{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T04:19:08Z","timestamp":1787804348249,"version":"build-2784847793"},"reference-count":50,"publisher":"CSIRO Publishing","issue":"5","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,20]]},"abstract":"<jats:p>Sexually transmitted infections (STIs) place a substantial burden on outpatient health care and are a key focus for antimicrobial stewardship due to rising antimicrobial resistance. Suboptimal treatment can result in ongoing transmission, reinfection and complications, such as pelvic inflammatory disease. Evaluating prescribing quality is essential to improve patient care and support stewardship efforts. This review synthesises evidence on antimicrobial prescribing quality for STIs and identifies gaps to inform targeted interventions for this unique but critical setting. This PRISMA-ScR scoping review searched Ovid MEDLINE and Embase for English-language studies published from 2015 to May 2025 assessing antimicrobial prescribing quality for STIs in outpatient settings. Results were summarised descriptively; no formal critical appraisal was undertaken. Fifteen studies assessing antimicrobial prescribing quality for STIs in outpatient settings were included, predominantly from high-income countries, and focused on Neisseria gonorrhoeae and Chlamydia trachomatis. Substantial heterogeneity was observed in analytic units, denominators and outcome definitions, limiting comparability across studies. Prescribing quality was primarily assessed against national guidelines, although approaches varied from antimicrobial choice alone to multi-criteria and all-or-nothing assessments, with inconsistent terminology used throughout. Reported guideline concordance varied widely, with generally higher concordance for chlamydia than gonorrhoea. Antimicrobial prescribing for STIs in outpatient settings is both understudied and highly variable. Despite increasing global policy emphasis on antimicrobial stewardship, there are no standardised frameworks to support routine auditing in this setting. Developing standardised auditing approaches would improve surveillance, support stewardship efforts and identify opportunities to optimise prescribing practices across a broader range of STIs.<\/jats:p>","DOI":"10.1071\/sh26138","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T03:46:35Z","timestamp":1787802395000},"source":"Crossref","is-referenced-by-count":0,"title":["Antimicrobial prescribing quality for sexually transmitted infections: a scoping review"],"prefix":"10.1071","volume":"23","author":[{"given":"Harlan","family":"Smith","sequence":"first","affiliation":[{"name":"AMelbourne Medical School, University of Melbourne, Melbourne, Vic, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine","family":"Wen","sequence":"additional","affiliation":[{"name":"BThe Royal Melbourne Hospital Guidance Group, The Royal Melbourne Hospital, Melbourne, Vic, Australia."},{"name":"CNational Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, Melbourne, Vic, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zohal","family":"Rashidzada","sequence":"additional","affiliation":[{"name":"BThe Royal Melbourne Hospital Guidance Group, The Royal Melbourne Hospital, Melbourne, Vic, Australia."},{"name":"CNational Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, Melbourne, Vic, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna","family":"Maleki","sequence":"additional","affiliation":[{"name":"BThe Royal Melbourne Hospital Guidance Group, The Royal Melbourne Hospital, Melbourne, Vic, Australia."},{"name":"CNational Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, Melbourne, Vic, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Fang","sequence":"additional","affiliation":[{"name":"BThe Royal Melbourne Hospital Guidance Group, The Royal Melbourne Hospital, Melbourne, Vic, Australia."},{"name":"CNational Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, Melbourne, Vic, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Thursky","sequence":"additional","affiliation":[{"name":"BThe Royal Melbourne Hospital Guidance Group, The Royal Melbourne Hospital, Melbourne, Vic, Australia."},{"name":"CNational Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, Melbourne, Vic, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney","family":"James","sequence":"additional","affiliation":[{"name":"BThe Royal Melbourne Hospital Guidance Group, The Royal Melbourne Hospital, Melbourne, Vic, Australia."},{"name":"CNational Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, Melbourne, Vic, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5472-8895","authenticated-orcid":true,"given":"Courtney","family":"Ierano","sequence":"additional","affiliation":[{"name":"BThe Royal Melbourne Hospital Guidance Group, The Royal Melbourne Hospital, Melbourne, Vic, Australia."},{"name":"CNational Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, Melbourne, Vic, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"67","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"2026082623463492500_R1","unstructured":"World Health Organization. Implementing the global health sector strategies on HIV, viral hepatitis and sexually transmitted infections, 2022\u20132030: Report on progress and gaps 2024. Geneva: World Health Organization; 2024."},{"issue":"1","key":"2026082623463492500_R2","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1136\/sti.2005.016931","article-title":"Sexual health problems managed in Australian general practice: a national, cross sectional survey.","volume":"82","author":"Freedman","year":"2006","journal-title":"Sex Transm Infect"},{"key":"2026082623463492500_R3","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.clinmicnews.2025.05.002","article-title":"A hidden epidemic: The rising challenge of Mycoplasma genitalium.","volume":"51","author":"Mira","year":"2025","journal-title":"Clin Microbiol Newsl"},{"issue":"Supplement_2","key":"2026082623463492500_R4","doi-asserted-by":"publisher","first-page":"S29","DOI":"10.1093\/infdis\/jiab067","article-title":"Etiology and Diagnosis of Pelvic Inflammatory Disease: Looking Beyond Gonorrhea and Chlamydia.","volume":"224","author":"Mitchell","year":"2021","journal-title":"J Infect Dis"},{"issue":"Supplement_2","key":"2026082623463492500_R5","doi-asserted-by":"publisher","first-page":"S134","DOI":"10.1086\/652395","article-title":"Risk of Sequelae after Chlamydia trachomatis Genital Infection in Women.","volume":"201","author":"Haggerty","year":"2010","journal-title":"J Infect Dis"},{"issue":"7","key":"2026082623463492500_R6","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1038\/s41579-024-01023-3","article-title":"Antimicrobial treatment and resistance in sexually transmitted bacterial infections.","volume":"22","author":"Jensen","year":"2024","journal-title":"Nat Rev Microbiol"},{"issue":"12","key":"2026082623463492500_R7","doi-asserted-by":"publisher","first-page":"1401","DOI":"10.2217\/fmb.12.117","article-title":"Emergence of Multidrug-Resistant, Extensively Drug-Resistant and Untreatable Gonorrhea.","volume":"7","author":"Unemo","year":"2012","journal-title":"Future Microbiol"},{"issue":"5","key":"2026082623463492500_R8","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1093\/cid\/cix898","article-title":"Increases in Neisseria gonorrhoeae With Reduced Susceptibility to Azithromycin Among Men Who Have Sex With Men in Seattle, King County, Washington, 2012-2016.","volume":"66","author":"Barbee","year":"2018","journal-title":"Clin Infect Dis"},{"issue":"2","key":"2026082623463492500_R9","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003543.pub4","article-title":"Interventions to Improve Antibiotic Prescribing Practices for Hospital Inpatients.","volume":"9","author":"Davey","year":"2017","journal-title":"Cochrane Datab Syst Rev"},{"issue":"10014","key":"2026082623463492500_R10","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1016\/S0140-6736(15)00473-0","article-title":"Understanding the mechanisms and drivers of antimicrobial resistance.","volume":"387","author":"Holmes","year":"2016","journal-title":"Lancet"},{"issue":"2","key":"2026082623463492500_R11","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1017\/ice.2014.41","article-title":"Antimicrobial Stewardship in Outpatient Settings: A Systematic Review.","volume":"36","author":"Drekonja","year":"2015","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"7","key":"2026082623463492500_R12","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1017\/ice.2020.94","article-title":"Antimicrobial stewardship in the outpatient setting: A review and proposed framework.","volume":"41","author":"Marcelin","year":"2020","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2026082623463492500_R13","unstructured":"Centers for Disease Control and Prevention. Core elements of hospital antibiotic stewardship programs. United States Department of Health and Human Services. Atlanta: Centers for Disease Control and Prevention; 2016."},{"key":"2026082623463492500_R14","unstructured":"Australian Commission on Safety and Quality in Health Care. Antimicrobial Stewardship in Australian Health Care. Sydney: ACSQHC; 2023."},{"issue":"7","key":"2026082623463492500_R15","doi-asserted-by":"publisher","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation.","volume":"169","author":"Tricco","year":"2018","journal-title":"Ann Int Med"},{"key":"2026082623463492500_R16","unstructured":"Antibiotic Expert Groups. Therapeutic Guidelines: Antibiotic. Melbourne: Therapeutic Guidelines Limited; 2025."},{"key":"2026082623463492500_R17","unstructured":"World Health Organization. Sexually transmitted infections (STIs). Geneva: World Health Organization; 2025."},{"issue":"1","key":"2026082623463492500_R18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1071\/SH22134","article-title":"Australian sexually transmitted infection (STI) management guidelines for use in primary care 2022 update.","volume":"20","author":"Ong","year":"2022","journal-title":"Sex Health"},{"key":"2026082623463492500_R19","unstructured":"Veritas Health Innovation. Covidence systematic review software. Melbourne: Veritas Health Innovation; 2025."},{"issue":"1","key":"2026082623463492500_R20","doi-asserted-by":"publisher","DOI":"10.3390\/pharmacy13010030","article-title":"A Pilot Study Evaluating the Impact of an Algorithm-Driven Protocol on Guideline-Concordant Antibiotic Prescribing in a Rural Primary Care Setting.","volume":"13","author":"Nkemdirim Okere","year":"2025","journal-title":"Pharmacy"},{"key":"2026082623463492500_R21","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/1860542","article-title":"Prescription of Antibiotics to Treat Gonorrhoea in General Practice in Flanders 2009-2013: A Registry-Based Retrospective Cohort Study.","volume":"2017","author":"Schweikardt","journal-title":"J Sex Transm Dis"},{"issue":"5","key":"2026082623463492500_R22","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1097\/OLQ.0000000000001930","article-title":"Treatment Rates for Chlamydia trachomatis and Neisseria gonorrhoeae in a Metropolitan Area: Observational Cohort Analysis.","volume":"51","author":"Dixon","year":"2024","journal-title":"Sex Transm Dis"},{"key":"2026082623463492500_R23","unstructured":"Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines, 2021. CDC; 2021."},{"issue":"5","key":"2026082623463492500_R24","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-007776","article-title":"Diagnosis and treatment of chlamydia and gonorrhoea in general practice in England 2000-2011: A population-based study using data from the UK Clinical Practice Research Datalink.","volume":"5","author":"Wetten","year":"2015","journal-title":"BMJ Open"},{"issue":"1","key":"2026082623463492500_R25","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-019-0900-9","article-title":"Trends in antimicrobial management of gonorrhoea by general practitioners in Amsterdam, the Netherlands, between 2010 and 2016: a cross-sectional study.","volume":"20","author":"van Amerongen","year":"2019","journal-title":"BMC Fam Pract"},{"issue":"6","key":"2026082623463492500_R26","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1071\/SH23096","article-title":"The chlamydia care cascade of young people attending Australian general practices; a descriptive study to assess gaps in care.","volume":"20","author":"Jung","year":"2023","journal-title":"Sex Health"},{"issue":"6","key":"2026082623463492500_R27","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1111\/imj.13433","article-title":"Treatment of gonorrhoea in Auckland, New Zealand: marked variation in prescriber adherence to treatment guidelines.","volume":"47","author":"Forster","year":"2017","journal-title":"Int Med J"},{"issue":"8","key":"2026082623463492500_R28","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0202267","article-title":"A mixed methods study of non-occupational post-exposure prophylaxis at an STI clinic in Singapore: Five-year retrospective analysis and providers\u2019 perspectives.","volume":"13","author":"Teo","year":"2018","journal-title":"PLoS One"},{"issue":"10","key":"2026082623463492500_R29","doi-asserted-by":"publisher","first-page":"812","DOI":"10.7196\/SAMJ.2022.v112i10.16397","article-title":"Improving primary care antimicrobial stewardship by implementing a peer audit and feedback intervention in Cape Town community healthcare centres.","volume":"112","author":"de Vries","year":"2022","journal-title":"S Afr Med J"},{"issue":"12","key":"2026082623463492500_R30","doi-asserted-by":"publisher","first-page":"1174","DOI":"10.1177\/09564624211022583","article-title":"Mycoplasma genitalium: test positivity in syndromic presentations and clinicians\u2019 adherence with treatment guidelines at Sydney Sexual Health Centre.","volume":"32","author":"Cheung","year":"2021","journal-title":"Int J STD AIDS"},{"issue":"7","key":"2026082623463492500_R31","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1136\/sextrans-2024-056120","article-title":"Unnecessary antibiotic use in men who have sex with men (MSM) with anogenital symptoms attending a sexual health clinic: a retrospective analysis.","volume":"100","author":"Wong","year":"2024","journal-title":"Sex Transm Infect"},{"issue":"1","key":"2026082623463492500_R32","doi-asserted-by":"publisher","DOI":"10.1071\/SH24140","article-title":"The gonorrhoea care cascade in general practice: a descriptive study to explore gonorrhoea management utilising electronic medical records.","volume":"22","author":"Jung","year":"2025","journal-title":"Sexual Health"},{"issue":"2","key":"2026082623463492500_R33","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1370\/afm.240164","article-title":"Treatment of Chlamydia and Gonorrhea in Primary Care and Its Patient-Level Variation: An American Family Cohort Study.","volume":"23","author":"Hao","year":"2025","journal-title":"Ann Fam Med"},{"issue":"7","key":"2026082623463492500_R34","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1177\/09564624221097751","article-title":"Factors associated with non-guideline-adherent treatment for gonorrhea and chlamydia among outpatient prescriptions in the United States.","volume":"33","author":"Sittig","year":"2022","journal-title":"Int J STD AIDS"},{"issue":"8","key":"2026082623463492500_R35","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1097\/OLQ.0000000000000309","article-title":"Management of Pelvic Inflammatory Disease in Selected U.S. Sexually Transmitted Disease Clinics: Sexually Transmitted Disease Surveillance Network, January 2010-December 2011.","volume":"42","author":"Llata","year":"2015","journal-title":"Sex Transm Dis"},{"issue":"6","key":"2026082623463492500_R36","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2026.01.011","article-title":"Identifying indicators for measuring appropriateness of antibiotic prescribing in high-income countries: a rapid systematic review.","volume":"32","author":"Berry","year":"2026","journal-title":"Clinical Microbiology and Infection"},{"issue":"4","key":"2026082623463492500_R37","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1016\/j.ajem.2019.10.018","article-title":"Factors associated with unsuccessful follow-up in patients undertreated for gonorrhea and chlamydia infections.","volume":"38","author":"Burkins","year":"2020","journal-title":"Am J Emerg Med"},{"issue":"1","key":"2026082623463492500_R38","doi-asserted-by":"publisher","DOI":"10.1186\/s43058-025-00780-3","article-title":"Implementability of clinical practice guidelines: the review and development of a Comprehensive Framework for Guideline Implementability (CFGI).","volume":"6","author":"Zhong","year":"2025","journal-title":"Implement Sci Commun"},{"key":"2026082623463492500_R39","doi-asserted-by":"crossref","unstructured":"Pereca J, N\u2019Dow J, Omar MI. The Importance of Clinical Practice Guidelines. Springer Nature Switzerland; 2025. p. 3\u201313.","DOI":"10.1007\/978-3-031-55405-6_1"},{"issue":"1","key":"2026082623463492500_R40","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-062158","article-title":"Barriers and enablers to implementing clinical practice guidelines in primary care: an overview of systematic reviews.","volume":"13","author":"Wang","year":"2023","journal-title":"BMJ Open"},{"issue":"3","key":"2026082623463492500_R41","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1016\/j.sapharm.2025.11.002","article-title":"Impact of Pharmacist-Led Antibiotic Stewardship Audit-Feedback Intervention; Systematic Review and Meta-analysis.","volume":"22","author":"Jawhar","year":"2025","journal-title":"Res Soc Adm Pharm"},{"issue":"2","key":"2026082623463492500_R42","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1093\/cid\/ciae604","article-title":"Audit and Feedback Interventions for Antibiotic Prescribing in Primary Care: A Systematic Review and Meta-analysis.","volume":"80","author":"Xu","year":"2025","journal-title":"Clin Infect Dis"},{"key":"2026082623463492500_R43","unstructured":"World Health Organization. Laboratory and point-of-care diagnostic testing for sexually transmitted infections, including HIV. Geneva: World Health Organization; 2023. Report No.: 978-92-4-007708-9."},{"key":"2026082623463492500_R44","unstructured":"World Health Organization. Diagnostic stewardship: a guide to implementation in antimicrobial resistance surveillance sites. Geneva: World Health Organization; 2016."},{"key":"2026082623463492500_R45","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr6506a1","article-title":"Core Elements of Outpatient Antibiotic Stewardship.","volume":"65","author":"Sanchez","year":"2016","journal-title":"MMWR Recomm Rep"},{"issue":"1","key":"2026082623463492500_R46","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-023-01279-z","article-title":"Best practice guidance for antibiotic audit and feedback interventions in primary care: a modified Delphi study from the Joint Programming Initiative on Antimicrobial resistance: Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN).","volume":"12","author":"Schwartz","year":"2023","journal-title":"Antimicrob Resist Infect Control"},{"key":"2026082623463492500_R47","unstructured":"Australasian Society for HIV Viral Hepatitis and Sexual Health Medicine (ASHM) Health. Fifth National Sexually Transmissible Infections Strategy 2024\u20132030 \u2013 consultation draft. Sydney: Care Department of Health and Aged Care; 2024."},{"issue":"11","key":"2026082623463492500_R48","doi-asserted-by":"publisher","first-page":"1344","DOI":"10.5858\/arpa.2020-0118-RA","article-title":"Point-of-care testing for sexually transmitted infections: a review of recent developments.","volume":"144","author":"Adamson","year":"2020","journal-title":"Arch Pathol Lab Med"},{"issue":"Supplement_1","key":"2026082623463492500_R49","doi-asserted-by":"publisher","first-page":"S43","DOI":"10.1093\/cid\/ciaf699","article-title":"Point-of-care Tests for Chlamydia trachomatis and Neisseria gonorrhoeae: Review of the Literature.","volume":"82","author":"Manabe","year":"2026","journal-title":"Clin Infect Dis"},{"key":"2026082623463492500_R50","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2025-056736","article-title":"Point-of-care testing for chlamydia and gonorrhoea: a narrative review of patient perspectives and implementation into non-traditional settings.","author":"Griner","year":"2026","journal-title":"Sex Transm Infect"}],"container-title":["Sexual Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/connectsci.au\/sh\/article-pdf\/doi\/10.1071\/SH26138\/1949866\/sh26138.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/connectsci.au\/sh\/article-pdf\/doi\/10.1071\/SH26138\/1949866\/sh26138.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T03:46:37Z","timestamp":1787802397000},"score":1,"resource":{"primary":{"URL":"https:\/\/connectsci.au\/sh\/article\/23\/5\/SH26138\/275753\/Antimicrobial-prescribing-quality-for-sexually"}},"subtitle":[],"editor":[{"given":"Jami","family":"Leichliter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,27]]},"references-count":50,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10,20]]}},"URL":"https:\/\/doi.org\/10.1071\/sh26138","relation":{},"ISSN":["1448-5028","1449-8987"],"issn-type":[{"value":"1448-5028","type":"print"},{"value":"1449-8987","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,27]]},"article-number":"SH26138"}}