Concept: Gonorrhea - Method of Identification

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Concept Description

Last Updated: 2019-01-17

Introduction
    This concept provides a working definition of gonorrhea and describes the methods used at MCHP to investigate gonorrhea in the administrative data held in the Manitoba Population Research Data Repository. The concept lists the ICD-9-CM and ICD-10-CA diagnostic codes to identify gonorrhea in the hospital abstracts data and the medical services data, and lists the codes that are used in laboratory tests to investigate its presence in the population. SAS code (internal access only) is also available for working with the laboratory data.
Definition of Gonorrhea
MCHP Gonorrhea Algorithms
    The following methods have been used at MCHP to identify testing and to identify individuals with gonorrhea.
1. Brownell et al. (2012)
    In Brownell et al. (2012), the percent of youths aged 13 to 19 years with at least one positive detection for gonorrhea in the Cadham Provincial Laboratory (CPL) database in the fiscal year 2008/09 was examined. A positive detection was defined as:

    • Neisseria gonorrhoeae identified in the Clinical Microbiology Section - Organism file (see Table 1 for the AUXCD5 code), OR

    • Neisseria gonorrhoeae isolated beta lactamase negative, Neisseria gonorrhoeae beta lactamase positive, Neisseria gonorrhoeae detected, or presumptive Neisseria gonorrhoeae detected from the Clinical Microbiology Section - Results file (see Table 2 for the AUXCD5 codes).

      NOTE: Table 3 lists the gonorrhea tests available in the Serology Section of the CPL data. In Brownell et al. (2012) , this was investigated and reviewed but not included as part of the gonorrhea results.

    The percent of youths with at least one positive detection for gonorrhea in Manitoba was higher for females (0.4%) than for males (0.2%) (p<0.01) with a provincial average of 0.3%. The lowest frequency was in the Rural South (0.08%) and the highest was in the North (1.2%). A Socioeconomic Status (SES) gradient for gonorrhea in rural areas was identified with the highest percentage found in the areas with the lowest income. Furthermore, the lowest income quintiles had much higher positive gonorrhea detection in both urban and rural areas. For more information read the section Gonorrhea in Brownell et al. (2012) .
Table 1 - Gonorrhea: Clinical Microbiology Section - Organism
    STARTDT 1 STOPDT 2 AUXCD5 DESCR40
    4/10/1992 1/1/2099 NG NEISSERIA GONORRHOEAE

    1 - The date that the code was created in the file.
    2 - The date that the code became inactive.

Table 2 - Gonorrhea: Clinical Microbiology Section - Results
    STARTDT 1 STOPDT 2 AUXCD5 DESCR70
    4/10/1992 1/01/2099 FAT F.A. TEST FOR N.GONORRHOEAE POS. UNABLE TO CONFIRM. CULTURE NON-VIABLE
    8/20/2004 1/01/2099 GRNR GONORRHEA RESULT NOT REPORTED
    4/10/1992 1/01/2099 GRU GONORRHOEA RESULT UNINTERPRETABLE. PLEASE REPEAT
    4/10/1992 1/01/2099 NGBLN N. GONORRHOEAE ISOLATED. BETA LACTAMASE NEGATIVE
    4/10/1992 1/01/2099 NGBLP N. GONORRHOEAE ISOLATED. BETA LACTAMASE POSITIVE
    4/10/1992 1/01/2099 NGD NEISSERIA GONORRHOEAE DETECTED
    4/10/1992 1/01/2099 NGND NEISSERIA GONORRHOEAE NEGATIVE
    4/10/1992 1/01/2099 NGNI N. GONORRHOEAE NOT ISOLATED
    4/10/1992 4/10/1992 NGP N. GONORRHOEAE POSITIVE
    5/13/2002 1/01/2099 NGRIN GONORRHOEAE RESULT INDETERMINATE
    2/20/2002 1/01/2099 NGRU NEISSERIA GONORRHOEAE RESULTS UNAVAILABLE
    4/04/2002 1/01/2099 PNG PRESUMPTIVE NEISSERIA GONORRHOEAE DETECTED
    4/10/1992 4/10/1992 PP PRESUMPTIVE POSITIVE FOR N.GONORRHOEAE. INTERPRETATION IS DEPENDANT ON
    7/17/1997 1/01/2099 RNG RE:ANTIGEN TESTING FOR N. GONORRHOEAE.

    1 - The date that the code was created in the file.
    2 - The date that the code became inactive.

Table 3 - Gonorrhea: Serology Section
    STARTDT 1 STOPDT 2 AUXCD5 DESCR40
    01/01/1990 11/07/1994 GON N.GONORRHEA
    11/07/1994 05/01/2006 GONO ANTIBODY TO N.GONORRHEA

    1 - The date that the code was created in the file.
    2 - The date that the code became inactive.
2. Lix et al. (2012)
    In Lix et al. (2012), the Cadham Provincial Laboratory (CPL) data from 1992/93 to 2008/09 was used to identify the total number of gonorrhea tests and the frequency of positive tests (laboratory-confirmed cases) by fiscal year in Manitoba. Less than 3% of all gonorrhea tests were positive in each of the study years. For more information on CPL, see the CADHAM Provincial Laboratory (CPL) - Overview of Services and Data concept.

    Data from the CPL Clinical Microbiology Section - Organism file was used to identify the pathogenic bacterium Neisseria gonorrhoeae . Table 1 reports the AUXCD5 code for this organism. The Clinical Microbiology Section - Results file was used to identify the CPL number of gonorrhea tests and the frequency of positive laboratory-confirmed cases in Manitoba. Table 2 lists the AUXCD5 codes used to report the results of these tests.
Comparison of Lab Data to Hospital Discharge Abstracts and Medical Services Data
SAS Code
    SAS code for identifying gonorrhea tests in the Cadham Provincial Laboratory is available in the SAS code and formats section below (internal access only).
Limitations / Cautions
  • CPL performs virtually all tests for gonorrhea in Manitoba, but laboratory data may not capture all gonorrhea cases in a jurisdiction.

  • In the Medical Services / Physician Claims data, the diagnosis recorded is limited to one, 3-digit ICD-9-CM code. In some cases, the 3-digit code is not specific enough to uniquely identify conditions and if used, may over report certain conditions. NOTE: In December 2018, a 5-digit diagnosis code variable was added to the Medical Services data. If recorded, the first 3-digits of both the 3-digit and 5-digit diagnosis code variables will match exactly. The 5-digit diagnosis code variable applies to records from 2015/16 forward.

  • A value of P [Positive] to identify a positive test result in the POSNEG field [Positive-Negative] or the presence of specific AUXCD5 codes for gonorrhea detection in the CPL data was used to determine if an individual was positive for gonorrhea.

  • The AUXCD5 codes used to identify gonorrhea in the CPL data should be verified at the beginning of each new study to ensure they are up-to-date.

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References 

  • Brownell M, Chartier M, Santos R, Ekuma O, Au W, Sarkar J, MacWilliam L, Burland E, Koseva I, Guenette W. How are Manitoba's Children Doing? Winnipeg, MB: Manitoba Centre for Health Policy, 2012. [Summary] [Full Report] [Data extras] [Errata] (View)
  • Chin J. Control of communicable diseases manual. 17th Edition. Washington, D.C: American Public Health Association; 2000.(View)
  • Dickerson MB, Johnston J, Delea TE, White A, Andrews E. The casual role for genital ulcer disease as a risk factor for transmission of human-immunodeficiency virus: An application of the Bradford Hill Criteria. Sexually Transmitted Diseases 1996;23(5):429-440.(View)
  • Lix L, Smith M, Azimaee M, Dahl M, Nicol P, Burchill C, Burland E, Goh C, Schultz J, Bailly A. A Systematic Investigation of Manitoba's Provincial Laboratory Data. Winnipeg, MB: Manitoba Centre for Health Policy, 2012. [Summary] [Full Report] (View)
  • Merck Research Laboratories. The Merck Manual of Diagnosis and Therapy. 16th ed. In: Berkow R, Fletcher AJ (ed). Rahway, NJ: Merck Research Laboratories; 1992.(View)