title: A systematic review and appraisal of the quality of practice guidelines for the management ofNeisseria gonorrhoeaeinfections.
abstract: Clinical guidelines help ensure consistent care informed by current evidence. As shifts in antimicrobial resistance continue to influence first-line treatment, up-to-date guidelines are important for preventing treatment failure. A guideline's development process will influence its recommendations and users' trust.
  
  
  
  To assess the quality of current gonorrhoea guidelines' development processes.
  
  
  
  Multiple databases.
  
  
  
  Original and current English-language guidelines targeting health professionals and containing treatment recommendations for uncomplicated gonorrhoea in the general adult population.
  
  
  
  Two appraisers assessed the guidelines independently using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Scores were combined as per the AGREE II users' manual.
  
  
  
  We identified 10 guidelines meeting the inclusion criteria. The quality of the gonorrhoea treatment guidelines varied. Most scored poorly onRigour of Development; information on the evidence review process and methods for formulating recommendations was often missing. TheWHO Guidelines for the Treatment of Neisseria gonorrhoeaeandUK National Guideline for the Management of Gonorrhoea in Adultsscored the highest onRigour of Development. Methods to address conflicts of interest were often not described in the materials reviewed. Implementation of recommendations was often not addressed.
  
  
  
  By limiting our study to English-language guidelines, a small number of guidelines we identified were excluded. Our analysis was limited to either published or online materials that were readily available to users. We could not differentiate between items addressed in the development process but not documented from items that were not addressed.
  
  
  
  Gonorrhoea treatment guidelines may slow antimicrobial resistance. Many current guidelines are not in line with the current guideline development best practices; this might undermine the perceived trustworthiness of guidelines. By identifying current limitations, this study can help improve the quality of future guidelines.
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Dickson
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Trevor
authors.initials: T
authors.lastname: Arnason
authors.affiliation: Ottawa Public Health, Ottawa, Canada.
authors.forename: Dara Spatz
authors.initials: DS
authors.lastname: Friedman
authors.affiliation: Ottawa Public Health, Ottawa, Canada.|Department of Family Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Gila
authors.initials: G
authors.lastname: Metz
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.|Department of Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Grimshaw
mesh_terms: D016208:Databases, Factual; D006069:Gonorrhea / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D009344:Neisseria gonorrhoeae; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care
keywords: ANTIBIOTIC RESISTANCE; ANTIBIOTICS; GONORRHOEA; GUIDELINE DEVELOPMENT; SYSTEMATIC REVIEWS