Poor adherence to gonorrhoea treatment guidelines in general practice in England

Gonorrhoea diagnoses are on the increase in England and a cluster of high-level azithromycin resistance was detected in 2015.^1,2 Treatment options are limited and, in response to emerging antimicrobial resistance, treatment guidelines have changed twice since 2004.^3,4 Current recommended treatment for gonorrhoea is dual therapy with 500 mg ceftriaxone (intramuscularly) and 1 g azithromycin (orally).³ Following a diagnosis of gonorrhoea in general practice, referral to specialist sexual health services for treatment, test of cure, partner notification, further STI testing and culture for antimicrobial susceptibility testing is recommended.⁵

Here, we report the results of an analysis of data from GPs in England from the Clinical Practice Research Datalink, an anonymised extract of visits to a sample of GPs whose patients are representative of the UK population.⁶ As the treatment guidelines were last updated in 2011,³ we focus on the gonorrhoea diagnoses reported from 2011–2014. During this time, an estimated 4150 gonorrhoea diagnoses were made by GPs in England, representing 4% of the total number of diagnoses made in all clinical settings reporting data (GPs and specialist sexual health clinics).

The proportion of cases treated each year by GPs fluctuated between 50–52% (P = 0729). Among those treated, the proportion given the recommended dual therapy ranged from 11–5% (2011–2014; P = 0.488). Most cases were prescribed antibiotics no longer recommended for the treatment of gonorrhoea. From 2011–2014, the proportion of gonorrhoea diagnoses for which penicillins were prescribed fluctuated between 15–20% (P = 0.729), whereas that of ciprofloxacin and azithromycin monotherapy ranged from 15–5% (P = 0.166) and 7–30% (P = 0.166), respectively.

These findings are consistent with trends reported prior to the most recent change in treatment guideline in 2011.⁷ Although GPs diagnose fewer cases of gonorrhoea than specialist clinics, they make an important contribution to the management of this infection and there is a need to raise awareness of current treatment guidelines among them; this has recently been highlighted in a letter from England’s Chief Medical Officer to GPs.⁸ Prompt and correct treatment of gonorrhoea is required to prevent treatment failure, onward transmission, and the further emergence of antimicrobial resistance.

• © British Journal of General Practice 2016