Clinical Microbiology and Antimicrobial Chemotherapy. 2010; 12(3):226-245
Objectives: We aimed to reveal the current practice of diagnosis and management of bacterial sexually transmitted diseases (STDs) in different regions of Russia and to compare it with the current national guidelines.
A multicenter retrospective study was conducted in 10 different cities of Russia. Randomly selected clinical records of 1250 adult patients (61% male, 39% female, mean age 28.8±9.2) treated for early syphilis (n=341), uncomplicated gonococcal (n=309), chlamydial (n=310), mycoplasma (n=137) and ureaplasma (n=153) infection during the period since January 2007 till December 2007 were analyzed.
We found wide use of outdated methods in diagnostic of STDs. Thus the main methods to diagnose syphilis were microprecipitation (81.5%) and complement fixation test (13.3%) with no treponemal tests confirmation. In 80.7% of patients methylene blue stain and/or Gram stain microscopy was the only used test to diagnose gonococcal infection. Although culture was done in 18.7% of patients, susceptibility testing was performed only in 2.3% of cases. Polymerase chain reaction was used to diagnose infections caused by intracellular pathogens only in 37.1% of cases, whereas low informative microscopy and ELISA in 21.5% and 13.3% of cases. A total of 1567 disease-specific physicians’ prescriptions was recorded (1352 [86.2%] were antimicrobials). Early syphilis was commonly treated with benzathine penicillin (38.4%), procaine penicillin (28.3%), ceftriaxone (26.9%) and penicillin G (5.5%); gonococcal infection – with ceftriaxone (57.5%), spectinomycin (9.3%), doxycycline (7.2%), azithromycin (5.1%); chlamydial infection – with azithromycin (28.2%), doxycycline (22.2%), claritromycin (14.9%), josamycin (11.1%), ofloxacin (7.9%); mycoplasma and ureaplasma infection – by doxycycline (32.4% and 31.3%), josamycin (21.4% and 21.3%), azithromycin (15.2 and 11.3%), claritromycin (14.5 and 11.3%), levofloxacin (4.1 and 6.9%). Other agents accounted for less than 5% each.
Prominent variability in the administrations of antibacterial agents with tendency to increase their course doses was revealed. Therapy administered to patients was not compliant with the with national guidelines in 28.2% of patients and among correctly chosen agents only 24% were used in recommended course doses. Inadequacy of diagnostics as well as relatively low compliance to national guidelines indicates the need of revision and correction of current practice of STD management in Russia.