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Background: Decreased susceptibility of Neisseria gonorrhoeae to oral cephalosporins and the high prevalence of pharyngeal infection suggest that ceftriaxone (CTX) should be the preferred agent for the treatment of gonorrhea.
Objectives: To describe gonorrhea treatment practices in diverse U.S. settings.
Methods: Six sites in the STD Surveillance Network (SSuN) contributed data on all gonorrhea cases diagnosed in 63 counties and independent cities. Treatment data were obtained through local surveillance and interviews with a random sample of patients. Cases were weighted to adjust for different sample fractions across sites and for differential non-response by diagnosing clinic type, age, and gender.
Results: In 2010, 36,436 gonorrhea cases were reported in participating areas, 4,604 (13.6%) of which were randomly sampled. Interview data were completed on 2,063 (44.8%) cases, among whom 65 (2.8%) were untreated. The weighted proportions of the following therapies were observed: CTX alone: 40.4%, (range:25.6-44.6%), CTX plus azithromycin or doxycycline: 35.7% (range:15.6-53.6%), oral cephalosporins alone: 11.1% (range:0-27.6%), oral cephalopsorins plus azithromycin/doxycycline: 6.5% (range:0-29.9%), quinolones: 2.1% (range:0.7-10.4%), and other: 4.4%, (range:0-14.2%). Overall, 76.5% were treated with CTX alone or with dual treatment, though this varied by area (range: 50.3-91.2%). Patients treated in STD clinics were more likely to receive CTX (86.6%) than patients treated by other providers (75.0%, p=0.02). Men were more likely to receive CTX than women (78.7% vs. 70.5%, p=0.04), and men who have sex with men (86.6%) were treated more frequently with CTX than other men (71.8%, p=0.008).
Conclusions: Most persons with gonorrhea receive CTX; use of the drug is significantly lower outside of STD clinics.
Implications for Programs, Policy, and Research: Efforts to identify and address barriers to the use of ceftriaxone in all treatment settings are required.