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Background: Compliance with CDC treatment recommendations for gonorrhea (GC) is an important component of efforts to combat antimicrobial resistance. We sought to evaluate compliance with GC treatment recommendations in four Midwestern states, with an emphasis on identifying specific types of providers who may benefit from additional training to improve compliance.
Methods: We retrospectively analyzed all state-level GC treatment reports (Jan. – Jun. 2015) from Iowa (IA), Illinois (IL), Kentucky (KY), and Missouri (MO). Dual treatment with ceftriaxone, plus either azithromycin or doxycycline, was defined as “recommended” (based on 2010 CDC Treatment Guidelines in effect for this time period). Treatment regimens containing cefixime, or treatment with azithromycin 2 g single-dose, were defined as “adequate but not recommended.” All other therapies were defined as “inappropriate.”
Results: During the six-month study period, 11,409 GC cases were reported (IL 49.6%; MO 27.5%; KY 14.7%; IA 8.2%). Among reported cases, mean age was 25.4 ± 8.4 years, 48.1% were male, and 57.6% were African American. Overall, 82.5% of cases received recommended treatment, with substantial variability between states (IA 89.0%; MO 88.5%; IL 81.1%; KY 67.5%). Adequate but not recommended treatment was provided to 5.7% of cases, and inappropriate treatment was provided to 11.9% of cases. Among the top five provider types, STD clinics reported the highest levels of recommended treatment (88.0%) while private physicians / HMO providers reported the lowest levels (70.8%).
Conclusions: While 82.5% of GC cases were treated with recommended regimen, we found substantial variability across states and across provider types. Private physicians / HMO providers represent an important target for additional education on GC treatment recommendations. Although efforts were made to homogenize data reports across states, important discrepancies exist which impede cross-state comparisons. Greater standardization in treatment reporting may lead to a better verification system of GC treatment.