Background: Neisseria gonorrhoeae has developed increasing resistance to cephalosporins. Correct treatment is essential to gonorrhea control efforts. The United States Centers for Disease Control and Prevention (CDC) has released two updated gonorrhea treatment guidelines in 2010 and 2012. This study examines adherence to these guidelines among clinicians in San Francisco.
Methods: Provider-reported treatment data from the San Francisco Sexually Transmitted Disease (STD) Surveillance Database was collected during three time periods. Time Period 1 was before the 2010 treatment update (January 1 to December 17, 2010), Time Period 2 was after the 2010 update (December 18 to August 10, 2012), and Time Period 3 was after the 2012 update (August 11, 2012 to August 1, 2013). Treatments administered for each case were categorized into recommended treatment (adhered to recommendations exactly), no treatment (inadequate treatment or no treatment), and recommended treatment + (correct or above adequate treatment). Chi-square tests were used for comparisons.
Results: There were 1,882, 3,831, and 2,283 cases of gonorrhea in Time Periods 1, 2 and 3, respectively. No treatment was recorded in 332 cases (17.64%) in Time Period 1, 543 cases (14.17%) in Time Period 2, and 279 cases (12.22%) in Time Period 3. In Time Period 1, only 659 cases (35.02%) were given correct treatment. Compared to Time Period 1, the proportion of correct treatment increased with statistical significance to 2,802 cases (73.14%) after the 2010 update (p<0.0001) and 1,873 cases (82.08%) after the 2012 update (p<0.0001).
Conclusions: The majority of San Francisco clinicians are using correct gonorrhea treatment after the release of the 2010 and 2012 CDC gonorrhea treatment guidelines. No studies to date examine the intervention components needed to effectively implement STD treatment guidelines in the outpatient setting. Future studies should explore which methods in guideline dissemination were most helpful in San Francisco.