The Korean Association of Urogenital Infection and Inflammation (KAUTII) published treatment guidelines and is operating a surveillance system to prevent resistance to the antibiotics used to treat sexually transmitted infections (STIs) in collaboration with the Korea Disease Control and Prevention Agency (KDCA) [1]. The revision of the 2023 Guidelines for Treatment of STIs (3rd edition) has been released, and regular updates will be implemented in the future [2]. Updates to the guidelines are made through collaboration with various academic societies, including the Korean Association of Obstetricians and Gynecologists, the Korean Society of Obstetrics and Gynecology, and the Korean College of Obstetrics and Gynecology, as well as the KAUTII. Therefore, the current treatments of STIs by urologists and gynecologists in Korea need to be examined.
A questionnaire titled “Analysis of antimicrobial agents for treatment of STIs and current status of treatment” was distributed to urologists and gynecologists from December 2022 to January 2023 to assess the current situation of sexually transmitted infection treatments in Korea. The questionnaire was distributed using an online survey program. The questions in the questionnaire consisted of nine questions:
1.Are you aware of the Korean STI guidelines (jointly published by the KAUTII and the KDCA)?
2.When male urethritis or female cervicitis/vaginitis is suspected, what sample do you use for polymerase chain reaction (PCR) testing?
3.Do you take additional samples from the pharynx when gonococcal urethritis is suspected?
4.What medications do you use to treat
5.What medications do you use to treat
6.What medications do you use to treat
7.Do you provide treatment if asymptomatic
8.Do you provide treatment if asymptomatic
9.If you have been diagnosed and treated for a sexually transmitted infection by PCR, when is a follow-up PCR test performed?
Three hundred and forty-one at urology (305 at primary medical institutions, 30 at secondary medical institutions, and six at tertiary medical institutions), 302 at obstetrics and gynecology (219 at primary medical institutions, 74 at secondary medical institutions, 37 at tertiary medical institutions, and two at other institutions) responded. Ethical approval was not applicable because this study did not involve humans or animals.
When urethritis is suspected in men, urologists use urine as a specimen for multiplex real-time PCR analysis rather than a urethral swab in approximately 98% of cases. When cervicitis/vaginitis is suspected in women, gynecologists mainly use vaginal and cervical swabs rather than urine as a specimen for PCR testing. In addition, in Korea, female patients do not directly collect vaginal swabs using a swab kit and send them to a laboratory, as in other countries.
For
Table 1
Answer choices (question: what regimen do you use to treat | Urologists | Gynecologists | ||
---|---|---|---|---|
% | n | % | n | |
Ceftriaxone 250 mg in a single dose+azithromycin 1 g in a single dose | 4.69 | 16 | 7.95 | 24 |
Ceftriaxone 500 mg in a single dose+azithromycin 1 g in a single dose | 12.32 | 42 | 15.23 | 46 |
Ceftriaxone 1 g in a single dose+azithromycin 1 g in a single dose | 11.73 | 40 | 8.61 | 26 |
Spectinomycin 2 g in a single dose+azithromycin 1 g in a single dose | 1.17 | 4 | 2.98 | 9 |
Ceftriaxone 250 mg in a single dose | 0.59 | 2 | 3.64 | 11 |
Ceftriaxone 500 mg in a single dose | 5.28 | 18 | 10.93 | 33 |
Ceftriaxone 1 g in a single dose | 5.28 | 18 | 9.93 | 30 |
Azithromycin 1 g in a single dose | 5.87 | 20 | 4.3 | 13 |
Spectinomycin 2 g in a single dose | 0.29 | 1 | 2.98 | 9 |
Ceftriaxone 250 mg in a single dose+doxycycline 100 mg twice a day for seven days | 8.5 | 29 | 4.97 | 15 |
Ceftriaxone 500 mg in a single dose+doxycycline 100 mg twice a day for seven days | 22.58 | 77 | 8.61 | 26 |
Ceftriaxone 1 g in a single dose+doxycycline 100 mg twice a day for seven days | 9.38 | 32 | 12.91 | 39 |
Fluoroquinolone | 1.17 | 4 | 0.66 | 2 |
Cephalosporin | 7.04 | 24 | 4.3 | 13 |
Others | 4.11 | 14 | 1.99 | 6 |
In the case of preferred
Table 2
Answer choices (question: what regimen do you use to treat | Urologists | Gynecologists | ||
---|---|---|---|---|
% | n | % | n | |
Azithromycin 1 g in a single dose | 36.07 | 123 | 51.32 | 155 |
Doxycycline 100 mg twice a day for seven days | 55.43 | 189 | 46.69 | 141 |
Minocycline 100 mg twice a day for seven days | 3.81 | 13 | 0.99 | 3 |
Fluoroquinolone | 3.23 | 11 | 0 | 0 |
Cephalosporin | 0.29 | 1 | 0.33 | 1 |
Others | 1.17 | 4 | 0.66 | 2 |
In the case of
Table 3
Answer choices (question: what regimen do you use to treat | Urologists | Gynecologists | ||
---|---|---|---|---|
% | n | % | n | |
Azithromycin 1 g in a single dose | 10.56 | 36 | 26.49 | 80 |
Azithromycin 500 mg once a day, followed by 250 mg once a day for four days | 29.03 | 99 | 11.26 | 34 |
Azithromycin 1 g once a day, followed by 500 mg once a day for three days | 4.69 | 16 | 5.30 | 16 |
Doxycycline 100 mg twice a day for seven days | 23.75 | 81 | 33.11 | 100 |
Minocycline 100 mg twice a day for seven days | 2.35 | 8 | 0.33 | 1 |
Moxifloxacin 400 mg once daily for 10-14 days | 1.17 | 4 | 2.65 | 8 |
Doxycycline 100 mg twice a day for seven days+azithromycin 500 mg once a day, followed by 250 mg once a day for four days | 12.61 | 43 | 6.95 | 21 |
Doxycycline 100 mg twice a day for seven days+azithromycin 1 g once a day, followed by 500 mg once a day for three days | 7.33 | 25 | 6.62 | 20 |
Doxycycline 100 mg twice a day for seven days+moxifloxacin 400 mg once a day for seven days | 2.35 | 8 | 3.97 | 12 |
Minocycline 100 mg twice a day for seven days+azithromycin 500 mg once a day, followed by 250 mg once a day for four days | 1.17 | 4 | 0.00 | 0 |
Minocycline 100 mg twice a day for seven days+azithromycin 1 g once a day, followed by 500 mg once a day for three days | 0.59 | 2 | 0.99 | 3 |
Minocycline 100 mg twice a day for seven days+moxifloxacin 400 mg once a day for seven days | 0.00 | 0 | 0.00 | 0 |
Fluoroquinolone | 2.35 | 8 | 0.33 | 1 |
Cephalosporin | 0.00 | 0 | 0.33 | 1 |
Others | 2.05 | 7 | 1.66 | 5 |
When asymptomatic
A questionnaire on antibacterial agents and STI treatment was distributed to analyze the STI treatment trends of domestic doctors. Currently, the primary treatment for
In addition, according to the 2nd edition of the STI treatment guidelines in 2016, combination therapy of ceftriaxone and azithromycin may be used until
In cases of suspected gonococcal urethritis or gonococcal cervicitis/vaginitis, the rate of additional specimen collection from the pharynx was less than 3% in urologists and gynecologists. Active sample collection may not occur in practice because the awareness and importance of pharyngeal gonococcal infections have only emerged recently. In addition, education on sample collection should be provided because most physicians are unfamiliar with collecting pharyngeal samples. Furthermore, pharyngeal samples are not currently covered by health insurance in Korea. Hence, there is an urgent need for coordination with the Health Insurance Review and Assessment Service of Korea.
In the case of the preferred treatment of
The primary treatment recommended for
In the case of follow-up PCR testing, 74% of the gynecologists perform the test after three weeks or later. On the other hand, only 40% of the urologists performed the test after three weeks, 28% after two weeks, and 22% after one week. Currently, post-treatment PCR follow-up testing can be covered by health insurance, and it is recommended after three weeks when the false-positive effect disappears to prevent unnecessary additional treatment. Therefore, providing education on the timing of post-treatment PCR follow-up testing is important.
Most urologists and gynecologists appeared to follow the treatments recommended in the 2nd edition of the STI treatment guidelines, revised in 2016. On the other hand, there were several changes in the 3rd edition of the STI treatment guidelines, including treatment guidelines for
The authors thank the doctors who participated in this survey.
No potential conflict of interest relevant to this article was reported.
The study was funded by the KDCA and supported by the KAUTII.
S.J.L. and J.B.C. participated in the conceptualization. B.K.H. and S.B. participated in data curation. S.P. and J.B.C. participated in the formal analysis. S.P. and J.B.C. participated in visualization and writing-original draft. S.J.L. and J.B.C. participated in writing, reviewing, and editing.