Population-Level Provider Compliance With Provincial Treatment Guidelines for the Management of Gonorrhea in Adolescents and Adults in Alberta, Canada; 2000 to 2019

BackgroundAppropriate antimicrobial therapy is one of the essential strategies in the global control of gonorrhea. We sought to determine the provider compliance with provincial treatment guidelines for gonococcal infections in Alberta, Canada, and to identify characteristics associated with provider noncompliance.MethodsA retrospective population-based analysis of gonorrhea treatment from January 1, 2000, to December 31, 2019, using data extracted from a communicable disease database was performed. Prevalence ratios were calculated for provider compliance to treatment guidelines of patient, infection, and treating provider characteristics.ResultsWe identified a total of 42,875 cases of gonorrhea, 58.3% were men, 40.3% were White, 28.2% were First Nations, and 16% were "unknown ethnicity." Most cases were treated by family physicians (43.4%), sexually transmitted infection (STI) clinics (31.9%) and urgent care centers/hospitals (10%). Overall, there was 80.3% provider compliance with treatment guidelines. Provider compliance to treatment guidelines had the highest rates of compliance when treatment was provided by STI nurses in correctional facilities, STI clinics, and treatment of men having sex with men (94.7%, 91.7%, and 87.5%, respectively). Provider compliance to treatment guidelines was lowest when treating women (75.5%), pregnancy status (68.4), individuals of "unknown race/ethnicity" (74.8%), and those treated in urgent care centers and emergency department (66.7%).ConclusionsDelivery of STI care by nurse-led models had the highest level of compliance with treatment guidelines. Our study informs areas for targeted interventions to improve the uptake of treatment guidelines, including the provision of treatment in urgent care centers and among women. A population-based study found that treatment of gonorrhea among women compared with men, and in urgent care centers compared with outpatient settings, was less likely to follow the treatment guideline recommendations.