Management of gonorrhoea in a hospital network: are we following best practice?

Abstract

Background Gonorrhoea is usually managed in community sexual health or general practice, but a proportion of cases present to hospital settings. In this study, we examined how gonorrhoea was managed through a large hospital network and what the implications may be for public health management. Methods: A retrospective chart review was performed of the management of patients with Neisseria gonorrhoeae infection diagnosed at a large Australian healthcare network from January 2015 to May 2018. Documentation rates of five parameters of care were assessed: (1) the presence (or absence) of previous sexually transmissible infections (STIs); (2) recent travel; (3) discussion of HIV testing; (4) contact tracing; and (5) public health notification. Results: In all, 110 cases (48 male, 62 female) were analysed. Most cases were in the 15–39 years age group; 98 cases (89%) were symptomatic, and 12 (11%) were screening tests. The most common presenting syndromes were pelvic inflammatory disease (32%; 31/98 symptomatic cases), urethritis (26%; 25/98) and epididymo-orchitis (13%; 13/98). None of the five parameters assessed were documented in most cases. Documentation was most likely to occur in patients admitted to hospital. When HIV testing was performed, no new cases of HIV were identified. Conclusion: Infections with gonorrhoea present on a regular basis to hospital practice, but overall management is suboptimal. Automated prompts for other recommended tests, including HIV testing when testing for other sexually transmissible diseases is ordered, may improve management. Better awareness of best practice is needed, which can be facilitated with ongoing education. However, the greatest benefit is likely achieved by linking patients back to community-based services, which are best placed to provide ongoing long-term care.

Population-Level Provider Compliance With Provincial Treatment Guidelines for the Management of Gonorrhea in Adolescents and Adults in Alberta, Canada; 2000 to 2019

“…Other studies have shown that management and documentation of sexual histories are suboptimal for cases that present to ED. 21,22 Merchant et al, 23 in a retrospective study of male adult patients attending the ED with a clinical diagnosis of gonorrhea urethritis, found that 87% received a CDC-recommended empiric treatment for gonorrhea, likely representing the study with the highest compliance to treatment guidelines. Settings with computerized decision support systems may facilitate the management of conditions based on guideline recommendations.…”

“…In a small retrospective study in a single ED in the United States, Kane et al 14 found even lower rates of adherence to treatment guidelines for the management of gonococcal infections of 40%. Other studies have shown that management and documentation of sexual histories are suboptimal for cases that present to ED 21,22 . Merchant et al, 23 in a retrospective study of male adult patients attending the ED with a clinical diagnosis of gonorrhea urethritis, found that 87% received a CDC-recommended empiric treatment for gonorrhea, likely representing the study with the highest compliance to treatment guidelines.…”

Gonorrhoea: tackling the global epidemic in the era of rising antimicrobial resistance

“…Loo et al uncover suboptimal management of gonorrhoea in a hospital network in Australia, reminding us of the need for a concerted, broad public health response involving multiple stakeholders including hospital systems, if we are to control this epidemic. 12 They examined five parameters of care:…”