Sexually transmitted diseases in Manitoba: evaluation of physician treatment practices, STD drug utilization, and compliance with screening and treatment guidelines.

Background And Goal: There is little information in Manitoba on the utilization of drugs for sexually transmitted disease (STD) treatment and the extent to which physicians comply with STD screening and treatment guidelines. This study was undertaken to provide such information to inform policy and program development.

Methods: Physicians providing STD care were asked to complete a simple record for each new STD index client or contact seen. This information was subsequently linked with data from provincial diagnostic and treatment databases.

Results: Between October 1997 and September 1998, there were 2535 reports of STD treatments. Only about 25% of drugs provided by the provincial health department to physicians for STD treatment could be accounted for on the basis of the treatment reports received. Seventy-four percent of all treatments provided were presumptive ones for urethral or cervical infection or pelvic inflammatory disease (PID), and 14.4% of these were associated with subsequent positive tests for Chlamydia trachomatis or Neisseria gonorrhoeae. About three quarters of presumptive treatments were in compliance with provincial guidelines, as were most etiology-based treatments for chlamydial infection and 72% of etiology-based treatments for gonorrhea. Noncompliance with guidelines was commonly due to presumptive treatment that covered only C trachomatis, nonrecommended treatment for N gonorrhoeae, and incorrect treatment of PID. Only about 25% of women and 4% of men aged 15 to 24 years who visited a physician in 1997 were tested for C trachomatis.

Conclusion: Increased educational efforts are required to improve physician compliance with STD screening and treatment guidelines, as well as ensure the appropriate use of STD drugs provided. Opportunities are being missed for screening for C trachomatis among young people, the majority of whom are seen regularly by a physician.