Provider attitudes to the empiric treatment of asymptomatic contacts of gonorrhoea
Sheina Low A , Rick Varma B C , Ruthy McIver B D , Tobias Vickers B C and Anna McNulty A CA School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052, Australia.
B Sydney Sexual Health Centre, Nightingale Wing, Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW 2000, Australia.
C The Kirby Institute, The University of New South Wales, Sydney, NSW 2052, Australia.
D Corresponding author. Email: ruthy.mciver@health.nsw.gov.au
Sexual Health 17(2) 155-159 https://doi.org/10.1071/SH19165
Submitted: 20 September 2019 Accepted: 13 November 2019 Published: 13 March 2020
Abstract
Background: In the current era of antimicrobial stewardship, the availability of highly sensitive assays and faster turnaround times, the practice of empiric treatment of asymptomatic contacts of gonorrhoea needs review. The views of clinicians in a range of settings across Australia and clinic costs associated with a change of practice was examined. Methods: An online anonymous survey for nurses and doctors working in public sexual health clinics and general practices in urban, regional and rural Australia was developed. Information on the relative importance of a range of factors influencing delivery of empiric treatment was collected. Participants were asked whether current guidelines should change. Results: Surveys were distributed to 468 healthcare providers and 188 (40.2%) fully completed the survey. Most of the participants worked in public practice (84.9%) and 86 (43.2%) were doctors. Factors influencing provision of empiric treatment were: if the patient was unable to return (95.9%) or may not return (95.3%); risk of transmission to others (93.3%); likelihood of infection (88.6%); and patient request (82.9%). Respondents were evenly split as to whether current guidelines should change, with providers in private practice being less likely to support guideline change (P = 0.03). The model of empiric treatment of all asymptomatic sexual contacts was 34% more expensive than a model of testing and treatment of those with a positive result. Conclusion: Currently, the majority of clinicians provide empiric treatment for asymptomatic contacts in Australia. There was significant support for a change in guidelines with specific scenarios requiring individualised responses.
Additional keywords: antimicrobial stewardship, models of care, treatment guidelines.
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