Background Washington State (WA) and CDC treatment guidelines recommend ceftriaxone (CFX) as the primary therapy for gonorrhoea (GC), and some evidence suggests that azithromycin (AZM) plus an oral cephalosporin is superior to an oral cephalosporin alone in the treatment of GC.

Methods We used information from WA GC case report forms submitted July 2009–December 2010 to calculate the proportion of cases receiving different GC therapies. We used log regression to identify factors associated with recommended treatments.

Results Treatment data were available for 3910 (96%) of 4066 reported GC cases; 2087 (53.4%) were treated with CFX, 931 (23.8%) with cefixime, (533) 13.6% with cefpodoxime, and 359 (9.2%) with another drug. Of 1464 persons receiving an oral cephalosporin, 507 (34.6%) also received AZM. Abstract P3-S1.40 table 1 displays the distribution of single and multidrug therapies for the three most common therapies observed. In a multivariate model, treatment with CFX was associated with male gender (prevalence ratio (PR): 1.23, 95% CI 1.14 to 1.32), Asian/Pacific Islander race (PR: 1.10, 95% CI 1.00 to 1.20) and other/multiple races (PR: 1.13, 95% CI 1.04 to 1.22) (vs White race). Compared to persons treated by private sector medical providers, CFX use was more common among persons treated in STD clinics (PR: 1.65, 95% CI 1.53 to 1.77), ER/urgent care clinics (PR: 1.37, 95% CI 1.25 to 1.50), other hospital settings (PR: 1.27, 95% CI 1.12 to 1.44), or community health centers (PR: 1.14, 95% CI 1.00 to 1.29), and less common among those treated in family planning clinics (PR: 0.38, 95% CI 0.30 to 0.47) and by other provider types (PR: 0.86, 95% CI 0.76 to 0.98). Among persons treated with oral cephalosprins, concurrent treatment with AZM was associated with male gender (PR: 1.71 95% CI 1.45 to 2.01), treatment in an STD clinic (PR: 1.64, 95% CI 1.41 to 1.91) or ER/urgent care clinic (PR: 1.28, 95% CI 1.03 to 1.58) vs by a private provider, having GC only (PR:3.88, 95% CI 2.84 to 5.28) (vs chlamydial coinfection), and Seattle residence (1.32, 95% CI 1.08 to 1.61).

Conclusions Approximately half of all persons with gonorrhoea in WA do not receive CFX and over 20% receive an oral cephalosporin alone, which is not recommended in WA guidelines. Efforts to increase CFX should focus on identifying and surmounting barriers to the use of CFX, particularly in places such as family planning clinics and other settings where use is now low.