This study has identified a low standard treatment rate among gonorrhea patients in Guangdong province. Additionally, an analysis of medication choices and prescription practices was conducted. Furthermore, factors associated with the standard treatment rate were identified. These findings provide compelling evidence to support the promotion of standard treatment among gonorrhea patients.
In comparison to the national survey conducted in China (37.8%)[11] and two studies conducted in Shenzhen (66.4% and 76.3%, respectively)[13 14], the standard treatment rate observed in our research was lower. The national survey calculates and determines the standard treatment rate based on physician questionnaires, whereas our research assesses it by collecting patient prescriptions. This disparity in methodology may account for the observed difference in rates. Shenzhen, as the leading economy in South China, possesses superior medical institutions and higher medical standards compared to the regional average in Guangdong[15]. This distinction could be a contributing factor to the higher prevalence of standard treatment in Shenzhen. Furthermore, when compared to compliance with treatment guidelines in China, developed countries such as the US and Europe demonstrate a greater adherence to recommended regimens [16 17].
Some studies have argued that performing Antimicrobial Susceptibility Testing (AST) of NG to guide individualized prescriptions may be a more effective therapeutic strategy than relying solely on guidelines[18]. However, the gold standard methods for AST of NG are laborious and time-consuming [19], highlighting the need to promote the adoption of novel AST methods for routine clinical use [20 21]. Although we found that two-thirds of the surveyed hospitals are capable of providing drug susceptibility tests for patients, it is important to note that the specific application data for NG-positive patients was not collected in this survey. Given that the gonorrhea treatment guidelines are periodically revised to incorporate the latest evidence on emerging trends in antimicrobial susceptibility, it is crucial to raise awareness about the increasing Antibiotic Resistance of NG and promote the adoption of the national gonorrhea treatment guidelines to control the gonorrhea epidemic.
We observed that more than 60% of patients in the compliance group opted for Ceftriaxone as the first-line drug, which is aligns with the primary preferences observed in other studies [16 22]. Incorrect drug selection and dosage were responsible for approximately three-quarters of the sampled cases that did not receive standard treatment. Physicians may have overlooked the possibility of treatment failure when prescribing second-generation cephalosporins, azithromycin, and other antimicrobials[11]. Additionally, many physicians tend to prescribe antimicrobial doses and treatment durations based on their own experience rather than following the national guideline, often choosing higher doses or longer courses to ensure effectiveness[23]. However, insufficient clinical data was available to support the effectiveness of overdose and longer course treatment, and it would contribute the AMR of NG and lead to adverse reaction for patients.
Based on the findings of this study, several actions should be considered. Firstly, although the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRSP) has been established for over four decades, there is currently no monitoring mechanism for gonorrhea treatment in China. Implementing a monitoring mechanism for gonorrhea treatment can help identify opportunities for intervention and improve provider adherence[16]. Furthermore, since even the latest guideline may not fully reflect the real drug resistance trends in individual gonorrhea patients, drug susceptibility testing is recommended for each patient whenever the service is available. We found that physicians who received training were more likely to adhere to guidelines, highlighting the importance of regular training on STD gonorrhea treatment for physicians, especially those with less experience in diagnosing gonorrhea. Lastly, many individuals infected with gonorrhea remain undiagnosed due to asymptomatic infections and misdiagnosis in hospitals[24]. To address this issue, increased testing should be provided to populations at high risk of NG infection, particularly among young individuals.
This study has certain limitations. The exclusion of gonorrhea patients who did not visit the hospital or were misdiagnosed may introduce sample bias. Additionally, various factors can influence whether patients receive standard treatment, some critical factors may have been overlooked. Besides that, patients detected by routine screening in the absence of symptoms were more or less likely to be under dosed than patients presenting with symptoms, while the data was unavailable in this survey. Lastly, the omission or misinterpretation of patient variables could lead to misleading conclusions in the study.