Treatment of Gonorrhea in Auckland, New Zealand: Marked Variation in Guideline Compliance

Background:

The high prevalence of multidrug resistance in Neisseria gonorrhoeae has raised concern about the potential for the emergence of untreatable strains. In response to this threat, since 2012, the treatment recommended by the New Zealand Sexual Health Service, for most patients with gonorrhea in New Zealand, has been ceftriaxone 500mg IM plus azithromycin 1 g orally. Recent studies elsewhere have shown only modest levels of compliance with similar treatment guidelines.

Methods:

With New Zealand Ministry of Health ethics committee approval, we obtained from the four Auckland microbiology laboratories, information on all patients aged ≥15 years, diagnosed with gonorrhea, in the Auckland region, between 1^st January and 30^thJune 2015. We obtained treatment information for these episodes of gonorrhea by contacting the relevant family doctor or other community care-provider, and by searching the medical records of the four sexual health clinics and the four public hospitals in Auckland.

Results:

There were 1181 positive tests for N. gonorrhoeae from Auckland residents, aged ≥15 years, during the study period. These positive test results represented 746 episodes of gonorrhea in 731 people. The overall annual incidence in the Auckland population aged ≥15 years was 130/10⁵.

Treatment information was available for 710/746 (95%) episodes of gonorrhea. Overall, 428/710 (60%) episodes of gonorrhea were treated with a recommended regimen: 199/407 (49%) episodes treated in general practice, 205/241 (85%) episodes treated in Sexual Health clinics, and 24/62 (39%) episodes treated by hospital departments. Overall 54/710 (8%) episodes of gonorrhea were not treated with any antimicrobial.

Conclusion:

These results are consistent with other studies that have found wide variation in the level of compliance with current, local, treatment guidelines. Improved compliance with treatment guidelines is required to reduce the transmission of infection, and the potentially serious consequences of infection, and also to prevent the emergence and spread of extremely resistant strains.