Gonorrhea Cases Reported with Non-CDC Recommended Treatment Regimens in New York City, 2013: Gaps in Provider Knowledge or Reporting Errors?

Background: The increase in Neisseria gonorrhoeae (GC) isolates with reduced susceptibility to cephalosporins highlights the importance of monitoring GC treatment practices. The Centers for Disease Control and Prevention (CDC) currently recommend treating uncomplicated GC with dual therapy: ceftriaxone (250mg administered intramuscularly) and azithromycin (1g by mouth).

Methods: The New York City Bureau of Sexually Transmitted Diseases contacted providers who reported GC cases treated with a non-CDC recommended regimen between January –June 2013 to confirm the accuracy of reported treatments and document reason(s) for not adhering to guidelines. Facilities reporting the greatest number of cases with non-recommended treatment were prioritized for follow up.

Results: Among 6,872 reported GC cases, 37% (2,553/6,872) had treatment recorded; 9% (222/2,553) had documentation of a non-CDC recommended regimen. Treatment information was obtained for 70% (155/222) after 166 phone calls, 61 faxes, and 3 site visits. Seventy percent (109/155) had, in fact, received a CDC-recommended regimen. Of the remaining 46 cases, 37% (17 individuals) were recalled by their providers to receive CDC-recommended treatment, but did not return. In 2 cases, providers recorded “penicillin allergies” as a reason ceftriaxone was not used; however, documentation of the reason(s) why patients did not receive a CDC-recommended regimen was unavailable for the remaining 27 cases. 

Conclusions: Most providers used, or made efforts to use CDC-recommended therapy for GC. Errors in reporting and data entry, and poor documentation were among the reasons for reporting non-recommended GC treatments. More individuals may be treated with CDC-recommended therapy than our findings suggest because some patients may have received treatment at facilities other than the one where they were diagnosed. Treatment verification efforts are resource intensive. Given the high proportion of case-patients in our sample who were correctly treated, it may be unnecessary to routinely conduct this verification.