)-5663.6(5)-4930.3(992)-3089.6(11)]TJ -1.002 -1.3129 TD [(Total)-14271.6(1677)-4916(100)-5542.7(7464)-4662.6(100)-4431.3(9141)-2595.3(100)]TJ 6.5633 0 0 5.8334 68.7685 308.9196 Tm (a)Tj 8.7511 0 0 8.7511 71.6598 305.0078 Tm [(This)-306(includes)-299.9(individuals)-299.1(who)-296.8(tested)-302.2(positive)-297.4(for)-298.1(gonorrhea)-300(and)-302.2(were)-303(subsequently)-300.1(treated,)-298.5(as)-301.7(well)-300.7(as)-301.7(those)-297(who)-303.3(tested)-302.2(negative.)]TJ 6.5633 0 0 5.8334 68.7685 299.9621 Tm (b)Tj 8.7511 0 0 8.7511 72.0567 296.0503 Tm -.0148 Tc [(M)8.6(a)-1.9(le)-235.1(p)5.8(a)-1.9(t)7.1(i).6(en)5.8(ts)-232.3(are)-235.1(e)4.6(nc)4.6(ou)5.8(ra)4.6(ge)4.6(d)-233.9(t).6(o)-233.9(h)-.7(a)4.6(v)-.7(e)-235.1(u)5.8(re)4.6(thr)7.2(a)-1.8(l,)-231.2(re)4.6(cta)4.6(l).6(,)-231.2(a)-1.9(n)5.8(d)-233.9(ph)5.8(ary)5.8(n)-.7(g)5.8(e)-1.8(a)4.6(l)-232.6(go)5.8(no)5.8(rrh)5.8(ea)-235.1(te)4.6(sts,)-231.2(bu)5.8(t)-232.6(m)1.8(ay)-233.9(c)4.6(h)-.7(o)5.8(o)-.7(se)-235.1(n)5.8(o)-.7(t)-232.6(t).6(o)-233.9(b)5.8(e)-235.1(t).6(est)7.1(e)-1.8(d)-233.9(o)5.8(r)-238.9(e)4.6(xa)4.6(min)5.8(e)-1.8(d)-233.9(a)4.6(t)-239.1(a)4.6(ll)-232.6(site)4.6(s.)]TJ 6.5633 0 0 5.8334 68.7685 290.948 Tm 0 Tc (c)Tj 8.7511 0 0 8.7511 71.6598 287.0929 Tm [(Categories)-306.2(are)-301.9(not)-299.7(mutually)-296.6(exclusive.)]TJ /F3 1 Tf 8.9663 0 0 8.9663 59.7543 749.5368 Tm [(ACCURACY)-308.5(OF)-299.5(PRESUMPTIVE)-307.4(GONORRHEA)-299.3(TREATMENT)-24789.7(141)]TJ ET endstream endobj 42 0 obj <>stream /GS1 gs BT /F5 1 Tf 9.843 0 0 9.843 62.022 574.1857 Tm 0 0 0 rg 0 Tc 0 Tw [(chlamydial)-229.2(infection)-225.7(was)-224(identied,)-223.3(9)-225.7(\(0.9%\))-223.1(included)-224.5(a)-221.1(pos-)]TJ 0 -1.1174 TD [(itive)-208.6(t)16.1(e)15(st)-180.7(f)16.2(o)16.2(r)-191.1(c)15(u)16.2(r)16.2(r)0(e)25.5(n)16.2(t)-191.3(s)16.4(y)16.2(p)0(h)]TJ 9.636 0 TD -.0158 Tc [(ilis)-206.8(i)-15.8(n)10.7(fect)-15.8(i)10.5(o).4(n)-207(a)-.8(nd)-207(9)-207(\().4(0)-15.8(.)14.2(9%)-15.8(\))-197.6(i).3(nclud)-15.8(e)9.6(d)-207(a)-.8(n)]TJ -9.636 -1.1116 TD -.016 Tc [(HI)-16(V)-220.6(p)-16(o)10.6(s).4(iti)-16(v)10.5(e)-237.1(test.)-238.3(A)-.7(t)-236.1(960)-236(pr)-16(e)9.5(s).4(ump)-16(t)10.5(ive)-237.1(t).1(re)-16(a)8.3(t).1(ment)-236.1(v).2(i)-16(s)10.7(its)-235.8(\(5)-16(7)10.6(%)-237(of)]TJ T* -.0156 Tc [(all)-304.8(pres)-15.6(u)11.2(mptiv)-15.6(e)-289.7(t).5(rea)-15.6(t)9.7(ment)-299.1(v)-15.6(i)10.9(s).8(it)-15.6(s)11.1(\)).6(,)-301.3(n).6(o)-298.9(i)-15.6(n)10.9(f).6(ect)-15.6(i)10.7(o).6(n)-298.9(w)-.3(a)-15.6(s)-289.5(iden)-15.6(t)10.9(i).5(ed)-15.6(.)]TJ /F3 1 Tf 8.9663 0 0 8.9663 62.022 519.3636 Tm 0 Tc (Discussion)Tj /F5 1 Tf 9.843 0 0 9.843 72 502.9227 Tm -.016 Tc [(Our)-224.4(s).4(tudy)-224.4(foun)-16(d)-208.3(t).1(ha)-16(t)-209.6(gon)-16(o)10.6(rrhe)-16(a)-210.6(pos)-16(i)10.7(tivi)-16(t)10.3(y)-218.7(w)-.7(as)-224.3(high)-16(e)9.4(r)-218.7(amo)-16(n)10.6(g)]TJ -1.0137 -1.1116 TD -.0158 Tc [(vis)-15.8(i)10.9(ts)-431.4(w)-15.8(i)9.8(th)-431.6(pr)-15.8(e)9.7(s).6(umpt)-15.8(i)10.5(v).4(e)-432.8(t).3(re)-15.8(a)8.5(t).3(ment)-431.7(\()-15.8(3)10.8(1).4(%\))-431.6(co)-15.8(m)9.6(p).4(ared)-437.4(to)-431.6(thos)-15.8(e)]TJ T* -.0159 Tc [(wit)-15.9(h)10.6(out)-184.2(presu)-15.9(m)9.5(p).3(tive)-185.2(t).2(reat)-15.9(m)9.3(e)-.9(nt)-178.4(\()-15.9(9)10.7(%\).)-180.6(T)-.9(he)-179.4(a)-15.9(c)8.4(curac)-15.9(y)-169(of)-178.2(p)-15.9(r)10.7(esu)-15.9(m)9.5(p-)]TJ 0 -1.1174 TD [(ti)-15.9(v)10.6(e)-277.3(gono)-15.9(r)10.7(rhea)-283.1(t).2(reatme)-15.9(n)9.5(t)-276.3(var)-15.9(i)10.6(ed)-276.2(by)-276.2(a)-15.9(n)9.5(atomi)-15.9(c)-267.1(site)-283.1(of)-276.1(gon)-15.9(o)10.7(rrhe)-15.9(a)]TJ 0 -1.1116 TD [(and)-299.3(pre)-16(s)9.6(e)-1(nce)-300.5(o).2(f)-299.3(s).4(ign)-16(s)-283(or)-299.3(sy)-16(m)9.4(p).2(toms.)-301.7(T)-1(he)-294.7(P)-16(P)10.9(V)-294.4(w)-16(a)8.6(s)-293.4(h)-16(i)10.5(ghes)-16(t)-283.1(fo)-16(r)]TJ T* [(gen)-16(i)10.5(tour)-16(i)10.5(n).2(ary)-316.6(s).4(i)-16(g)10.5(ns,)-318.9(but)-316.7(given)-316.6(t).1(h)-16(e)-301.6(s)-16(u)10.8(bsta)-16(n)9.4(tial)-316.7(bur)-16(d)10.6(e)-1(n)-316.6(a)-1(t)-316.7(e)-1(xtra)-16(-)]TJ 0 -1.1174 TD [(gen)-15.9(i)10.6(tal)-276.3(s).5(i)-15.9(t)10.4(es,)-278.5(a)-.9(nd)-276.2(the)-277.3(l).2(ow)-277.1(P)-15.9(P)11(V)-277.1(o).3(f)-276.2(s).5(ign)-15.9(s)-265.6(and)-276.2(s).5(ymp)-15.9(t)10.6(oms)-276(a)-.9(t)-276.3(t).2(he)-15.9(s)9.7(e)]TJ 0 -1.1116 TD -.0158 Tc [(si)-15.8(t)10.5(e)-.8(s,)-209.3(ot)-15.8(h)10.7(e)-.8(r)-206.9(s).6(t)-15.8(r)10.7(ateg)-15.8(i)10.7(e)-.8(s)-206.8(b)-15.8(e)9.6(yond)-212.7(presu)-15.8(m)9.6(p).4(tive)-213.9(t).3(reat)-15.8(m)9.4(e)-.8(nt)-207.1(ar)-15.8(e)-197.7(n).4(eed)-15.8(e)9.6(d)]TJ T* 0 Tc [(t)16.1(o)-237.2(r)16.2(e)15(d)16.2(u)0(c)25.4(e)-232.6(th)26.5(e)-232.6(p)16.2(ot)26.5(e)15(n)16.2(t)16.1(i)0(a)25.3(l)-231.6(fo)26.6(r)-231.5(o)0(v)26.6(e)15(r)16.2(t)16.1(re)25.5(a)15(t)16.1(m)15(e)15(n)0(t)26.5(.)]TJ 1.0137 -1.1116 TD [(The)-339.7(nding)-340.6(that)-339.9(gonococcal)-344.1(infections)-341.8(were)-341.6(identied)-340.8(at)]TJ -1.0137 -1.1174 TD [(only)-430.8(one)-436.4(third)-431.9(of)-434.1(visits)-432.8(where)-434.9(presumptive)-436.2(treatment)-435.4(was)]TJ 0 -1.1116 TD [(provided)-240.5(highlights)-236(the)-235(potential)-237.4(for)-239.4(point-of-care)-236.8(tests)-242.7(to)-232.7(re-)]TJ T* [(duce)-536.6(this)-534.4(overtreatment.)-536.6(Rapid)-532(point-of-care)-542.1(tests)-530.7(would)]TJ 0 -1.1174 TD [(allow)-226.7(providers)-229.8(to)-221.2(prevent)-229(unnecessary)-229.5(provision)-223.1(of)-226.8(antibiot-)]TJ 0 -1.1116 TD [(ics)-309.7(and)-309.7(reduce)-309.6(the)-309.9(issue)-311.7(of)-307.4(loss)-309.4(to)-307.6(follow-up)-310.5(for)-308.5(individuals)]TJ T* [(who)-321(need)-317.8(to)-313.4(return)-318.9(for)-320(treatment.)-323.7(As)-313.9(of)-319(2017,)-318.9(point-of-care)]TJ 0 -1.1174 TD [(gonorrhea/chlamydia)-356.6(tests)-352.1(have)-352.3(only)-350.1(been)-352.3(approved)-350.9(by)-347.8(the)]TJ 0 -1.1116 TD [(Food)-205.8(and)-206.1(Drug)-201.1(Administrat)-9.9(ion)-199.3(for)-204.8(use)-205.9(in)-203.9(genitourina)-9(ry)-203.8(infec-)]TJ T* (tions.)Tj 7.3823 0 0 6.5614 83.6787 310.0535 Tm (11)Tj 9.843 0 0 9.843 93.9968 305.6881 Tm [(Despite)-304.7(this,)-301.6(some)-306.1(tests)-300.3(have)-300.5(been)-306.2(validated)-301.8(for)-302.7(use)]TJ -3.2485 -1.1174 TD [(at)-320.3(extragenital)-329.4(sites)-323.3(by)-319(various)-319.8(laboratories)-327.9(and)-321.2(thus)-321.1(can)-322.4(be)]TJ 25.504 16.6628 TD [(used)-414.3(by)-411.1(laboratories)-414.3(that)-414.8(meet)-411.3(all)-413.7(regulatory)-411(requirements)]TJ 0 -1.1116 TD [(for)-354.6(an)-348.9(off-label)-352.2(procedure.)]TJ 7.3823 0 0 6.5614 420.2078 452.1259 Tm (1,12)Tj 9.843 0 0 9.843 436.592 447.7605 Tm [(In)-347.7(settings)-349.8(where)-354.3(prevalence)]TJ -12.5504 -1.1116 TD [(of)-445.7(gonorrhea)-438.4(and)-442.2(chlamydia)-446.9(infections)-439.7(is)-445.6(high,)-439.9(especially)]TJ T* -.0158 Tc [(a)-15.8(t)-226.6(extr)-15.8(a)9.7(g).4(eni)-15.8(t)10.5(al)-207.1(sit)-15.8(e)9.5(s)-206.8(w)-.5(here)-208.1(s)-15.8(y)11(mptoma)-15.8(t)9.5(o).4(log)-15.8(y)-196.5(has)-206.8(poo)-15.8(r)-196.5(predic)-15.8(t)9.5(ive)]TJ 0 -1.1174 TD -.016 Tc [(v)-16(a)9.4(lue,)-267.1(point)-16(-)10.5(of-c)-16(a)8.3(r).2(e)-260.2(t)-16(e)9.3(s).4(ts)-264.6(wou)-16(l)10.5(d)-259(b)-16(e)-249.7(u).2(s)-16(e)9.6(ful.)-267.1(C)-.8(urren)-16(t)10.5(ly,)-261.3(f)-16(e)9.5(w)-259.9(c)-16(l)9.3(in-)]TJ 0 -1.1116 TD -.0273 Tc [(i)-27.3(c)-2(s)-333.5(u)-27.3(se)-334.8(p)-5.4(o).4(i)-5.5(n).4(t-)-5.3(of)-5.3(-c)-6.5(ar)-5.3(e)-323.3(g)-5.4(on)-5.4(orr)-5.3(he)-6.5(a/)-5.5(chl)-5.5(a)-.8(m)-6.6(ydi)-5.5(a)-323.3(t)-5.5(es)-5.2(ts)-5.2(,)-324.5(b)-5.4(ut)-328(th)-5.4(ese)-329.1(t)-5.5(est)-5.5(s)]TJ T* -.0229 Tc [(sh)4.8(ou)4.8(ld)-674.8(be)-676(ad)4.8(op)4.8(ted)-680.6(w)3.9(id)4.8(ely)4.8(,)-677.2(part)4.7(icu)4.8(l)-1.1(arl)4.7(y)-680.6(i)4.7(n)-680.6(cli)4.7(n)-1(i)4.7(c)-2.1(s)-674.7(s)-.8(erv)4.8(i)-1.1(n)4.8(g)]TJ 0 -1.1174 TD -.0272 Tc [(M)-6.2(S).7(M)-6.2(.)-341.6(A)-345.9(s).7(y)-5.3(s).7(t)-5.4(ema)-6.4(ti)-5.4(c)-340.5(r)-5.2(ev)-5.3(iew)-346(o)-5.3(f)-345(poi)-5.4(nt)-5.4(-o)-5.3(f-)-5.2(car)-5.2(e)-346.2(t).4(es)-5.1(ti)-5.4(ng)-345.1(f)-5.2(o).5(r)-345(g).5(o)-5.3(nor)-5.2(-)]TJ 0 -1.1116 TD -.0274 Tc [(r)-5.4(h).3(e)-6.6(a)-467.4(su)-5.5(gg)-5.5(est)-5.6(s)-466(it)-466.4(i)-5.6(s)-466(fe)-6.6(as)-5.3(ib)-5.5(le,)-468.6(a)-.9(c)-6.6(c)]TJ 12.6771 0 TD -.0257 Tc [(e)-4.9(p)2(ta)-4.9(ble,)-466.9(and)-464.5(c).8(ost-effe)-4.9(ctive)-465.7(i)-25.7(n)]TJ -12.6771 -1.1116 TD 0 Tc [(the)-211.9(settings)-211.6(where)-204.5(it)-209.8(has)-211.6(been)-208.3(studied,)-208.2(but)-205(more)-208.4(observational)]TJ 0 -1.1174 TD [(data)-289.1(are)-287.8(needed)-292.3(to)-284.6(determine)-291.3(how)-286.4(wait)-288.9(time,)-287(cost)-293.5(to)-284.5(patient,)]TJ 0 -1.1116 TD [(and)-211.8(initial)-211.1(cost)-207.1(to)-209.7(a)-209.6(clinic)-210.9(may)-207.3(inuence)-213.9(adoption)-211.8(in)-203.9(clinics.)]TJ 7.3823 0 0 6.5614 544.8187 342.5385 Tm (13)Tj 9.843 0 0 9.843 323.0361 327.2314 Tm [(The)-259.1(strengths)-258.6(of)-255.6(this)-257.9(study)-253.1(included)-259.1(the)-258(large)-255.6(sample)-257.8(size,)]TJ -1.0137 -1.1174 TD [(a)-244.2(study)-235.8(population)-243(with)-235.9(high)-240.7(incidence)-245.2(of)-238.3(gonorrhea,)-240.2(and)-240.6(the)]TJ 0 -1.1116 TD [(ability)-303.1(to)-301.8(investigate)-303.9(signs,)-302.4(symptoms,)-302.4(and)-304(exposure)-304.7(as)-296.9(pre-)]TJ T* [(dictors)-354.5(of)-353.5(gonorrhea)-352(positivity.)-349(Studying)-354.5(both)-350.1(self-reported)]TJ T* [(symptoms)-339.3(and)-338.5(provider-determined)-343.9(signs)-333.5(enabl)-8(ed)-331.7(us)-336.1(to)-336.4(ex-)]TJ 0 -1.1174 TD [(amine)-435.4(the)-425.1(trade-off)-432.7(between)-432.7(syndromic)-432.7(algorithms)-428.3(with)-431.8(a)]TJ 0 -1.1116 TD [(high)-246.4(PPV)-245.8(\(treating)-248.7(all)-246.6(with)-247.4(observed)-247.1(urethral)-247.5(discharge\))-250.5(ver-)]TJ T* [(sus)-354.3(those)-352.2(that)-351.4(result)-353.4(in)-353.7(a)-347.8(larger)-354.6(number)-354.6(of)-353.5(infections)-353.3(being)]TJ 0 -1.1174 TD [(treated)-305.2(presumptively)-306(\(treating)-306.3(all)-298.5(who)-303.7(report)-301.6(symptoms\).)]TJ /F10 1 Tf 8.9663 0 0 8.9663 313.0582 215.6598 Tm (Limitations)Tj /F5 1 Tf 9.843 0 0 9.843 323.0361 199.2755 Tm [(This)-374.2(study)-368.3(had)-373.1(several)-374(key)-373.1(limitations.)-375.6(The)-368.5(Center)-372.9(does)]TJ -1.0137 -1.1174 TD [(not)-372.1(employ)-366.2(laboratory)-376.4(staff)-369.4(trained)-367.4(to)-370.9(perform)-372.9(gram)-369.6(stains)]TJ 0 -1.1116 TD [(and)-321.2(does)-322.2(not)-320.2(presently)-329.1(have)-317.8(the)-321.4(capability)-326(to)-319.1(perform)-326.8(other)]TJ T* [(point-)-6.8(of-care)-339.4(gonorrhea)-340.5(testing.)-340.8(Having)-342.8(either)-337.5(would)-340.6(likely)]TJ 0 -1.1174 TD -.0216 Tc [(i)-5.5(n).3(cr)-5.4(eas)-5.2(e)-404(t).2(h)-5.4(e)-404(pr)-5.4(opor)-5.4(tio)-5.4(n)-402.8(o).3(f)-408.6(u).3(re)-6.6(thr)-5.4(a)-.8(l)-403(i)-5.5(nfe)-6.6(c)-.8(tio)-5.4(ns)-408.4(trea)-6.6(ted)-408.6(a)-.8(nd)-408.6(de-)]TJ 0 -1.1116 TD -.0201 Tc [(c)-5.1(r)1.9(ea)-5.1(se)-275.8(overtreatment.)-271.2(P)-3.8(revalence)-275.8(o)1.8(f)-274.6(r)-3.9(ecta)-5.1(l)-274.8(signs)-274.4(m).6(ay)-274.6(be)-275.8(under-)]TJ T* -.0217 Tc [(e)-6.7(s).4(ti)-5.7(mat)-5.7(e)-.9(d)-345.3(f).3(o)-5.5(r)-345.3(tw)-6.4(o)-345.3(r).3(e)-6.7(a)-.9(so)-5.5(ns.)-347.7(I)-5.5(t)-345.5(w)-.6(a)-6.7(s)-345.1(no)-5.5(t)-345.5(pos)-5.3(si)-5.6(ble)-352.3(i).1(n)-345.3(t).1(h)-5.5(e)-346.5(EM)-6.4(R)-346.4(t).1(o)]TJ 0 -1.1174 TD [(d)-5.4(i).2(s)-5.2(ting)-5.4(u).3(is)-5.2(h)-431.6(b).3(e)-6.6(t).2(we)-6.6(en)-431.6(pa)-6.6(tie)-6.6(nts)-437.2(w)-.5(ho)-437.4(had)-431.6(p)-5.4(hys)-5.2(ica)-6.6(l)-431.8(exa)-6.6(m)-.9(in)-5.4(atio)-5.4(ns)]TJ 0 -1.1116 TD 0 Tc [(w)15.3(i)21.8(t)21.8(h)-254.5(no)-272.9(ndings)-272.4(and)-269.4(those)-271.5(who)-274.9(declined)-277.5(part)-270.6(of)-272.9(the)-269.5(physical)]TJ T* [(exam)-8(ination.)-208.5(Because)-214.8(the)-211.9(Center)-211.7(does)-212.7(not)-210.8(perform)-211.6(anoscopic)]TJ 0 -1.1174 TD [(exam)-8(s)-219.8(routinely)-224.5(in)-221.2(the)-223.5(sexual)-227.7(health)-222.3(clinic,)-225.9(only)-223.4(external)-225.6(rec-)]TJ 0 -1.1116 TD [(tal)-327.3(signs)-316.3(were)-324.4(detected.)-328.2(In)-319(addition,)-324.8(the)-321.4(proportion)-322.2(of)-318.9(treat-)]TJ T* [(ment)-502.3(visits)-501.9(in)-503.4(which)-497.2(no)-503.3(infection)-502.2(was)-500.5(detected)-503.3(is)-503.2(likely)]TJ T* [(overestimated)-602.1(because)-599.7(urethritis)-599.9(can)-598.9(also)-593(be)-596.6(caused)-597.4(by)]TJ ET 62.022 224.674 239.131 .28348 re f 62.022 77.669 239.131 .22681 re f 62.022 166.167 239.131 .22676 re f BT /F8 1 Tf 9.845 0 0 9.845 81.8645 261.2409 Tm (Table)Tj /F5 1 Tf 2.9656 0 TD (3.)Tj /F8 1 Tf 1.2496 0 TD [(Positive)-301.3(Predictive)-297.6(Value)-306.2(of)-296.7(Signs,)]TJ -3.3975 -1.0135 TD [(Symptoms,)-301.7(and)-297.5(Exposure)-304.6(at)-301.3(Visits)-300.5(Where)]TJ -2.0673 -1.0077 TD [(Presumptive)-301.8(Gonorrhea)-299.5(Treatment)-300(was)-303.2(Provided)]TJ /F5 1 Tf 22.5102 0 TD (,)Tj -19.1472 -1.0135 TD (\()Tj /F9 1 Tf .334 0 TD (n)Tj /F6 1 Tf .668 0 TD (=)Tj /F5 1 Tf .7198 0 TD (1677\),)Tj /F8 1 Tf 2.885 0 TD (February)Tj /F5 1 Tf 4.5665 0 TD (2015)Tj /F8 1 Tf 2.4992 0 TD (July)Tj /F5 1 Tf 2.3552 0 TD (2015)Tj /F9 1 Tf -18.1567 -5.9889 TD (Indication)Tj /F5 1 Tf 7.3837 0 0 6.5625 102.6141 176.7684 Tm (a)Tj /F9 1 Tf 9.845 0 0 9.845 163.0488 212.2582 Tm (Gonorrhea)Tj .6565 -1.0135 TD (positive)Tj -1.5836 -1.0135 TD [(\(controlling)-336.1(for)]TJ .3513 -1.0135 TD [(infection)-334.4(site\))]TJ 7.2615 1.0135 TD [(Total)-333.4(with)]TJ .0518 -1.0135 TD [(indication)-1370.8(PPV)]TJ /F5 1 Tf -4.7738 -1.0077 TD 5.9496 Tc (nN)Tj /F9 1 Tf 10.7224 0 TD 0 Tc (%)Tj /F5 1 Tf -22.9478 -1.9003 TD (Genitourinary)Tj .9905 -1.0135 TD (symptoms)Tj 10.7397 1.0135 TD [(256)-5053.2(869)-3083.8(29)]TJ -11.7302 -2.0212 TD [(Genitourinary)-339(signs)-3719(134)-5053.2(240)-3083.8(56)]TJ 0 -1.0135 TD [(Rectal)-339(symptoms)-5204.3(43)-5058(155)-3083.8(28)]TJ T* [(Rectal)-339(signs)-7767.3(2)-5558(1)0(1)-3082.8(1)0(8)]TJ 0 -1.0077 TD [(Pharyngitis)-8166.3(3)-5558(4)0(9)-3583.8(6)]TJ 0 -1.0135 TD (Asymptomatic,)Tj .9905 -1.0135 TD (exposed)Tj 10.7397 1.0135 TD [(154)-5053.2(591)-3083.8(26)]TJ 6.5633 0 0 5.8334 70.9795 69.7322 Tm (a)Tj 8.7511 0 0 8.7511 73.9275 65.8205 Tm [(Categories)-215.5(are)-217.7(not)-209(mutually)-212.4(exclusive.)-218.3(All)-210(who)-212.6(had)-217.9(genitourinary)]TJ -1.3605 -1.0236 TD [(signs)-300.7(also)-298.1(reported)-299.9(genitourinary)-304.5(symptoms.)]TJ ET 313.058 669.033 239.131 .28351 re f 313.058 521.064 239.131 .22675 re f 398.381 640.233 46.942 .22681 re f 451.786 640.233 53.008 .22681 re f 511.257 640.233 40.932 .22681 re f 313.058 622.545 239.131 .22675 re f BT /F8 1 Tf 9.845 0 0 9.845 327.0613 725.5557 Tm (Table)Tj /F5 1 Tf 2.9657 0 TD (4.)Tj /F8 1 Tf 1.2496 0 TD [(Sexually)-302.1(Transmitted)-301.8(Infection)-300.4(Test)]TJ -1.6354 -1.0135 TD [(Results)-302.4(and)-303.2(Treatment)-300(Indications)]TJ -1.0135 -1.0135 TD [(at)-301.3(Visits)-300.5(Where)-302(Presumptive)-301.8(Treatment)]TJ -1.9694 -1.0078 TD [(was)-297.5(Provided)-300.9(and)-303.2(Gonorrhea)-299.5(Test)-304.4(was)-297.5(Negative)]TJ 3.6912 -1.0135 TD [(at)-295.5(All)-303.2(Anatomic)-304.4(Sites)]TJ /F5 1 Tf 10.5727 0 TD (\()Tj /F9 1 Tf .334 0 TD (n)Tj /F6 1 Tf .668 0 TD (=)Tj /F5 1 Tf .7141 0 TD (1150\),)Tj /F8 1 Tf -10.5669 -1.0135 TD (February)Tj /F5 1 Tf 4.5723 0 TD (2015)Tj /F8 1 Tf 2.4992 0 TD (July)Tj /F5 1 Tf 2.3552 0 TD (2015)Tj /F9 1 Tf -15.859 -3.7603 TD (Treatment)Tj 0 -1.0135 TD (indication)Tj /F5 1 Tf 7.3837 0 0 6.5625 353.1967 633.1463 Tm (a)Tj /F9 1 Tf 9.845 0 0 9.845 400.1952 656.6172 Tm (Chlamydia)Tj .6392 -1.0135 TD (positive)Tj 4.7854 1.0135 TD [(No)-331.2(infection)]TJ .6046 -1.0135 TD [(identified)-2287.7(Total)]TJ /F5 1 Tf 7.3837 0 0 6.5625 540.2833 651.0045 Tm (b)Tj 9.845 0 0 9.845 406.0345 628.7242 Tm (n)Tj /F9 1 Tf 2.5453 0 TD (%)Tj /F5 1 Tf 3.0348 0 TD (n)Tj /F9 1 Tf 2.8562 0 TD (%)Tj /F5 1 Tf 2.8966 0 TD (N)Tj /F9 1 Tf 2.3437 0 TD (%)Tj /F5 1 Tf -23.1206 -1.8946 TD (Genitourinary)Tj .9962 -1.0135 TD (symptoms)Tj 8.4478 1.0135 TD [(90)-1712.3(52)-1366.8(462)-2018.5(48)-1591.3(557)-1154.7(48)]TJ -9.444 -2.0212 TD [(Genitourinary)-339(signs)-1432.9(14)-2213.3(8)-1866.8(7)0(7)-2518.5(8)-2091.3(92)-1654.7(8)]TJ 0 -1.0135 TD [(Rectal)-339(symptoms)-2422.9(20)-1712.3(12)-1867.8(85)-2518.5(9)-1590.4(109)-1655.7(9)]TJ T* [(Rectal)-339(signs)-4985.9(1)-2212.3(1)-2362(8)-2523.2(1)-2592.3(9)-1653.7(1)]TJ T* [(Pharyngitis)-5385(3)-2212.3(2)-1866.8(41)-2518.5(4)-2091.3(4)0(5)-1654.7(4)]TJ 0 -1.0077 TD (Asymptomatic,)Tj .9962 -1.0135 TD (exposed)Tj 8.4478 1.0135 TD [(60)-1712.3(35)-1366.8(369)-2018.5(38)-1591.3(437)-1154.7(38)]TJ -9.444 -2.3322 TD [(Total)-6820(172)-1212.3(100)-1367.7(960)-1523.2(100)-1085.6(1150)-654.7(100)]TJ 6.5633 0 0 5.8334 322.0724 513.1274 Tm (a)Tj 8.7511 0 0 8.7511 325.0204 509.2723 Tm [(Categories)-299.7(are)-301.9(not)-299.7(mutually)-296.6(exclusive.)]TJ 6.5633 0 0 5.8334 322.0724 504.1699 Tm (b)Tj 8.7511 0 0 8.7511 325.1905 500.2581 Tm -.0155 Tc [(Eig)5.1(h)-1.4(teen)-202.2(p)5.1(a)-2.6(ti)6.4(en)5.1(ts)-207.1(wh)5.1(o)-208.7(t)6.4(est)6.4(e)-2.6(d)-202.2(n)-1.4(egativ)5.1(e)-203.4(f).1(or)-200.8(go)5.1(no)5.1(rrh)5.1(ea)-203.4(and)-202.2(c)-2.6(h)5.1(l)-.1(amyd)5.1(ia,)]TJ -1.3864 -1.0236 TD -.0147 Tc [(an)5.9(d)-266.2(p)-.6(o)5.9(s)1(it)7.2(ive)-260.9(f).9(or)-264.7(sy)5.9(ph)5.9(ili)7.2(s)-264.6(\()]TJ /F9 1 Tf 9.9119 0 TD 0 Tc (n)Tj /F6 1 Tf .6478 0 TD (=)Tj /F5 1 Tf .7061 0 TD -.0188 Tc [(9\))-268.9(o)-4.7(r)-268.8(HIV)-266.1(\()]TJ /F9 1 Tf 4.4312 0 TD 0 Tc (n)Tj /F6 1 Tf .6478 0 TD (=)Tj /F5 1 Tf .7061 0 TD -.0209 Tc [(9\))-270.9(a)-8(r)1.1(e)-273.6(i)-5.5(nc)-7.9(lu)-6.8(de)-7.9(d)-272.4(i)1(n)-272.4(t)-5.5(he)-273.6(t)-5.5(o)-.3(t)-5.5(a)-7.9(l)]TJ -17.0511 -1.0236 TD -.0148 Tc [(co)5.8(lumn)5.8(.)]TJ ET 62.022 698.967 239.981 .22675 re f 62.022 603.723 239.981 .28345 re f 152.731 680.031 107.49 .28345 re f 62.022 662.4 239.981 .22675 re f BT /F8 1 Tf 9.845 0 0 9.845 76.4787 725.5557 Tm 0 Tc (Table)Tj /F5 1 Tf 2.9657 0 TD (2.)Tj /F8 1 Tf 1.2496 0 TD [(Proportion)-305.4(of)-296.7(Gonococcal)-304.9(Infections)]TJ -3.1154 -1.0135 TD [(Treated)-301.4(Presumptively,)-301.2(by)-301.2(Anatomic)-298.6(Site,)]TJ 3.9101 -1.0135 TD (February)Tj /F5 1 Tf 4.5665 0 TD (2015)Tj /F8 1 Tf 2.4992 0 TD (July)Tj /F5 1 Tf 2.3552 0 TD (2015)Tj /F9 1 Tf -5.7643 -1.9406 TD [(Treated)-337.3(presumptively)]TJ 12.1275 -.8062 TD (Total)Tj /F5 1 Tf -10.8549 -1.0135 TD (n)Tj /F9 1 Tf 6.3574 0 TD (%)Tj /F5 1 Tf 5.1942 0 TD (N)Tj -22.9593 -1.8946 TD [(Positive,)-335.1(any)-332.4(site)-4174.5(527)-5024.4(45)-3635.6(1184)]TJ 1.002 -1.0135 TD [(Urethral)-6818(266)-5024.4(78)-4130.9(341)]TJ T* [(Rectal)-7589(397)-5024.4(54)-4130.9(734)]TJ 0 -1.0077 TD [(Pharyngeal)-5651(222)-5024.4(35)-4130.9(643)]TJ -1.002 -1.0135 TD [(Negative)-335.1(all)-338.5(sites)-3576.4(1150)-5025.4(14)-3635.6(7957)]TJ /F3 1 Tf 8.9663 0 0 8.9663 62.022 749.5368 Tm (142)Tj 46.9539 0 TD [(SHOVER)-305.9(ET)-300.7(AL.)]TJ ET endstream endobj 46 0 obj <>stream /GS1 gs BT /F5 1 Tf 9.843 0 0 9.843 59.7543 725.5557 Tm 0 0 0 rg 0 Tc 0 Tw [(bacterial)-233.8(or)-232.6(viral)-225.8(agents)-233.5(not)-228.1(routinely)-230.3(tested)-227.9(for)-227.9(at)-233.9(the)-229.2(Center.)]TJ 0 -1.1174 TD [(Routine)-361.5(testing)-360.4(was)-362.2(not)-360.5(performed)-359(for)]TJ /F9 1 Tf 16.1848 0 TD (Mycoplasma)Tj /F5 1 Tf 5.1146 0 TD (,)Tj /F9 1 Tf .6048 0 TD (Urea-)Tj -21.9042 -1.1116 TD (plasma)Tj /F5 1 Tf 2.8856 0 TD .2914 Tc [(,o)291.4(r)]TJ /F9 1 Tf 1.6646 0 TD 0 Tc [(Neisseria)-289.4(meningitidis)]TJ /F5 1 Tf 9.0255 0 TD [(.)-291.4(Reviews)-288.3(suggest)]TJ /F9 1 Tf 7.5625 0 TD [(M.)-293.6(gen-)]TJ -21.1381 -1.1116 TD (italium)Tj /F5 1 Tf 3.1333 0 TD [(accounts)-294.5(for)-291.2(10%25%)-292.1(of)-290.2(non-gonococcal)-290.9(urethritis)]TJ -3.1333 -1.1116 TD [(\(NGU\))-296(among)-284.4(men,)-291.4(and)-286.7(other)-294.8(causes)-291.9(of)-284.4(NGU)-293.9(among)-290.1(MSM)]TJ 0 -1.1174 TD (include)Tj /F9 1 Tf 3.3003 0 TD [(Ureaplasma)-336.2(urealyticum)]TJ /F5 1 Tf 10.0622 0 TD (,)Tj /F9 1 Tf .5875 0 TD [(Escherichia)-345(coli)]TJ /F5 1 Tf 6.6409 0 TD [(,)-337.5(oropha-)]TJ -20.591 -1.1116 TD [(ryngeal)-810.7(bacteria,)-812(herpes)-809.3(simplex)-810.8(virus,)-809.4(and)-805.1(adenovi-)]TJ T* (ruses.)Tj 7.3823 0 0 6.5614 82.4315 653.2156 Tm (14,15)Tj 9.843 0 0 9.843 103.0677 648.8502 Tm [(One)-408.5(gram)-409.9(of)-405.3(azithromycin)-415.7(is)-405.3(the)-407.8(recommended)]TJ -4.4004 -1.1174 TD [(treatment)-262.7(for)-256.7(both)]TJ /F9 1 Tf 7.5222 0 TD (Ureaplasma)Tj /F5 1 Tf 5.1953 0 TD (and)Tj /F9 1 Tf 1.7049 0 TD [(M.)-259(genitalium)]TJ /F5 1 Tf 5.633 0 TD [(;)-260.4(however,)]TJ /F9 1 Tf -20.0553 -1.1116 TD [(M.)-247.5(genitalium)]TJ /F5 1 Tf 5.8634 0 TD [(has)-246.2(shown)-248.1(increasing)-244.9(resistance)-251.6(to)-244.2(azithromy-)]TJ -5.8634 -1.1116 TD [(cin,)-301.8(so)-295.7(presumptive)-297.9(gonorrhea)-300.2(treatment)-297.2(may)-299.4(be)-297.1(inadequate)]TJ 0 -1.1174 TD [(to)-301.8(clear)-302.8(all)-304.2(infections.)]TJ 7.3823 0 0 6.5614 147.0047 609.392 Tm (16,17)Tj 9.843 0 0 9.843 69.7323 594.0282 Tm [(Although)-263.4(signicant)-272.6(differences)-270(in)-261.5(presumptive)-269.1(treatment)]TJ -1.0137 -1.1116 TD [(by)-307.5(sexual)-308.4(orientation)-308.7(were)-312.8(not)-302.9(observed)-310.4(in)-301.8(bivariate)-313.3(associ-)]TJ 0 -1.1174 TD [(ations,)-431.7(it)-428.7(is)-428.3(possible)-430.3(that)-432(grouping)-429.4(together)-431.8(gay,)-428.4(bisexual,)]TJ 0 -1.1116 TD [(and)-223.3(other)-225.6(MSM)-223.8(for)-222.1(the)-223.5(other)-225.6(analyses)-225.2(limits)-227(the)-223.5(ability)-222.5(to)-221.2(de-)]TJ T* [(tect)-306.5(potential)-300.7(differences)-304.6(between)-305.9(these)-301.5(populations.)]TJ 1.0137 -1.1116 TD -.0159 Tc [(The)-375.3(gon)-15.9(o)10.7(rrhe)-15.9(a)-360.2(p).3(o)-15.9(s)10.9(itiv)-15.9(i)10.6(t).2(y)-374.1(among)-374.1(pati)-15.9(e)9.4(n).3(ts)-373.9(tre)-15.9(a)8.4(ted)-374.1(pres)-15.9(u)10.9(mp-)]TJ -1.0137 -1.1174 TD -.0158 Tc [(t)-15.8(i)10.5(vely)-425.8(was)-425.6(l).3(o)-15.8(w)9.9(er)-425.8(than)-425.8(that)-426(ob)-15.8(s)11(e)-.8(rve)-15.8(d)-410.8(i).3(n)-425.8(t).3(h)-15.8(e)-410.8(sm)-15.8(a)8.4(l).3(l)-426(s).6(tudi)-15.8(e)9.5(s)-425.6(of)]TJ 0 -1.1116 TD -.0153 Tc [(MS)-15.3(M)]TJ 7.3823 0 0 6.5614 82.2047 521.688 Tm -.0218 Tc [(9,1)-5.6(0)]TJ 9.843 0 0 9.843 96.8882 517.3227 Tm -.0158 Tc [(an)-15.8(d)-225.3(h)-15.8(i)10.7(gher)-241.5(c)-.8(o)-15.8(m)9.6(pared)-241.5(w)-.5(i)-15.8(t)10.5(h)-241.5(l).3(arge)-15.8(r)-226.5(s)-15.8(t)10.9(udi)-15.8(e)9.5(s)-241.3(of)-241.5(pres)-15.8(u)11(mp-)]TJ -3.7726 -1.1116 TD [(t)-15.7(i)10.6(ve)-219.5(tr)-15.7(e)9.8(a)-.7(tmen)-15.7(t)-208.1(i).4(n)-218.4(U)-.4(.S.)-220.7(eme)-15.7(r)9.8(g).5(enc)-15.7(y)-209.1(depar)-15.7(t)10.8(ments)-15.7(,)-210.1(i).4(n)-218.4(w)-.4(hi)-15.7(c)9.6(h)-218.4(gon)-15.7(o)10.9(r).5(-)]TJ 0 -1.1174 TD [(r)-15.8(h)10.8(ea)-369.4(p)-15.8(o)10.8(siti)-15.8(v)10.7(ity)-374(was)-368(c)-15.8(o)9.6(n).4(sis)-15.8(t)10.9(entl)-15.8(y)]TJ /F6 1 Tf 12.9075 0 TD 0 Tc (<)Tj /F5 1 Tf .5357 0 TD -.0162 Tc [(15)-16.2(%)9.3(.)]TJ 7.3823 0 0 6.5614 212.0314 499.7479 Tm -.0228 Tc [(18)-6.6(,19)]TJ 9.843 0 0 9.843 231.5338 495.3825 Tm -.0159 Tc [(Al)-15.9(t)10.4(hough)-15.9(,)-360.3(a)-.9(s)-368.1(t)-15.9(h)10.6(i).2(s)]TJ -17.4519 -1.1116 TD [(s)-15.9(t)10.8(udy)-253.1(demons)-15.9(t)10.8(r).3(at)-15.9(e)9.4(s).5(,)-249.7(over)-15.9(t)10.6(reat)-15.9(m)9.3(e)-.9(nt)-247.5(i)-15.9(n)-237.1(se)-15.9(t)9.4(ting)-15.9(s)-236.8(wit)-15.9(h)-237.1(hig)-15.9(h)-237(gon)-15.9(o)10.7(r).3(-)]TJ T* -.0157 Tc [(r)-15.7(h)10.9(ea)-357.8(pr)-15.7(e)9.8(v).5(alen)-15.7(c)9.7(e)-357.8(is)-356.4(l)-15.7(i)10.6(kely)-356.6(t)-15.7(o)-346.3(be)-357.8(lo)-15.7(w)10(e)-.7(r)-356.6(t).4(h)-15.7(a)9.7(n)-356.6(i).4(n)-356.6(g).5(e)-15.7(n)9.7(eral)-362.5(clinic)-15.7(a)8.6(l)]TJ 0 -1.1174 TD [(s)-15.8(e)9.8(ttin)-15.8(g)10.8(s).6(,)-416.6(t).3(here)-415.5(is)-414.1(st)-15.8(i)10.5(l).3(l)-414.4(roo)-15.8(m)-399.4(f).4(o)-15.8(r)-403.9(improv)-15.8(e)9.6(ment.)-416.6(Overt)-15.8(r)10.7(eatme)-15.8(n)9.6(t)]TJ 0 -1.1116 TD [(o)-15.8(f)-242.6(un)-15.8(i)10.7(nfec)-15.8(t)9.5(ed)-253(i)-15.8(n)10.7(divi)-15.8(d)10.7(u).4(als)-258.6(may)-258.8(have)-260(seve)-15.8(r)9.7(a)-.8(l)-258.9(d).4(elete)-15.8(r)9.7(ious)-258.6(eff)-15.8(e)9.7(cts)-15.8(,)]TJ T* 0 Tc [(in)26.5(c)15(l)16.1(u)16.2(d)0(i)26.5(n)16.2(g)-352.4(s)0(i)26.7(d)16.2(e)-353.6(e)15(ff)26.7(e)15(c)15(t)16.1(s,)-344.2(p)16.2(o)16.2(s)16.4(si)26.7(b)16.2(l)16.1(e)-353.6(i)0(n)26.5(c)15(r)16.2(e)15(a)15(s)0(e)25.6(d)-352.4(ri)26.5(s)16.4(k)-352.4(of)]TJ /F9 1 Tf 19.6636 0 TD -.016 Tc [(Clos)-16(t)10.7(r).4(id)-16(i)10.5(u).2(m)]TJ -19.6636 -1.1174 TD 0 Tc [(di)26.5(f)16.1()16.2(c)15(i)0(l)26.3(e)]TJ /F5 1 Tf 3.2715 0 TD -.016 Tc [(infe)-16(c)8.3(tion,)-370.8(and)-374.2(t).1(he)-369.6(pot)-16(e)9.3(n).2(tial)-374.3(t).1(o)-368.4(promo)-16(t)10.5(e)-369.6(a)-1(nti)-16(m)9.2(icrob)-16(i)10.5(a)-1(l)]TJ -3.2715 -1.1116 TD 0 Tc [(re)25.5(s)16.4(i)16.1(st)26.7(a)15(n)16.2(c)15(e)-238.4(of)-226.8(o)16.2(t)16.1(he)25.4(r)-237.2(s)16.4(pe)25.4(c)15(i)16.1(e)15(s)-242.8(o)16.2(f)-237.2(b)16.2(a)15(ct)25.3(e)15(r)16.2(i)16.1(a)-244.2(c)15(o)16.2(l)16.1(o)16.2(ni)26.5(z)15(i)16.1(n)16.2(g)-243(t)16.1(h)16.2(e)-238.4(s)16.4(it)26.3(e)-238.4(o)16.2(f)-243(i)16.1(n)16.2(-)]TJ T* -.0158 Tc [(f)-15.8(e)9.7(ctio)-15.8(n)10.8(.)]TJ 7.3823 0 0 6.5614 88.4976 412.1007 Tm -.0173 Tc [(20,2)6.6(1)]TJ 9.843 0 0 9.843 107.1496 407.7353 Tm -.0248 Tc [(Pre)-4(s)3.1(umptive)-274.7(t)-3(re)-4(atment)-279.5(i)2.8(s)-279.1(u)2.9(nlikely)-279.3(t)2.8(o)-279.3(l)-3(ead)-279.3(to)-273.6(a)-4(n)2.9(tibi-)]TJ -4.8151 -1.1116 TD -.0274 Tc [(o)-5.5(t).2(i)-5.6(c)-231.2(r)-5.4(e)-.9(si)-5.6(st)-5.6(an)-5.5(ce)-231.2(i)-5.6(n)-230.1(i)-5.6(n).3(d)-5.5(i).2(vi)-5.6(du)-5.5(al)-5.6(s)-229.9(w)-6.3(ho)-230.1(r)-5.4(e)-.9(c)-6.6(e)-.9(iv)-5.5(e)-231.2(p)-5.5(re)-6.6(sum)-6.7(p).3(t)-5.6(i).2(ve)-237(tr)-5.4(ea)-6.6(tme)-6.6(n).3(t)]TJ 0 -1.1174 TD [(o)-5.4(n).4(l)-5.5(y)-201.2(on)-5.4(ce.)-203.5(Ho)-5.4(we)-6.5(ver)-5.3(,)-197.8(i)-5.5(n)-201.2(in)-5.4(di)-5.5(vid)-5.4(u).4(a)-6.5(l).3(s)-201(w)-6.2(ho)-201.2(r)-5.3(ece)-6.5(iv)-5.4(e)-202.3(m)-.8(ul)-5.5(ti)-5.5(ple)-202.4(c)-6.5(ou)-5.4(rs)-5.2(es)]TJ 0 -1.1116 TD [(o)-5.4(f)-281.8(pr)-5.3(es)-5.2(ump)-5.4(t).3(i)-5.5(v).4(e)-283(t).3(r)-5.3(e)-.8(a)-6.5(t).3(me)-6.5(nt)-5.5(,)-278.4(i).3(t)-282(i)-5.5(s)-281.6(p).4(l)-5.5(a)-.8(us)-5.2(ib)-5.4(le)-283(t)-5.5(h).4(at)-282(e)-6.5(ndo)-5.4(ge)-6.5(no)-5.4(us)-281.6(ba)-6.5(ct)-5.5(e-)]TJ T* [(r)-5.3(i).3(a)-271.5(c)-.8(ou)-5.4(ld)-270.3(acq)-5.4(ui)-5.5(re)-271.5(res)-5.2(i).3(s)-5.2(t).3(a)-6.5(n).4(c)-6.5(e)-265.7(th)-5.4(at)-264.7(i)-5.5(s)-264.3(t)-5.5(h).4(e)-6.5(n)-264.5(pa)-6.5(ss)-5.2(ed)-270.3(on)-264.5(t)-5.5(o)-264.5(s)-5.2(u).4(b)-5.4(s).6(eq)-5.4(ue)-6.5(nt)]TJ 0 -1.1174 TD [(c)-6.6(o).3(l)-5.6(o).3(n)-5.5(i).2(za)-6.6(ti)-5.6(on)-546.9(by)]TJ /F9 1 Tf 6.6985 0 TD -.0277 Tc [(N)-6.8(e)-1.2(i)-5.9(s).2(s)-5.6(e)-1.2(r)-5.6(i)-.1(a)-541.4(g)-5.8(on)-5.8(or)-5.6(rh)-5.8(oe)-6.9(ae)]TJ /F5 1 Tf 8.9851 0 TD -.0226 Tc [(.)-538.6(T)-1.8(h)5.1(i)-.8(s)-536.1(r)-.6(el)5(at)5(io)5.1(ns)5.3(hi)5(p)-536.3(i)-.8(s)]TJ -15.6837 -1.1116 TD 0 Tc [(s)22.1(p)27.7(e)20.8(c)26.5(u)21.9(l)27.6(a)26.5(t)21.8(i)27.6(v)21.9(e)-284.5(a)26.5(s)-283.1(n)21.9(o)-283.3(p)27.7(r)27.7(e)20.8(v)27.7(i)21.8(o)27.7(u)21.9(s)-283.1(s)27.9(t)21.8(u)27.7(d)27.7(i)21.8(e)26.5(s)-283.1(to)-313.4(our)-308.5(knowledge)-312.8(have)-306.2(ex-)]TJ T* [(amined)-304(the)-298.3(link)-298.4(between)-300.2(presumptive)-297.9(treatment)-303(and)-298.2(antimi-)]TJ 0 -1.1174 TD [(crobial)-304(resistance.)]TJ 1.0137 -1.1116 TD .0122 Tc [(Fu)5.3(rt)5.2(her)-443.9(s)-.2(tu)5.3(di)5.2(es)-449.5(s)5.5(hou)5.3(ld)-443.9(examine)-445.1(presu)5.3(mp)5.3(ti)5.2(ve)-450.8(t)5.2(r)-.4(eat)5.2(m)-1.6(ent)]TJ -1.0137 -1.1116 TD [(in)-357.5(ot)5.2(her)-363.2(p)5.3(opu)5.3(lati)5.2(on)5.3(s)-363.1(w)4.5(ith)-357.5(h)5.3(i)-.5(gh)]TJ 13.1552 0 TD [(i)5.2(n)-.4(ci)5.2(dence)-364.4(o)5.3(f)-357.5(gon)5.3(or)5.4(rhea,)-354.1(as)]TJ -13.1552 -1.1116 TD .0069 Tc [(w)-6.6(e)-1.1(l)-5.8(l)-483.9(a)-6.9(s)-483.6(ho)-5.7(w)-484.6(t)-5.8(he)-484.9(p)-5.7(r).1(e)-6.9(c)-1.1(i)-5.8(s)-5.5(io)-5.7(n)-483.8(a)]TJ 12.2624 0 TD .012 Tc [(nd)-478.7(accuracy)-478.7(o)5.1(f)-478.6(presu)5.1(mp)5.1(ti)5(ve)]TJ -12.2624 -1.1174 TD .0073 Tc [(t)-5.4(r)-5.3(ea)-6.5(tm)-6.5(en)-5.3(t)-552.6(m)-.8(a)-6.5(y)-552.5(b)-5.3(e)-553.6(im)-6.5(pr)-5.3(ov)-5.3(e)-6.5(d)-552.5(am)-6.5(on)-5.3(g)-552.5(M)-.5(S)-5.2(M)-6.2(.)-549.1(T)-6.5(he)-559.4(pr)-5.3(ed)-5.3(ic)-6.5(-)]TJ 0 -1.1116 TD .0071 Tc [(t)-5.6(i)-5.6(v).2(e)-467.5(v)-5.5(al)-5.6(ue)-6.7(s)-466.1(o).2(f)-466.3(s)-5.3(pe)-6.7(ci)-5.6()-5.4(c)-461.7(g)-5.5(o)-5.5(n).2(o)-5.5(r).3(r)-5.5(h)-5.5(e)-.9(a)-467.5(s)-5.3(ym)-6.7(pt)-5.6(om)-6.7(s,)-468.6(pa)-6.7(rt)-5.6(i)-5.6(c)-.9(u)-5.5(l).1(a)-6.7(r).3(l)-5.6(y)]TJ T* .0123 Tc [(ureth)5.4(ral)-507.3(d)-.3(i)5.3(s)-.1(ch)5.4(ar)5.5(ge,)-509.5(a)-1.5(n)5.4(d)-507.2(wh)5.4(et)]TJ 12.3949 0 TD .0118 Tc [(her)-507.6(a)-2(n)4.9(o)-.8(scop)4.9(ic)-508.8(exami)4.8(n)-.8(at)4.8(io)4.9(ns)]TJ -12.3949 -1.1174 TD [(impro)5(ve)-514.5(i)4.9(d)-.7(en)5(ti)4.9(cat)4.9(ion)-513.3(o)5(f)-519.1(r)5.1(ectal)-519.2(g)5(on)5(orr)5.1(hea,)-515.7(als)5.2(o)-519.1(war)5.1(r)-.7(ant)]TJ 0 -1.1116 TD .0123 Tc 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[(WHO)-375.4(a)-1.3(lg)5.6(or)5.7(it)5.5(hm)-375.7(in)5.6(cl)5.5(ud)5.6(e)-381.4(s)5.8(el)5.5(f-r)5.7(ep)5.6(or)5.7(ted)-380.3(s)5.8(ympt)5.5(oms.)-376.8(P)5.8(o)-.1(li)5.5(ci)5.5(es)]TJ 0 -1.1174 TD .0132 Tc [(tha)5.2(t)-431.5(inc)5.2(l).5(u)6.3(d).6(e)-432.6(e)-.6(m)5.1(p).6(i)6.2(r).6(i)6.2(c)-438.3(e)5.2(x).6(t)6.2(r).6(a)5.2(g).6(e)5.2(n).6(it)6.2(al)-431.5(tr)6.4(ea)5.2(tm)5.1(en)6.3(t)-437.3(r)6.4(ec)5.2(om)5.1(me)5.2(nd)6.3(a-)]TJ 0 -1.1116 TD .0118 Tc [(tio)4.9(ns)-524.8(are)-526.1(n)4.9(eeded)-524.9(t)-.9(o)-519.2(i)-.9(mpro)4.9(ve)-526.1(manag)4.9(e)-2(men)4.9(t)-525.1(of)-519.2(gon)4.9(or)5(rh)4.9(ea)]TJ T* .0131 Tc [(for)-293.2(MS)6.4(M.)]TJ /F3 1 Tf 8.9663 0 0 8.9663 59.7543 84.2456 Tm 0 Tc (Conclusion)Tj /F5 1 Tf 9.843 0 0 9.843 69.7323 67.8047 Tm [(There)-256.7(are)-259(opportunities)-257.7(to)-255.8(improve)-257.9(presumptive)-257.6(treatment)]TJ -1.0137 -1.1116 TD -.0217 Tc 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