Gonorrhea Control, United States, 1972-2015, A Narrative Review.

Gonorrhea is the second most commonly reported infection. It can lead to pelvic inflammatory disease, ectopic pregnancy, and infertility. Rates of gonorrhea decreased after the National Gonorrhea Control Program began in 1972, but stabilized in the mid 1990s. The emergence of antimicrobial resistant strains increases the urgency for enhanced gonorrhea control efforts. To identify possible approaches for improving gonorrhea control, we reviewed historic protocols, reports, and other documents related to the activities of the National Gonorrhea Control Program using Centers for Disease Control and Prevention records and the published literature. The Program was a massive effort that annually tested up to 9.3 million women, and treated up to 85,000 infected partners and 100,000 additional exposed partners. Reported gonorrhea rates fell by 74% between 1976 and 1996, then stabilized. Testing positivity was 1.6-4.2% in different settings in 1976. In 1999-2008, the test positivity of a random sample of 14- to 25-year-olds was 0.4%. Gonorrhea testing rates remain high, however, partner notification efforts decreased in the 1990s as attention shifted to human immunodeficiency virus and other sexually transmitted diseases. The decrease and subsequent stabilization of gonorrhea rates was likely also influenced by changes in behavior, such as increases in condom use in response to acquired immune deficiency syndrome. Renewed emphasis on partner treatment might lead to further decreases in rates of gonorrhea.

Variation in adherence to the treatment guidelines for Neisseria gonorrhoeae by clinical practice setting, California, 2009 to 2011.

BACKGROUND: Declining susceptibility of Neisseria gonorrhoeae to available antimicrobial agents has prompted repeated updates of the Centers for Disease Control and Prevention (CDC) treatment guidelines. The only regimen currently recommended as first-line treatment is dual therapy consisting of an intramuscular dose of ceftriaxone together with azithromycin or doxycycline. The objective of this analysis is to identify how adherence to the CDC guidelines varies by clinical practice setting. METHODS: A geographically representative random sample of N. gonorrhoeae cases reported from 2009 to 2011 was analyzed. Weighted generalized linear models were fit to calculate cumulative incidence ratios for receipt of non-recommended treatment regimen in relation to clinical practice setting, adjusted for age, race, and whether or not the participant was a man who has sex with men. RESULTS: Data from 3178 participants were available for analysis. Overall, 14.9% (weighted) of participants received non-recommended treatment. Among participants with gonorrhea identified by surveillance data as having received non-recommended treatment, the largest proportions were treated at private physicians' offices or health maintenance organizations (34.7% of participants receiving non-recommended treatment), family planning facilities (22.3%), and emergency departments/urgent care centers (12.8%). CONCLUSIONS: Barriers to adherence to the CDC treatment guidelines for gonorrhea seem to be experienced in a variety of clinical practice settings. Despite only moderate rates of nonadherence, interventions targeting private physicians/health maintenance organizations and family planning facilities may produce the largest absolute reductions in guideline-discordant treatment.

Exploring sexual health among female sexually transmitted disease clinic patients, San Francisco 2010.

BACKGROUND: Current data on sexual health in the United States is limited, in part, because of a lack of measurement tools. It is difficult for programs to develop a holistic approach to improving sexual health that is data-driven and evaluable without a tool that encompasses sexual health beyond the absence of disease. The objective of this study was to understand possible factors associated with sexual health and reported differences in sexual health among women. METHODS: We conducted a survey measuring sexual health among women seeking care at the municipal sexually transmitted disease (STD) clinic in San Francisco between January 25, 2010, and June 15, 2010. Records were matched on variables including basic demographics, reason for visit, symptoms at visit, history of an STD, and STD diagnosis at the visit. RESULTS: A total of 822 women completed the questionnaire during the study period. Women reporting no recent sexual activity reported feeling more insecure, angry, isolated, and limited because of health compared with women with recent sexual activity. However, few differences were seen among women based on symptoms and diagnosis at visit. DISCUSSION: Given the minimal differences based on symptoms and disease, this suggests that there are other factors that impact the quality of life and sexual health. Creating tools that can be used to measure sexual health is a necessary first step for programs to understand the sexual health of a community. More broad-based assessments of sexual health in a variety of populations will be critical to identifying points of intervention and progress toward success.