Background New British Association for Sexual Health and HIV guidelines for the management of gonorrhoea in adults were introduced in June 2011. First line therapy was changed to ceftriaxone 500 mg intramuscularly plus azithromycin 1 g orally, with a test of cure (TOC) recommended for all patients at 2 weeks. Our clinic policy changed to reflect these guidelines. TOC, previously performed in selected cases, was recommended in all cases.
Aims To identify the proportion of cases correctly treated following the change in guidelines and analyse TOC outcomes.
Methods A retrospective case notes review was carried out from 17 June to 22 November 2011. Diagnosis of gonorrhoea was from microscopy, nucleic acid amplification tests (NAAT) and culture. The NAAT test used was Gen-Probe APTIMA Combo 2, confirmed by the Aptima GC mono-assay.
Results 152 cases were identified; 63% of cases were in men, 75% were heterosexual. The median age was 25 years (IQR 20–33.5). 24% had previously had gonorrhoea, 29% had concurrent sexually transmitted infections and 5% had HIV co-infection. 88% of patients received correct treatment as per British Association for Sexual Health and HIV guidelines. 76% were offered TOC; of these, 43% attended for TOC. TOC was negative in all patients tested (NAAT and/or culture). 4% of patients attending TOC were retreated because of re-infection risk. 22% (82/369) of partners were tested and treated for gonorrhoea; however, written or official verification of this was limited.
Discussion Our data show that a high proportion, though not all, of patients are offered correct treatment at our centre, but only 43% return for TOC. Of those who return, persistent infection, to date, has not been detected at our centre. This may indicate that guidelines can be refined to direct TOC towards populations at greater risk of persistent or resistant gonorrhoea infection. More data regarding the best time to offer TOC is also required, as earlier TOC may improve uptake.
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