Field Emma, Heel Karen, Palmer Cheryn, Vally Hassan, Beard Frank, McCall Brad
Communicable Disease Branch, Queensland Health, Division of the Chief Health Officer, Fortitude Valley BC, Qld 4006, Australia.
Sex Health. 2010 Dec;7(4):448-52. doi: 10.1071/SH09111.
Gonorrhoea is the second most common notifiable sexually transmissible infection (STI) in Queensland. Notifications have been increasing since 2002. Enhanced surveillance was undertaken in this study in order to evaluate clinical management and add to understanding of the epidemiology of gonorrhoea and in South East Queensland.
Information on clinical management and an enhanced surveillance form were faxed to clinicians who notified gonorrhoea in the Brisbane Southside Population Health Unit area from 2003 to 2008. Ceftriaxone was recommended for treatment of gonorrhoea cases, as was simultaneous treatment for chlamydia, testing for other STIs and management of sexual contacts. Enhanced surveillance focussed on collecting more detailed epidemiological and clinical management information.
A total of 909 enhanced surveillance forms were returned (response rate 72.2%). The use of ceftriaxone increased significantly over the study period from 31.3% in 2003 to 68.4% in 2008 (P < 0.05). However, there remained a considerable proportion of cases that did not receive ceftriaxone (31.6% in 2008). Simultaneous treatment for chlamydia was reported for 70.5% of cases and did not increase over the study period. A high proportion of males were not screened for high risk co-infection such as HIV (49.6%) and syphilis (51.7%). Contact tracing was initiated for 76.5% of cases and did not increase during the study period.
Continued education of clinicians on treatment guidelines is needed. Screening of other STIs such as HIV in males with gonorrhoea and increasing contact tracing were identified as aspects of clinical management for future improvement. Overall this study provides useful insights into the clinical management of gonorrhoea in South East Queensland.
淋病是昆士兰州第二常见的法定性传播感染（STI）。自2002年以来，报告病例数一直在增加。本研究开展了强化监测，以评估临床管理情况，并增进对昆士兰州东南部淋病流行病学的了解。
2003年至2008年期间，将临床管理信息和一份强化监测表格传真给在布里斯班南区人口健康部门辖区内报告淋病病例的临床医生。推荐使用头孢曲松治疗淋病病例，同时治疗衣原体感染、检测其他性传播感染并管理性伴侣。强化监测的重点是收集更详细的流行病学和临床管理信息。
共返回909份强化监测表格（回复率72.2%）。在研究期间，头孢曲松的使用显著增加，从2003年的31.3%增至2008年的68.4%（P<0.05）。然而，仍有相当比例的病例未接受头孢曲松治疗（2008年为31.6%）。70.5%的病例报告同时接受了衣原体治疗，且在研究期间没有增加。很大一部分男性未接受如艾滋病毒（49.6%）和梅毒（51.7%）等高风险合并感染的筛查。76.5%的病例启动了接触者追踪，且在研究期间没有增加。
需要持续对临床医生进行治疗指南方面的教育。对淋病男性患者筛查其他性传播感染（如艾滋病毒）以及加强接触者追踪被确定为未来临床管理中需要改进的方面。总体而言，本研究为昆士兰州东南部淋病的临床管理提供了有用的见解。
