Diagnosis and treatment of XXXX and gonorrhoea in general practice in England 2000-2011: a population-based study using data from the UK Clinical Practice Research Datalink.

@entity1 @entity1047 @entity2953 @entity2177
OBJECTIVES: To determine the relative contribution of general practices (GPs) to the diagnosis of @entity1047 and gonorrhoea in England and whether treatment complied with national guidelines. DESIGN: Analysis of longitudinal electronic health records in the Clinical Practice Research Datalink (CPRD) and national @entity2953 ( @entity2953 ) surveillance databases, England, 2000-2011. SETTING: GPs, and community and specialist @entity2953 services. @entity1 : @entity1 diagnosed with @entity1047 (n=1,386,169) and gonorrhoea (n=232,720) at CPRD GPs, and community and specialist @entity2953 Services from 2000-2011. MAIN OUTCOME MEASURES: Numbers and rates of @entity1047 and gonorrhoea diagnoses; percentages of @entity1 diagnosed by GPs relative to other services; percentage of GP @entity1 treated and antimicrobials used; percentage of GP @entity1 referred. RESULTS: The diagnosis rate (95% CI) per 100,000 population of @entity1047 in GP increased from 22.8 (22.4-23.2) in 2000 to 29.3 (28.8-29.7) in 2011 (p<0.001), while the proportion treated increased from 59.5% to 78.4% (p=0.001). Over 90% were prescribed a recommended antimicrobial. Over the same period, the diagnosis rate (95% CI) per 100,000 population of gonorrhoea in GP ranged between 3.2 (3-3.3) and 2.4 (2.2-2.5; p=0.607), and the proportion treated ranged between 32.7% and 53.6% (p=0.262). Despite being discontinued as a recommended therapy for gonorrhoea in 2005, @entity2177 accounted for 42% of prescriptions in 2007 and 20% in 2011. Over the study period, GPs diagnosed between 9% and 16% of @entity1047 cases and between 6% and 9% of gonorrhoea cases in England. CONCLUSIONS: GP makes an important contribution to the diagnosis and treatment of bacterial STIs in England. While most @entity1 diagnosed with @entity1047 were managed appropriately, many of those treated for gonorrhoea received antimicrobials no longer recommended for use. Given the global threat of antimicrobial resistance, GPs should remain abreast of national treatment guidelines and alert to treatment failure in their @entity1 .
