Background Clinical guidelines for sexually transmissible proctitis can provide a framework for testing, clinical management, antimicrobial stewardship, public health control and opportunities for sexual health interventions. This review aimed to evaluate the currently available clinical guidelines for sexually transmissible proctitis and highlight any areas for improvement. Method An online search for clinical guidelines was reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, followed by an evaluation using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool by six independent reviewers. An AGREE II domain score of >60% is the threshold for sufficient quality, and each guideline was rated high, medium or low based on the domain percentages (5 domains scoring >60%=high, 3–4 domains scoring >60%=medium, ≤2 domains scoring >60%=low). A bespoke quality framework for sexually transmissible proctitis guidelines was developed and applied to each guideline assessing microbiology testing, partner notification, sexual health interventions (including a period of sexual abstinence) and antimicrobial recommendations. Results Nine clinical guidelines (UK-British Association for Sexual Health and HIV (BASHH), WHO, Europe-International Union Against Sexually Transmitted Infection (IUSTI), USA-Centers for Disease Control and Prevention (CDC), Australia-Australasian Society for HIV, Viral Hepatitis and Sexual Health (ASHM), Spain-Spanish Academy of Dermatology and Venereology (EADV), Eswatini, India, Canada) were included in the analysis, and the overall median domain score was 56% (IQR=31–72), domain 1 scope and purpose 65% (IQR=56–71), domain 2 stakeholder involvement 44% (IQR=35–61), domain 3 rigour of development 32% (IQR=26–58), domain 4 clarity of presentation 77% (IQR=72–81), domain 5 applicability 31% (IQR=29–39) and domain 6 editorial independence 44% (IQR=14–69). The overall median scores out of 7 and rating (low, medium, high) were: UK-BASHH (6, high), WHO (7, medium), Europe-IUSTI (5, medium), USA-CDC (5, medium), Australia-ASHM (4, low), Spain-EADV (3, low) Eswatini (2, low), India (3, low), and Canada (4, low). Six guidelines made recommendations on all of the bespoke framework domains (UK-BASHH, Europe-IUSTI, USA-CDC, Australia-ASHM, Spain-EADV & India). Conclusion Future clinical guidelines for sexually transmissible proctitis require greater consistency to improve their applicability, rigour of development, editorial independence and stakeholder involvement.
Macdonald et al. (Mon,) studied this question.