A systematic review and appraisal of the quality of practice guidelines for the management of Neisseria gonorrhoeae infections

Sex Transm Infect. 2017 Nov;93(7):487-492. doi: 10.1136/sextrans-2016-052939. Epub 2017 Mar 30.


Background: Clinical guidelines help ensure consistent care informed by current evidence. As shifts in antimicrobial resistance continue to influence first-line treatment, up-to-date guidelines are important for preventing treatment failure. A guideline's development process will influence its recommendations and users' trust.

Objective: To assess the quality of current gonorrhoea guidelines' development processes.

Data sources: Multiple databases.

Study eligibility criteria: Original and current English-language guidelines targeting health professionals and containing treatment recommendations for uncomplicated gonorrhoea in the general adult population.

Study appraisal and synthesis methods: Two appraisers assessed the guidelines independently using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Scores were combined as per the AGREE II users' manual.

Results: We identified 10 guidelines meeting the inclusion criteria. The quality of the gonorrhoea treatment guidelines varied. Most scored poorly on Rigour of Development; information on the evidence review process and methods for formulating recommendations was often missing. The WHO Guidelines for the Treatment of Neisseria gonorrhoeae and UK National Guideline for the Management of Gonorrhoea in Adults scored the highest on Rigour of Development. Methods to address conflicts of interest were often not described in the materials reviewed. Implementation of recommendations was often not addressed.

Limitations: By limiting our study to English-language guidelines, a small number of guidelines we identified were excluded. Our analysis was limited to either published or online materials that were readily available to users. We could not differentiate between items addressed in the development process but not documented from items that were not addressed.

Conclusions and implications of key findings: Gonorrhoea treatment guidelines may slow antimicrobial resistance. Many current guidelines are not in line with the current guideline development best practices; this might undermine the perceived trustworthiness of guidelines. By identifying current limitations, this study can help improve the quality of future guidelines.


Publication types

  • Review
  • Systematic Review

MeSH terms

  • Databases, Factual
  • Gonorrhea / diagnosis
  • Gonorrhea / drug therapy*
  • Humans
  • Neisseria gonorrhoeae
  • Practice Guidelines as Topic*
  • Quality Assurance, Health Care