Verifying Treatment for Reported Cases of Gonorrhea: One Aim, More Than One Approach

Background: Verifying that gonorrhea cases receive appropriate treatment may reduce morbidity and decrease the development of antibiotic resistance. Little is known about the approaches that sexually transmitted disease (STD) programs are using—if any—to verify gonorrhea treatment. Methods: We reviewed all applications for 2014 STD Program funding from the Centers for Disease Control and Prevention and noted each program’s current activities and future plans for gonorrhea treatment verification.  Programs using distinct approaches were studied in greater detail via interviews of program staff. Results: Current and proposed treatment verification approaches vary widely.  At present, most programs do not monitor gonorrhea treatment. While many programs collect treatment details from physician case reports, information is complete for only 30%–60% of all cases.  Some jurisdictions verify treatment for a sample of cases using sentinel surveillance data.  Many low-morbidity states and a few high-morbidity cities fax or call providers for all gonorrhea cases with undocumented or inappropriate treatment.  These jurisdictions are able to verify appropriate treatment for 70%–92% of all cases within 30 days of diagnosis.  Many programs are developing gonorrhea treatment verification plans to meet new funding requirements.  Most programs passively collect provider-reported treatment information and they intend to review this in the future.  A few programs have identified specific interventions to increase this reporting, including training providers about reporting requirements. Others plan to monitor treatment appropriateness using non-representative data sources like infertility prevention activity data and STD clinic data.  Very few programs intend to implement comprehensive treatment verification. 

Conclusions: Most programs are only beginning to develop plans to verify treatment appropriateness.  Approaches to treatment verification vary widely. More information is needed to determine the cost-effectiveness of different verification strategies for identifying and treating persons who were untreated or inappropriately treated.