The gonorrhoea care cascade in general practice: a descriptive study to explore gonorrhoea management utilising electronic medical records

Background 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.Methods 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.Results 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.Conclusion 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.