Gonococcal Case Treatment By Provider Type in North Carolina State Surveillance Data, 2013-2014

Background:  Appropriate treatment of Neisseria gonorrhoeae infections is necessary to eradicate infection and prevent further antibiotic drug resistance from developing.  We analyzed North Carolina (NC) sexually transmitted disease (STD) surveillance program data to determine statewide gonorrhea treatment practices and identify ways to improve adherence to the CDC STD treatment guidelines.

Methods:  Gonorrhea surveillance data were extracted from the NC Electronic Disease Surveillance System (NCEDSS). Using the 2010 CDC STD Treatment Guidelines, we evaluated the 2013-2014 gonorrhea treatment data to determine the proportion of cases that received first-line or second-line therapy and those with incomplete/incorrect or no recorded treatment.  Treatment data was also assessed by provider type (public versus private providers) and time between specimen collection and treatment. 

Results:  Using 2013 data to establish a baseline, 66% of 2013 cases (N=9,315/14,114) were treated with dual treatment; number of treatment days and mode of administration was not verified.   Furthermore, using 2014 data, 72% of cases (N=10,776/14,967) received first line therapy, 5% received second line therapy, 14% received incomplete/incorrect treatment and 9% had no treatment recorded. Private providers (17%, N=2,614/14,967) were more likely than public providers (3%, 506/14,967) to report cases with incorrect/incomplete or no treatment recorded.  Seventy-nine percent of cases treated with first line therapy were treated between 0-7 days of the specimen date.

Conclusions:  State surveillance data was useful in understanding the gonorrhea treatment landscape in NC and identifying providers that need further outreach.  The NC HIV/STD Surveillance Unit and the Technical Assistance and Training Program are utilizing the analysis findings to tailor provider training and raise awareness statewide.