Diagnosing gonorrhoea – how do doctors and nurses compare? An audit of gonorrhoea management in a large provincial NHS Trust.

Background/introduction: Although gonorrhoea rates are rising, incidence of urethral and cervical infection remain low in comparison to historic data. There is therefore concern that expertise in microscopic diagnosis of gonorrhoea may be falling. Additionally, in light of emerging resistance of gonorrhoea to extended-spectrum cephalosporins, multiple guidelines highlight the importance of taking cultures from NAAT positive sites prior to antibiotic treatment. 

Aim(s)/objectives: To evaluate the sensitivity of urethral microscopy performed by doctors / nurses and the frequency with which cultures are taken from all NAAT positive sites prior to treatment.

Methods: A retrospective case note review of 100 patients with a gonorrhoea diagnosis and all gonorrhoea contacts in the same time period. 

Results: 16 men with genitourinary symptoms had positive urethral cultures on initial visit. 16/16(100%) had positive microscopy. 32 men with genitourinary symptoms had a positive urethral/urine NAAT, of which 30 had microscopy. In 25/30(83%), microscopy was positive. When performed by doctors, this was 7/8(88%), and by nurses was 18/22(82%)(p=0.46). 64 patients with a positive NAAT were consulted by exclusively doctors or nurses before treatment. 11/15(73%) of doctors’ patients and 30/49(61%) of nurses’ patients had cultures taken from all NAAT positive sites before treatment (p=0.12). 

Discussion/conclusion: Microscopy in men with genitourinary symptoms remains sensitive in comparison with culture. However, there may be a case for a new auditable standard comparing microscopy with NAATs. Doctors and nurses are inconsistent in taking cultures from all NAAT positive sites prior to treatment and training in both groups should be addressed.