title: Identifying variations in adherence to the CDC sexually transmitted disease treatment guidelines of Neisseria gonorrhoeae.
abstract: OBJECTIVE
  Neisseria gonorrhoeae is identified as a national challenge due to emerging antimicrobial resistance. The Centers for Disease Control and Prevention (CDC) sexually transmitted diseases (STD) Treatment guidelines are updated to address emerging concerns. The aims of this study were 1) to determine the proportion of cases that were adherent to two aspects of the treatment guidelines: antimicrobial treatment and follow-up recommendations and 2) to evaluate differences in adherence based on clinical location.
  
  
  METHODS
  A retrospective review of medical records was performed for the first positive N. gonorrhoeae tests identified in subjects between May 2011 and December 2013 at a large urban academic medical centre. We hypothesised that provider adherence to STD treatment and prevention guidelines was better at STD specialised clinics than non-specialised settings.
  
  
  METHODS
  Adherence to CDC STD treatment guidelines was determined for both treatment and prevention management. Demographic, testing differences, and appropriate treatment and follow-up between speciality and non-speciality clinics were evaluated using chi-squared, Fisher's exact, and Student's t-test, when appropriate.
  
  
  RESULTS
  During the study period, 542/714 positive tests were analysed. Healthcare provider adherence to antimicrobial management guidelines was 82% during the study period. Adherence to the guidelines was 76% and 88% for the 2010 and 2012 time periods, respectively. Non-adherence to recommendations included lack of dual therapy for N. gonorrhoeae in speciality clinics and incorrect dose in non-speciality clinics. Appropriate preventive follow-up was identified in only 31% of cases. Both speciality clinics and non-speciality clinics had errors related to partner therapy.
  
  
  CONCLUSIONS
  Providers in speciality clinics were more adherent to the guidelines compared with providers at other clinical sites. Significant lack of adherence was identified in the follow-up management of N. gonorrhoeae. Evaluation of treatment errors may help improve medical management of N. gonorrhoeae.
authors.affiliation: Columbia University College of Physicians & Surgeons, New York, NY, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Boyajian
authors.affiliation: Columbia University, Nursing School, New York, NY, USA.
authors.forename: M
authors.initials: M
authors.lastname: Murray
authors.affiliation: Columbia University College of Physicians & Surgeons, New York, NY, USA.
authors.forename: M
authors.initials: M
authors.lastname: Tucker
authors.affiliation: Columbia University Medical Center, Department of Pediatric Infectious Disease, New York, NY, USA. Electronic address: nn45@cumc.columbia.edu.
authors.forename: N
authors.initials: N
authors.lastname: Neu
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002487:Centers for Disease Control and Prevention, U.S.; D005260:Female; D006069:Gonorrhea / Q000628:therapy*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D009519:New York City; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014481:United States; D019037:Urban Health Services; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents
keywords: Adherence; Neisseria gonorrhoeae; STD; Treatment