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Background: In December 2010, the CDC recommended new gonorrhea (GC) treatment regimens: ceftriaxone (250mg intramuscularly [IM]) or, if ceftriaxone is not an option, cefixime (400mg orally); plus dual therapy azithromycin or doxycycline. Emphasizing ceftriaxone as the first-line therapy may delay treatment in facilities that routinely treat with oral medications.
Objectives: (1) Examine whether the new IM treatment recommendation delays or prevents treatment in facilities that did not routinely provide ceftriaxone, and (2) determine whether these facilities transitioned to new recommendations.
Methods: We retrieved all urogenital and/or rectal GC cases diagnosed within Los Angeles County (LAC) between April-August 2010 and April-August 2011. We identified facilities who treated <10% of their GC cases with ceftriaxone (any dosage) in 2010 as “infrequent injectors”. For cases diagnosed in these facilities, we compared changes in overall and median time to treatment (for treatments within 30 days of specimen collection), as well as compliance with recommendations.
Results: During the two time periods, 11% (p=.46) of LAC urogenital and/or rectal GC cases were diagnosed by infrequent injectors (n=180 facilities). Among these cases (n=431 in 2010; n=374 in 2011), overall proportion treated (81.2% in 2010 and 77.5% in 2011, p=0.20) and median time to treatment (4 and 6 days, respectively, p=0.08) were not greatly affected. In 2010, 84.0% of cases received CDC recommended regimens, while 83.9% received recommended doses of ceftriaxone or cefixime in 2011 (p=0.97), although the proportion of IM treatment among these cases increased drastically (12.6% in 2010 to 91.2% in 2011, p<0.0001). Dual treatment with azithromycin/doxycycline, however, only occurred in 59.2% of those treated with ceftriaxone or cefixime in 2011.
Conclusions: IM treatment recommendation for GC did not significantly delay treatment among previously infrequent injectors; compliance with dual therapy, however, was low.
Implications for Programs, Policy, and Research: Health departments should promote the first-line therapy for GC, including a focus on the importance of dual therapy.