Treatment Verification Among Cases of Gonorrhea Reported from Federally Qualified Health Centers, New York City, 2012

Background: The emergence of Neisseria gonorrhoeae (GC) with reduced susceptibility to cephalosporins makes it critical for public health programs to monitor appropriate gonorrhea treatment in the community.  In New York City, approximately two-thirds of GC case reports from laboratories and/or providers do not include information about treatment, so it is unknown what proportion of patients with GC received treatment.

Methods: During March–May, 2012, 2,470 (65%) of 3,774 reported GC cases did not have treatment documented.  Treatment verification was attempted for all cases diagnosed by Federally Qualified Health Centers (FQHCs) (10% of all diagnosing facilities; 234/2,470 cases) to estimate the proportion of patients without treatment documentation that did receive treatment. We gathered information for 91% (212/234) of these cases through 121 phone calls, 18 faxes, and 3 site visits. This information included whether treatment was provided, treatment date, regimen used, and reasons for no treatment. 

Results: Treatment was received by 81% of patients (171/212), 99% (169/171) of whom received a CDC-recommended regimen. Forty-five percent (77/171) received treatment on the day they were diagnosed. Of the 41 patients who did not receive treatment, 22 had not returned for treatment, 1 had refused, and 18 had no reason available.

Conclusions: Our study shows that, combined with the 33% of cases that already had treatment documented,  the majority (>87%) of FQHC patients received treatment, at minimum (those for whom no treatment could be documented might have been treated elsewhere).  Most patients received a CDC-recommended regimen, but additional work is needed to ensure treatment for the remaining 13%. Treatment rates from FQHC facilities might not be representative; further efforts are needed to obtain more generalizable estimates. GC treatment verification might not be feasible as a routine surveillance activity, as substantial effort was necessary to collect this information.