{"id":1099,"date":"2015-07-27T15:50:17","date_gmt":"2015-07-27T15:50:17","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1099"},"modified":"2015-07-22T22:50:43","modified_gmt":"2015-07-22T22:50:43","slug":"can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2015\/07\/27\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\/","title":{"rendered":"Can we ensure adherence to STI treatment guidelines in a world threatened by antimicrobial resistance?"},"content":{"rendered":"<p>Sexual health care in the UK has traditionally centred on specialist GUM (genitor-urinary medicine) services.\u00a0 Since the turn of the twenty-first century primary care has played an increasing role, however.\u00a0 The 2012 Health and Social Care Act is in line with this tendency, with most GP (general practitioner) practices now being commissioned to provide level 1 STI screening.\u00a0 Questions have recently been raised about the conformity of care provided by GPs to national guidelines, established for the UK by the <em>British Association for Sexual Health and HIV<\/em> (BASHH) (<a href=\"http:\/\/sti.bmj.com\/content\/91\/Suppl_1\/A68.3.abstract?sid=d68bbb2e-d810-4d34-8949-cf38301787e1\">Trotter &amp; Okunwobi-Smith (STIs)<\/a>).<\/p>\n<p>So what is currently the extent of GP involvement in the UK in care of infections previously dealt with by specialist services (i.e. Chlamydia and Gonorrhoea), and how is this impacting on the treatment of these conditions?\u00a0 <a href=\"http:\/\/bmjopen.bmj.com\/content\/5\/5\/e007776.abstract?sid=8a12d35b-057a-49ae-b1bb-95ae9efa3d82\">Wetten &amp; Hughes<\/a> (W&amp;H), in a population-based study using data from the UK Clinical Practice Research Datalink (CPRD), provide the answers to both questions.\u00a0 As regards the role of GPs, the proportion of Chlamydia cases they diagnosed varied over the study period (2000-2011) between 16% and 9%, and appeared to be on a downward trajectory, while the proportion of Gonorrhoea cases fluctuated between 6% and 9%.\u00a0 As for the quality of care received in general practice, there is a marked disparity between the two conditions.\u00a0 Whereas, in the case of Chlamydia, 90% were prescribed a recommended therapy, of the patients presenting with Gonorrhoea only 40% received the recommended anti-microbial regimen.\u00a0 Ciprofloxacin continued to used (42% of prescriptions in 2006, 20% in 2011) long after the 2005 change in national treatment guidelines favouring cephalosporins.<\/p>\n<p>These findings appear to corroborate the concerns expressed by UK patients in another recent study that their expectations for appropriate in-house care or referral to specialist services were not always being met (<a href=\"http:\/\/sti.bmj.com\/content\/87\/2\/131.abstract?sid=b951f9c7-ad09-4e47-a9ac-f4753c3e46a6\">Sutcliffe &amp; Cassell (STIs)<\/a>).<\/p>\n<p>The issues raised by these UK studies around the adherence to prescribing guidelines by generalist physicians are not, of course, unique to the UK.\u00a0 Similar concerns have been voiced in studies based on data emerging from the BEACH (Bettering Evaluation and Care of Health) programme in Australia (<a href=\"http:\/\/sti.bmj.com\/content\/89\/Suppl_1\/A139.3.abstract?sid=d68bbb2e-d810-4d34-8949-cf38301787e1\">Santella &amp; Hillman (STIs)<\/a>; <a href=\"http:\/\/sti.bmj.com\/content\/82\/1\/61.abstract?sid=d68bbb2e-d810-4d34-8949-cf38301787e1\">Freedman &amp; Mindel (STIs)<\/a>; <a href=\"http:\/\/sti.bmj.com\/content\/80\/3\/212.abstract?sid=d68bbb2e-d810-4d34-8949-cf38301787e1\">Johnston &amp; Mindel (STIs)<\/a>, as well as in studies from more diverse settings (<a href=\"http:\/\/sti.bmj.com\/content\/76\/5\/383.abstract?sid=d05249a5-0078-4950-b0af-317ab1e1f3fd\">Khandwalla &amp; Rahman (STIs)<\/a>). \u00a0Quite apart from the need to optimize patient outcomes and reduce the burden of infection in the population, the problem of adherence by generalists to guidelines raises more general questions.\u00a0 The issue of antimicrobial resistance has prompted recent national interventions to \u201csteward\u201d our remaining antibiotic defences (<a href=\"https:\/\/blogs.bmj.com\/sti\/2014\/05\/14\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\/\">Gonorrhoea antimicrobial resistance (STIs\/blog)<\/a>.\u00a0 Such policies will evidently depend on the adherence to guidelines, including by generalists &#8211; especially in settings where they are responsible for much of STI care.\u00a0 In a world where Gonorrhoea \u2013 and perhaps one day Chlamydia \u2013 is set to become increasingly hard to treat, the problem of ensuring the conformity of generalists to universal standards of treatment is unlikely to go away.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Sexual health care in the UK has traditionally centred on specialist GUM (genitor-urinary medicine) services.\u00a0 Since the turn of the twenty-first century primary care has played an increasing role, however.\u00a0 The 2012 Health and Social Care Act is in line with this tendency, with most GP (general practitioner) practices now being commissioned to provide level [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2015\/07\/27\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[264,1613,4370],"tags":[],"class_list":["post-1099","post","type-post","status-publish","format-standard","hentry","category-health-policy","category-sexual-health-services","category-sti-management-in-primary-care"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Can we ensure adherence to STI treatment guidelines in a world threatened by antimicrobial resistance? - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2015\/07\/27\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Can we ensure adherence to STI treatment guidelines in a world threatened by antimicrobial resistance? - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"Sexual health care in the UK has traditionally centred on specialist GUM (genitor-urinary medicine) services.\u00a0 Since the turn of the twenty-first century primary care has played an increasing role, however.\u00a0 The 2012 Health and Social Care Act is in line with this tendency, with most GP (general practitioner) practices now being commissioned to provide level [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/sti\/2015\/07\/27\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\/\" \/>\n<meta property=\"og:site_name\" content=\"Sexually Transmitted Infections\" \/>\n<meta property=\"article:published_time\" content=\"2015-07-27T15:50:17+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2015\\\/07\\\/27\\\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2015\\\/07\\\/27\\\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"Can we ensure adherence to STI treatment guidelines in a world threatened by antimicrobial resistance?\",\"datePublished\":\"2015-07-27T15:50:17+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2015\\\/07\\\/27\\\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\\\/\"},\"wordCount\":490,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\"},\"articleSection\":[\"health policy\",\"Sexual health services\",\"STI management in primary care\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2015\\\/07\\\/27\\\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2015\\\/07\\\/27\\\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\\\/\",\"name\":\"Can we ensure adherence to STI treatment guidelines in a world threatened by antimicrobial resistance? - Sexually Transmitted Infections\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#website\"},\"datePublished\":\"2015-07-27T15:50:17+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2015\\\/07\\\/27\\\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2015\\\/07\\\/27\\\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2015\\\/07\\\/27\\\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Can we ensure adherence to STI treatment guidelines in a world threatened by antimicrobial resistance?\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/\",\"name\":\"Sexually Transmitted Infections\",\"description\":\"Discussion and suggestion space for readers of STIs\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\",\"name\":\"Sexually Transmitted Infections\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/files\\\/2017\\\/10\\\/blog-logo-sti.png\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/files\\\/2017\\\/10\\\/blog-logo-sti.png\",\"width\":378,\"height\":34,\"caption\":\"Sexually Transmitted Infections\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#\\\/schema\\\/logo\\\/image\\\/\"}},{\"@type\":\"Person\",\"@id\":\"\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/author\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Can we ensure adherence to STI treatment guidelines in a world threatened by antimicrobial resistance? - Sexually Transmitted Infections","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/sti\/2015\/07\/27\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\/","og_locale":"en_US","og_type":"article","og_title":"Can we ensure adherence to STI treatment guidelines in a world threatened by antimicrobial resistance? - Sexually Transmitted Infections","og_description":"Sexual health care in the UK has traditionally centred on specialist GUM (genitor-urinary medicine) services.\u00a0 Since the turn of the twenty-first century primary care has played an increasing role, however.\u00a0 The 2012 Health and Social Care Act is in line with this tendency, with most GP (general practitioner) practices now being commissioned to provide level [...]Read More...","og_url":"https:\/\/blogs.bmj.com\/sti\/2015\/07\/27\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\/","og_site_name":"Sexually Transmitted Infections","article_published_time":"2015-07-27T15:50:17+00:00","twitter_card":"summary_large_image","twitter_misc":{"Written by":"","Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/sti\/2015\/07\/27\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/sti\/2015\/07\/27\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\/"},"author":{"name":"","@id":""},"headline":"Can we ensure adherence to STI treatment guidelines in a world threatened by antimicrobial resistance?","datePublished":"2015-07-27T15:50:17+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/sti\/2015\/07\/27\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\/"},"wordCount":490,"publisher":{"@id":"https:\/\/blogs.bmj.com\/sti\/#organization"},"articleSection":["health policy","Sexual health services","STI management in primary care"],"inLanguage":"en-US"},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/sti\/2015\/07\/27\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\/","url":"https:\/\/blogs.bmj.com\/sti\/2015\/07\/27\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\/","name":"Can we ensure adherence to STI treatment guidelines in a world threatened by antimicrobial resistance? - Sexually Transmitted Infections","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/sti\/#website"},"datePublished":"2015-07-27T15:50:17+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/sti\/2015\/07\/27\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/sti\/2015\/07\/27\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/sti\/2015\/07\/27\/can-we-ensure-adherence-to-sti-treatment-guidelines-in-a-world-threatened-by-antimicrobial-resistance\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/sti\/"},{"@type":"ListItem","position":2,"name":"Can we ensure adherence to STI treatment guidelines in a world threatened by antimicrobial resistance?"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/sti\/#website","url":"https:\/\/blogs.bmj.com\/sti\/","name":"Sexually Transmitted Infections","description":"Discussion and suggestion space for readers of STIs","publisher":{"@id":"https:\/\/blogs.bmj.com\/sti\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/sti\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/sti\/#organization","name":"Sexually Transmitted Infections","url":"https:\/\/blogs.bmj.com\/sti\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/sti\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/sti\/files\/2017\/10\/blog-logo-sti.png","contentUrl":"https:\/\/blogs.bmj.com\/sti\/files\/2017\/10\/blog-logo-sti.png","width":378,"height":34,"caption":"Sexually Transmitted Infections"},"image":{"@id":"https:\/\/blogs.bmj.com\/sti\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"","url":"https:\/\/blogs.bmj.com\/sti\/author\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/posts\/1099","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/users\/152"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/comments?post=1099"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/posts\/1099\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/media?parent=1099"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/categories?post=1099"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/tags?post=1099"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}