Availability of the laboratory diagnosis of gonorrhea and its meaning in case reporting in Shandong Province, China

Abstract Background: Gonorrhea, which is caused by the bacterium Neisseria gonorrhea (NG), is a major public health concern worldwide. The aim of this study is to understand the availability of the laboratory diagnosis of gonorrhea in Shandong Province and its meaning in case reporting. Methods: Two surveys were conducted among hospitals providing clinical services for patients with sexually transmitted infections (STIs) in Shandong Province in 2012 and 2018. The availability of laboratory tests for NG and the distribution of reported gonorrhea cases among different hospitals providing clinical services for patients with STIs in Shandong Province were compared. Descriptive analysis and chi-square test were used for statistical analysis. Results: Smear, culture, and PCR tests for NG were used in 301 (74.69%), 123 (30.52%), and 43 (10.67%) hospitals in 2012 and in 356 (74.48%), 176 (36.82%), and 73 (15.27%) hospitals in 2018. Significant differences were observed in the availability of smear tests among hospitals with different levels (X2 = 12.159, p = 0.000) and with different affiliations (X2 = 4.551, p = 0.033) in 2018. Significant differences were observed in the availability of culture and PCR tests among hospitals at different levels in 2012 (X2 = 34.532, p = 0.000; X2 = 7.380, p = 0.007) and 2018 (X2 = 49.820, p = 0.000; X2 = 21.658, p = 0.000). The availability of culture and PCR tests for NG in hospitals in 2018 was higher than that in 2012 (X2 = 3.870, p = 0.049; X2 = 4.050, p = 0.044). More hospitals reported gonorrhea cases in 2018 than that in 2012 (X2 = 6.768, p = 0.009). A significant difference was observed in the distribution of case reporting among hospitals at different levels in 2018 (X2 = 6.975, p = 0.008) and among different types of hospital in 2012 (X2 = 52.362, p = 0.000) and 2018 (X2 = 74.478, p = 0.000). Conclusions: The poor availability of NG laboratory tests affects case reporting and is a crucial reason that leads to the high sex ratio and under-reporting of gonorrhea cases in Shandong Province.