Downloaded from https://journals.lww.com/stdjournal by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD30z+H3cjNBCkEcQh2EKBsdsFs7tLTm+fTwCBgjTUD6tQ= on 09/24/2018 Factors Associated With Primary Care Physician Knowledge of the Recommended Regimen for Treating Gonorrhea Marta Bornstein, MPH,* Faruque Ahmed, PhD,* Roxanne Barrow, MD, MPH,* Jami Fraze Risley, PhD,* Sheena Simmons, MPH,* and Kimberly A. Workowski, MD† Background: The recommended regimen for treating uncomplicated gonorrhea has changed over time, due to the emergence of antimicrobial re- sistance. We assessed physician knowledge of the recommendation for treating uncomplicated urogenital gonorrhea in adolescents and adults using ceftriaxone and azithromycin dual therapy. Methods: We analyzed DocStyles 2015 survey data from 1357 primary care physicians practicing for at least 3 years who provided screening, diag- nosis, or treatment for sexually transmitted diseases to one or more patients in an average month. Logistic regression and χ 2 analyses were used to iden- tify factors associated with knowledge of dual therapy. Results: Among the options of treatment with ceftriaxone alone, azithromycin alone, both of these, or spectinomycin plus levofloxacin, 64% of physicians correctly preferred ceftriaxone plus azithromycin. Knowledge of the recommended dual therapy decreased with increasing years of practice, ranging from 74% among physicians with 3–9 years of practice to 57% among those practicing for ≥24 years (adjusted odds ratio, ORa, for ≥24 vs 3–9 years of practice, 0.50; 95% confidence in- terval [CI], 0.35–0.70). Knowledge of dual therapy decreased with higher socioeconomic status of patients (ORa for high income vs poor/lower middle income patients, 0.47; 95% CI, 0.32–0.69). Physi- cians who pursued continuing medical education using journals, podcasts, and government health agencies were more likely to report dual therapy than those who did not use these sources (ORa, 2.09; 95% CI, 1.31–3.33). Conclusions: Knowledge of the recommended regimen for treating gon- orrhea decreased with increasing years of practice and with higher socio- economic status of patients. G onorrhea is the second most commonly reported notifiable disease in the United States, 1 with an estimated 820,000 new gonococcal infections occurring each year. 2 The first-line rec- ommended regimen for treating gonococcal infections has changed over time, due to the emergence of antimicrobial resistance. From 1993 to 2010, the Centers for Disease Control and Prevention (CDC) recommended ceftriaxone or cefixime or ciprofloxacin or ofloxacin or levofloxacin as the first-line regimen for treatment of uncomplicated gonococcal infections of the cervix, urethra, or rectum in adolescents and adults; cotreatment for chlamydia with azithromycin or doxycycline was recommended if chlamydia infection was not ruled out. 3 In 2010, CDC recommended dual therapy for gonococcal infections with ceftriaxone (or cefixime if ceftriaxone was not an option) plus either azithromycin or doxy- cycline, even if chlamydia test was known to be negative at the time of treatment, to potentially slow the emergence and spread of resistance to cephalosporins. 4 In 2012, dual therapy with ceftri- axone plus either azithromycin or doxycycline was recommended regardless of the chlamydia test results (cefixime was no longer recommended as a first-line regimen). 5–7 Since June 5, 2015, dual therapy with ceftriaxone plus azithromycin is recommended. In the context of rapidly changing recommendations for manage- ment of uncomplicated gonorrhea in the past decade, we assessed primary care physicians' knowledge of the first-line recommended regimen for treating uncomplicated urogenital gonorrhea using ceftriaxone and azithromycin dual therapy as opposed to mono- therapy with ceftriaxone or azithromycin. METHODS Survey The data were collected through the DocStyles Web-based survey developed by Porter Novelli with guidance provided by federal public health agencies and other non-profit and for-profit clients. A random sample of physicians was selected to match the American Medical Association's Masterfile of licensed US physicians for age, gender, and region. 8 The 2015 survey included questions on counseling, screening, alcohol, physical activity, hy- pertension, human papillomavirus, human immunodeficiency vi- rus, and sexually transmitted diseases (STDs). The survey also contained standard general and demographic questions that are in- cluded every year, such as sources used to pursue continuing med- ical education (CME). The sampling frame was SERMO's Global Medical Panel (www.sermo.com), which includes over 330,000 medical professionals in the United States. The panel was primar- ily recruited at clinicians' place of work (84%) and through online and face-to-face methods with additional work-place verification (16%). Panelists were then verified using a double opt-in sign up process with telephone confirmation at their place of work. SERMO panelists agree to participate and meet the criteria for each survey (US clinicians actively seeing patients in an individ- ual, group, or hospital practice for at least 3 years). To reach the quotas of 1000 family medicine and internal medicine physicians, 250 pediatricians, and 250 obstetricians/gynecologists, 1794 phy- sicians were randomly sampled. Respondents were paid an hono- rarium of US $35–80. Porter Novelli Public Services (www.porternovelli.com) conducted the survey from June 4 to June 23, 2015. Of the 1794 physicians sampled, 1500 (84%) completed the survey (Table 1). Compared with the American Medical Association's master file, physicians who completed the survey comprised a higher propor- tion of males (by 10 percentage points). Physicians who responded that they provided STD screening, diagnosis, or treatment to zero From the *Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, and †Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA Conflict of interest and sources of funding: None declared. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. MB and FA are co- leads on the manuscript. Correspondence: Faruque Ahmed, PhD, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mail Stop E-03, Atlanta, GA 30329. E‐mail: fahmed@cdc.gov. Received for publication June 16, 2016, and accepted September 16, 2016. DOI: 10.1097/OLQ.0000000000000542 Copyright © 2016 American Sexually Transmitted Diseases Association All rights reserved. ORIGINAL STUDY 14 Sexually Transmitted Diseases • Volume 44, Number 1, January 2017 Copyright © 2016 by the American Sexually Transmitted Diseases Association. Unauthorized reproduction of this article is prohibited.