The gonorrhoea care cascade in general practice: a descriptive study to explore gonorrhoea management utilising electronic medical records
J. Jung
A B C * , J. L. Goller D , P. Chondros A , J. Ong C E F , R. Biezen A , D. Pires B G , D. Capurro B G , N. Faux H and J. A. Manski-Nankervis A I
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Abstract
Gonorrhoea notification rates in Australia have more than doubled between 2014 and 2019. We explored gonorrhoea testing patterns and management of gonorrhoea infection in general practice.
We analysed de-identified electronic medical record data for individuals who attended 73 Australian general practices (72 in the state of Victoria) between January 2018 and December 2020. The ‘care cascade’ model was utilised to explore gonorrhoea detection and management. Descriptive analysis and logistic regression were used to investigate factors associated with gonorrhoea testing, treatment and retesting.
During the study period, there were a total of 1,027,337 clinical episodes. Of these, 5.6% (n = 57,847, 95% confidence interval [CI] 4.5–6.7) involved a gonorrhoea test and 1.1% (n = 637, 95% CI 0.8–1.4) tested positive. Of the 637 gonorrhoea cases, 48.4% (n = 308, 95% CI 29.8–67.0) had an Australian guideline-recommended dual antibiotic prescription (ceftriaxone and azithromycin) recorded. Of 329 cases without a dual antibiotic prescription, 84.2% (n = 277, 95% CI 77.5–90.9) had reattended the clinic. Among the 206 gonorrhoea cases with dual antibiotic prescription recorded in 2018 and 2019, 32.0% (n = 66, 95% CI 25.3–38.8) were retested from 6 weeks to 6 months post-treatment. Of the 140 gonorrhoea cases that were not retested, 54.3% (n = 76, 95% CI 46.8–61.8) reattended the clinic within 6 months of treatment.
The low proportion of gonorrhoea cases prescribed recommended antibiotics and retested within recommended timeframes suggests opportunities for integrating Australian STI guidelines into primary care. Further exploration of care pathways is warranted to determine if care was provided but not recorded, provided elsewhere or not provided.
Keywords: care cascade, epidemiology, general practice, gonorrhoea, primary care, routinely collected clinical data, sexually transmitted infection, STI.
References
2 Goller JL, De Livera AM, Guy RJ, et al. Rates of pelvic inflammatory disease and ectopic pregnancy in Australia, 2009-2014: ecological analysis of hospital data. Sex Transm Infect 2018; 94(7): 534-41.
| Crossref | Google Scholar |
3 Reekie J, Donovan B, Guy R, et al. Risk of pelvic inflammatory disease in relation to chlamydia and gonorrhea testing, repeat testing, and positivity: a population-based cohort study. Clin Infect Dis 2018; 66(3): 437-43.
| Crossref | Google Scholar |
4 Gray RT, Callander D, Hocking JS, et al. Population-level diagnosis and care cascade for chlamydia in Australia. Sex Transm Infect 2020; 96(2): 131-6.
| Crossref | Google Scholar |
5 Jung J, Biezen R, Goller JL, et al. The chlamydia care cascade of young people attending Australian general practices; a descriptive study to assess gaps in care. Sex Health 2023; 20: 542-9.
| Crossref | Google Scholar |
6 Australian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). Australian STI management guidelines for use in primary care. 2024. Available at https://sti.guidelines.org.au/sexually-transmissible-infections/gonorrhoea/ [accessed December 2023]
8 Australian Bureau of Statistics. Patient experience in Australia: summary of findings. Canberra: ABS; 2020. Available at https://www.abs.gov.au/statistics/health/health-services/patient-experiences/2019-20 [accessed December 2023]
9 Gordon J, Britt H, Miller GC, Henderson J, Scott A, Harrison C. General practice statistics in Australia: pushing a round peg into a square hole. Int J Environ Res Public Health 2022; 19(4): 1912.
| Crossref | Google Scholar |
10 Grulich AE, de Visser RO, Smith AMA, Risse CE, Richters J. Sex in Australia: sexually transmissible infection and blood-borne virus history in a representative sample of adults. Aust N Z J Public Health 2003; 27(2): 234-41.
| Crossref | Google Scholar |
11 The University of Melbourne. Data for decisions and the patron program of research. 2023. Available at https://medicine.unimelb.edu.au/school-structure/general-practice/engagement/data-for-decisions [accessed December 2023]
12 Traeger MW, Cornelisse VJ, Asselin J, et al. Association of HIV preexposure prophylaxis with incidence of sexually transmitted infections among individuals at high risk of HIV infection. JAMA 2019; 321(14): 1380-90.
| Crossref | Google Scholar |
13 Traeger MW, Schroeder SE, Wright EJ, et al. Effects of pre-exposure prophylaxis for the prevention of human immunodeficiency virus infection on sexual risk behavior in men who have sex with men: a systematic review and meta-analysis. Clin Infect Dis 2018; 67(5): 676-86.
| Crossref | Google Scholar |
14 Australian Government, Department of Health and Aged Care. Modified monash model. 2024. Available at https://www.health.gov.au/health-topics/rural-health-workforce/classifications/mmm [accessed December 2022]
15 R Core Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2022. Available at https://www.R-project.org/
16 Adams G, Gulliford MC, Ukoumunne OC, et al. Patterns of intra-cluster correlation from primary care research to inform study design and analysis. J Clin Epidemiol 2004; 57(8): 785-94.
| Crossref | Google Scholar |
17 Smith AKJ, Haire B, Newman CE, et al. Challenges of providing HIV pre-exposure prophylaxis across Australian clinics: qualitative insights of clinicians. Sex Health 2021; 18(2): 187-94.
| Crossref | Google Scholar |
18 World Health Organisation (WHO). Guidelines for the treatment of Neisseria gonorrhoeae. Geneva, Switzerland; 2016. pp. 10–11. Available at https://www.who.int/publications/i/item/9789241549691 [accessed December 2023]
19 Tu K, Sarkadi Kristiansson R, Gronsbell J, et al. Changes in primary care visits arising from the COVID-19 pandemic: an international comparative study by the International Consortium of Primary Care Big Data Researchers (INTRePID). BMJ Open 2022; 12: e059130.
| Crossref | Google Scholar |
20 Chow EPF, Hocking JS, Ong JJ, et al. Sexually transmitted infection diagnoses and access to a sexual health service before and after the national lockdown for COVID-19 in Melbourne, Australia. Open Forum Infect Dis 2021; 8(1): ofaa536.
| Crossref | Google Scholar |
21 Saul A, Scott N, Crabb BS, et al. Impact of Vicotria’s stage 3 lockdown on COVID-19 case numbers. MJA 2020; 213(11): 494-6.
| Crossref | Google Scholar | PubMed |
22 Fifer H, Saunders J, Soni S, et al. 2018 UK national guideline for the management of infection with Neisseria gonorrhoeae. Int J STD AIDS 2020; 31(1): 4-15.
| Crossref | Google Scholar |
23 McCool-Myers M, Turner D, Henn MC, et al. Finding the gaps in retesting for Chlamydia and Gonorrhea: differences across high-volume testing departments in an urban health care setting. Sex Transm Dis 2021; 48(11): 819-22.
| Crossref | Google Scholar |
24 Australian Government. Australian Digital Health Agency. My Health Record. 2024. Available at https://www.digitalhealth.gov.au/initiatives-and-programs/my-health-record [accessed December 2023]
25 Australian Government. Australian Digital Health Agency. Statistics and insights. 2023. Available at https://www.digitalhealth.gov.au/initiatives-and-programs/my-health-record/statistics [accessed December 2023]
26 Rose SB, Garrett SM, Stanley J, Pullon SRH. Retesting and repeat positivity following diagnosis of Chlamydia trachomatis and Neisseria gonorrhoea in New Zealand: a retrospective cohort study. BMC Infect Dis 2017; 17(1): 526.
| Crossref | Google Scholar |
27 Wijers JNAP, van Liere GAFS, Hoebe CJPA, et al. Test of cure, retesting and extragenital testing practices for Chlamydia trachomatis and Neisseria gonorrhoeae among general practitioners in different socioeconomic status areas: a retrospective cohort study, 2011–2016. PLoS ONE 2018; 13(3): e0194351.
| Crossref | Google Scholar |
