title: Treatment of gonorrhoea in Auckland, New Zealand: marked variation in prescriber adherence to treatment guidelines.
abstract: BACKGROUND
  The relentless emergence and spread of strains of Neisseria gonorrhoeae that are resistant to many antimicrobial agents has led to frequent changes in treatment guidelines, with a consequent risk that prescribers may not be aware of current guidelines.
  
  
  OBJECTIVE
  To determine the proportion of patients with gonorrhoea who were treated with a regimen consistent with the New Zealand Sexual Health Society (NZSHS) guidelines.
  
  
  METHODS
  We audited the treatment given to adult patients with laboratory-proven gonorrhoea in Auckland, New Zealand, during the first 6 months of 2015.
  
  
  RESULTS
  Treatment compliant with the current NZSHS guidelines was administered in only 65% (458/706) episodes overall. Guideline-compliant treatment was much more likely to be prescribed for patients who presented to a sexual health clinic (89%) than for patients who presented to either a general practice or other community clinic (52%) or to a hospital (56%) (P < 0.0001). Overall, 52 of 706 (7%) episodes were not treated with any antimicrobial regimen by the service that diagnosed the patients' gonorrhoea, 13 of 62 (21%) episodes in patients who presented to a hospital, 34 of 403 (8%) episodes in patients who presented to a general practice or other community clinic and 5 of 241 (2%) episodes in patients who presented to a sexual health clinic (P < 0.0001).
  
  
  CONCLUSIONS
  Low levels of compliance with treatment guidelines increase the risk that antibiotic-resistant strains of N. gonorrhoeae will spread within the Auckland region. Improved compliance with treatment guidelines, particularly in patients who present either to general practice or to hospitals, is necessary to maintain the efficacy of current treatment regimens.
authors.affiliation: Auckland Sexual Health Service, Auckland District Health Board, Auckland, New Zealand.
authors.forename: Rose
authors.initials: R
authors.lastname: Forster
authors.affiliation: Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand.
authors.forename: Diana
authors.initials: D
authors.lastname: Ng
authors.affiliation: Department of Microbiology, Labtests, Auckland, New Zealand.
authors.forename: Arlo
authors.initials: A
authors.lastname: Upton
authors.affiliation: Auckland Sexual Health Service, Auckland District Health Board, Auckland, New Zealand.
authors.forename: Rick
authors.initials: R
authors.lastname: Franklin
authors.affiliation: Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand.
authors.forename: Mark
authors.identifier: http://orcid.org/0000-0001-9381-7623
authors.initials: M
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000592:standards*; D024881:Drug Resistance, Bacterial / Q000187:drug effects / Q000502:physiology; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D009344:Neisseria gonorrhoeae / Q000187:drug effects / Q000502:physiology; D009520:New Zealand / Q000453:epidemiology; D010819:Physician's Role; D017410:Practice Guidelines as Topic / Q000592:standards*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic resistance; gonorrhoea; guideline adherence; treatment