Variation in adherence to the treatment guidelines for Neisseria gonorrhoeae by clinical practice setting, California, 2009 to 2011.
BACKGROUND
Declining susceptibility of Neisseria gonorrhoeae to available antimicrobial agents has prompted repeated updates of the Centers for Disease Control and Prevention (CDC) treatment guidelines. The only regimen currently recommended as first-line treatment is dual therapy consisting of an intramuscular dose of ceftriaxone together with azithromycin or doxycycline. The objective of this analysis is to identify how adherence to the CDC guidelines varies by clinical practice setting.


METHODS
A geographically representative random sample of N. gonorrhoeae cases reported from 2009 to 2011 was analyzed. Weighted generalized linear models were fit to calculate cumulative incidence ratios for receipt of non-recommended treatment regimen in relation to clinical practice setting, adjusted for age, race, and whether or not the participant was a man who has sex with men.


RESULTS
Data from 3178 participants were available for analysis. Overall, 14.9% (weighted) of participants received non-recommended treatment. Among participants with gonorrhea identified by surveillance data as having received non-recommended treatment, the largest proportions were treated at private physicians' offices or health maintenance organizations (34.7% of participants receiving non-recommended treatment), family planning facilities (22.3%), and emergency departments/urgent care centers (12.8%).


CONCLUSIONS
Barriers to adherence to the CDC treatment guidelines for gonorrhea seem to be experienced in a variety of clinical practice settings. Despite only moderate rates of nonadherence, interventions targeting private physicians/health maintenance organizations and family planning facilities may produce the largest absolute reductions in guideline-discordant treatment.
From the *School of Public Health, University of California, Berkeley, CA; †Sexually Transmitted Disease Control Branch, California Department of Public Health, Richmond, CA; and ‡Sexually Transmitted Disease, Prevention and Control Services, San Francisco Department of Public Health, San Francisco, CA.
Richard J
RJ
Lechtenberg
Michael C
MC
Samuel
Kyle T
KT
Bernstein
Maureen
M
Lahiff
Nicole
N
Olson
Heidi M
HM
Bauer
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017963:Azithromycin / Q000008:administration & dosage; D002140:California / Q000453:epidemiology; D002443:Ceftriaxone / Q000008:administration & dosage; D004318:Doxycycline / Q000008:administration & dosage; D005260:Female; D006069:Gonorrhea / Q000188:drug therapy* / Q000517:prevention & control; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000187:drug effects*; D017410:Practice Guidelines as Topic; D014481:United States
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D017963:Azithromycin; D004318:Doxycycline