Inappropriate treatment of gonorrhea persists despite growing antibiotic resistance, investigators reported in the Morbidity and Mortality Weekly Report.
In 2016, about 19% of gonorrhea cases diagnosed in the United States were not treated according to recommendations from the Centers for Disease Control and Prevention, wrote Emily J. Weston, MPH, and her associates. They recommended additional training and education on the need for providers to follow treatment recommendations.
To assess adherence to this recommendation, Ms. Weston and her associates analyzed data for 3,213 gonorrhea cases with complete treatment data reported in the United States in 2016. The cases spanned seven CDC sentinel surveillance jurisdictions, including California (excluding San Francisco), Florida, Massachusetts, Minnesota, Philadelphia (Pa.), Baltimore (Md.), and Multnomah County (Oregon).
In all, 18.7% of patients did not receive CDC-recommended treatment, the investigators reported. Inappropriate treatment most often consisted of ceftriaxone (250 mg) alone (5.9%), ceftriaxone with doxycycline (4.4%), azithromycin only (3.1%), ceftriaxone with azithromycin of other or unknown dosages (2.1%), or doxycycline only (1.2%).
Rates of appropriate treatment varied from 79% to 83% among individual jurisdictions and were unrelated to patient race, ethnicity, sex, or age, the researchers found. Men who had sex with men were more likely to receive recommended treatment (85%) than were heterosexual men and women (79%). Patients also were more likely to receive appropriate treatment at family planning, reproductive health, or sexually transmitted disease clinics than in other health care settings.
The results highlight the need for state and local departments to identify and educate providers who are inadequately treating gonorrhea, the researchers concluded. “State and local health departments should continue to work with providers and patients to assure timely detection and treatment of gonorrhea according to current CDC treatment recommendations.”
The study received no external funding. The investigators reported having no conflicts of interest.
SOURCE: Weston EJ et al. MMWR. 2018 Apr 27. doi: 10.15585/mmwr.mm6716a4