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A systematic review and appraisal of the quality of practice guidelines for the management of Neisseria gonorrhoeae infections
  1. Catherine Dickson1,
  2. Trevor Arnason1,
  3. Dara Spatz Friedman2,
  4. Gila Metz2,3,
  5. Jeremy M Grimshaw4,5
  1. 1 School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
  2. 2 Ottawa Public Health, Ottawa, Canada
  3. 3 Department of Family Medicine, University of Ottawa, Ottawa, Canada
  4. 4 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
  5. 5 Department of Medicine, University of Ottawa, Ottawa, Canada
  1. Correspondence to Dr Catherine Dickson, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Alta Vista Campus, Room 101, 600 Peter Morand Crescent, Ottawa, Ontario, Canada K1G 5Z3; Catherinedickson01{at}


Background Clinical guidelines help ensure consistent care informed by current evidence. As shifts in antimicrobial resistance continue to influence first-line treatment, up-to-date guidelines are important for preventing treatment failure. A guideline's development process will influence its recommendations and users' trust.

Objective To assess the quality of current gonorrhoea guidelines' development processes.

Data sources Multiple databases.

Study eligibility criteria Original and current English-language guidelines targeting health professionals and containing treatment recommendations for uncomplicated gonorrhoea in the general adult population.

Study appraisal and synthesis methods Two appraisers assessed the guidelines independently using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Scores were combined as per the AGREE II users' manual.

Results We identified 10 guidelines meeting the inclusion criteria. The quality of the gonorrhoea treatment guidelines varied. Most scored poorly on Rigour of Development; information on the evidence review process and methods for formulating recommendations was often missing. The WHO Guidelines for the Treatment of Neisseria gonorrhoeae and UK National Guideline for the Management of Gonorrhoea in Adults scored the highest on Rigour of Development. Methods to address conflicts of interest were often not described in the materials reviewed. Implementation of recommendations was often not addressed.

Limitations By limiting our study to English-language guidelines, a small number of guidelines we identified were excluded. Our analysis was limited to either published or online materials that were readily available to users. We could not differentiate between items addressed in the development process but not documented from items that were not addressed.

Conclusions and implications of key findings Gonorrhoea treatment guidelines may slow antimicrobial resistance. Many current guidelines are not in line with the current guideline development best practices; this might undermine the perceived trustworthiness of guidelines. By identifying current limitations, this study can help improve the quality of future guidelines.


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  • Handling editor Jackie A Cassell

  • Contributors CD developed the research protocol, developed the search strategy, conducted the original searches, acted as one of the AGREE II appraisers, conducted the data analysis and wrote the manuscript. TA acted as one of the AGREE II appraisers and reviewed and provided feedback on the manuscript. DSF and GM provided guidance on the planning of the systematic review, and reviewed and provided feedback on the manuscript. JMG provided guidance on the planning of the systematic review, recommended the use of the AGREE II tool and provided input on the write-up of the manuscript.

  • Funding JMG holds a Canada Research Chair for Health Knowledge Transfer and Uptake.

  • Ethical approval Ottawa Health Science Network Research Ethics Board (OHSN-REB) – IRB00002616. REB ethics approval number: OHSN-REB 20140074-01H.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.