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Treatment of chlamydia and gonorrhoea, compliance with treatment guidelines and factors associatedwith non-compliant prescribing: findings form a cross-sectional study
  1. Anna Tisler-Sala1,
  2. Sven-Erik Ojavee2,
  3. Anneli Uusküla3
  1. 1 Department of Clinical Microbiology, Virology and Molecular Diagnostics, East-Viru Central Hospital, Kohtla-Jarve, Estonia
  2. 2 Department of Mathematics and Statistics, University of Tartu, Tartu, Estonia
  3. 3 Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
  1. Correspondence to Anna Tisler-Sala, Department of Clinical Microbiology, Virology and Molecular Diagnostics, East-Viru Central Hospital, Tervise 1, 31025, Kohtla-Jarve, Estonia; annatisler{at}


Objectives Proper antibiotic treatment of STI reduces transmission, antimicrobial resistance and serious disease complications. In this study, we assessed compliance with STI treatment guidelines for genital gonorrhoea and chlamydia infections in Estonia.

Methods Prescription data from the Estonian Health Insurance Fund on 7556 treatment episodes of 6499 patients treated for gonorrhoea or chlamydia during 2012–2014 were analysed to assess compliance with the guidelines and factors associated with it.

Results Between 1 January 2012 and 31 December 2014, a total of 6074 patients were treated for chlamydia and 425 for gonorrhoea in Estonia. Among all prescriptions, 48.6% were non-compliant with gonorrhoea treatment guidelines and 3.8% for chlamydia. Non-compliant antibiotic treatment for gonorrhoea was associated with patient gender (female (adjusted OR (AOR)) 3.0, 95% CI 1.6 to 5.9), region (east AOR 3.3, 95% CI 1.3 to 8.2; west AOR 6.5, 95% CI 2.2 to 19.7) and prescribing physician specialty (general healthcare doctors: AOR 5.6, 95% CI 2.3 to 13.8; gynaecologists: AOR 5.9, 95% CI 2.8 to 12.4). Non-compliant antibiotic treatment for chlamydia was associated with younger patient age (15–24 AOR 0.5, 95% CI 0.4 to 0.7), region (north AOR 1.9, 95% CI 1.4 to 2.6; west AOR 2.3, 95% CI 1.5 to 3.4) and multiple treatment episodes (AOR 2.7, 95% CI 2.1 to 3.9). Approximately 14% of prescriptions were multiple treatments for the same patient for the same infection over the 3-year period (6.1% for gonorrhoea and 14.5% for chlamydia).

Conclusion There are significant differences in terms of compliance with treatment guidelines for gonorrhoea and chlamydia, and several factors associated with non-compliance that can potentially be targeted with interventions. Future research should explore reasons clinicians do not follow guidelines and examine ways to improve practice among doctors and patients and assess factors associated with multiple treatments, particularly multiple treatments for the same STI.

  • chlamydia trachomatis
  • antIbIotics
  • neisseria gonorrhoea
  • compliance
  • treatment

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  • Handling editor Jane S Hocking

  • Contributors This paper was conceived by AT-S and AU. AT-S wrote the draft of the article with further contributions from AU and help from S-EO in carrying out statistical analysis. All authors interpreted data, reviewed successive drafts and approved the final version of the article.

  • Competing interests None declared.

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