Background/introduction:
Most (~60%) rectal gonorrhoea (GC) occurs in MSM with 25% symptomatic at presentation. Those with rectal GC are at increased risk of other STIs. BASHH provides guidelines on management and targets to be achieved in testing, treatment and partner notification.

Aim(s)/objectives: To compare our clinic’s performance in managing rectal GC compared to the national recommendations.

Methods: Retrospective case-note review of confirmed cases of rectal GC on NAAT between 1st November 2011 and 31st March 2015. Data were obtained from clinic notes, the clinic database and laboratory results. Audit standards were based on BASHH guidelines in managing rectal GC.

Results: 184 cases from 156 men: 61% White, 12% Black, median age 31 years (IQR 26,37), 71% MSM, 29% bisexual, 58% symptomatic. Triple site testing was done in 91%. Rectal GC cultures were taken in 55%. Adequate treatment was given to 94%. Quinolone resistance occurred in 31%. Partner notification was done in 43%. 14% had other STIs (syphilis, LGV, chlamydia and HSV). There were 2 new diagnoses of HIV at the time of GC diagnosis, and 2 further cases at 3 months follow-up. 

Discussion/conclusion: Management of rectal GC did not reach the BASHH targets on any recommendation, suggesting that improvements in managing rectal GC are needed within our clinic. Re-testing and re-attendance were poor. Staff have received further training and a re-audit in 2017 will assess improvement. We have established a robust call/recall system to enable early diagnosis of HIV which was significant in our cohort of men with rectal GC.

Managing rectal GC : room for improvement