Evaluation of current clinical guidelines for the management of sexually transmissible enteric infections using the AGREE II toolkit.

Abstract

Background: Clinical guidelines for sexually transmissible enteric infections can provide a framework for testing, management, antimicrobial stewardship and public health control. This review aimed to evaluate the currently available clinical guidelines and to highlight any areas for improvement.

Method: A comprehensive online search for clinical guidelines was performed and reported using Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, followed by evaluation using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool by three independent reviewers. An AGREE II domain score of >60% is the threshold for sufficient quality, and each guideline was rated high, average or low based on the domain percentages (five domains scoring >60%=high, 3-4 domains scoring >60%=average and ≤2 domains scoring>60%=low). Two authors developed a bespoke quality framework for sexually transmissible enteric infection guidelines and this was used to evaluate each guideline.

Results: Six clinical guidelines were identified from the UK (British Association for Sexual Health and HIV (UK-BASHH)), USA (Centers for Disease Control and Prevention (USA-CDC)), Europe (International Union against Sexually Transmitted Infections (Europe-IUSTI)), Canada-government, Brazil-government and Australia (Australasia Society for HIV, Viral Hepatitis, and Sexual Health Medicine (Australia-ASHM)). The overall AGREE II score was 56% (IQR 43-67) (domain 1 (scope and purpose) 67% (IQR=42-67), domain 2 (stakeholder involvement) 46% (IQR 34-62), domain 3 (rigour of development) 42% (IQR 22-49), domain 4 (clarity of presentation) 80% (IQR 57-89), domain 5 (applicability) 23% (IQR 11-30) and domain 6 (editorial independence) 67% (IQR 56-84)). The median global scores (out of 7) and rating (low, medium and high) were UK-BASHH (5/7, high), USA-CDC (5/7, average), Europe-IUSTI (4/7, average), Canada government (4/7, low), Brazil government (3/7, low) and Australia-ASHM (1/7, low). All six guidelines recommended testing using molecular platforms: UK-BASHH, USA-CDC and Europe-IUSTI recommended offering sexual health interventions and STI testing; the UK-BASHH and Australia-ASHM did not recommend empirical antimicrobials, and the Europe-IUSTI and Brazil government guidelines made specific antimicrobial recommendations, including macrolides, quinolones and cephalosporins.

Conclusion: Future clinical guidelines for sexually transmissible enteric infections require consistency and to improve their applicability, rigour of development, stakeholder involvement and recommendations for sexual health interventions, sexually transmitted infection testing, partner notification, handwashing and food handlers' advice and antimicrobial treatment.