Survey of Health Care Providers Serving Men Who Have Sex with Men Suggests Suboptimal Gonorrhea Diagnosis and Management Practices, New York City 2012

Background: Neisseria gonorrhoeae(GC) antimicrobial susceptibility test results in New York City (NYC) suggest cephalosporin-resistant GC will first be identified among men who have sex with men (MSM), thus screening and appropriate treatment is critical. We characterized sexual history-taking, GC diagnosis, and treatment practices among NYC health care providers (HCP) serving MSM.

Methods:  During 2012, we surveyed HCP reporting infectious syphilis (assumed indicative of HCP serving MSM) to the NYC Department of Health and Mental Hygiene in 2011, and calculated the prevalence of clinical practices.

Results:  Surveys were completed by 54% (153/283) of HCP; 61% (93/153) were male, 42% (64/153) internists, 27% (42/153) infectious disease physicians. Most HCP (67% (99/148)) estimated >15% of their male patients were MSM. Taking at least an annual sexual history of male patients was reported by 68% (104/152), among whom 78% (81/104) ask about gender of recent partners. When taking a sexual history of MSM, 73% of HCP (109/150) ask about receptive anal intercourse, and 64% (96/150) about performing oral sex. More than a third of HCP reported testing extragenital sites for GC only when symptoms are present (34%, 48/140 performed anorectal, 37% (52/140) oropharyngeal testing only with symptoms). More than a quarter (29%, 43/150) reported sometimes/always treating for GC without sending a specimen for laboratory testing. To treat GC, 58% (88/151) of HCP reported using the CDC-recommended regimen (ceftriaxone 250 mg and azithromycin 1 gram). Regarding the greatest obstacle to STD screening in MSM, HCP reported: patient reluctance (20% (28/142)), time constraints (18% (26/142)), lack of clear screening guidelines (17% (24/142)), and lack of laboratories offering anorectal/oropharyngeal nucleic acid amplification tests (NAATs) (16% (23/142)).

Conclusions:  GC diagnosis, and treatment practices are suboptimal and provider education is needed. HCP-identified obstacles to screening suggest encouraging laboratory validation of extra-genital NAATs for GC could facilitate necessary extra-genital screening.