Abstract
BackgroundCurrent routine surveillance schemes for sexually transmitted infections (STIs) in the United Kingdom (UK) are not designed for outbreak identification. Recognising STI outbreaks, therefore, depends almost entirely on the alertness of health professionals. The objective of this study was to explore health professionals' knowledge of, and attitudes towards, identification and investigation of STI outbreaks in Wales.MethodsWe conducted a cross-sectional survey in Wales in June 2005, and sent a questionnaire to consultants of genitourinary medicine (GUM, n = 11), a consultant microbiologist from each laboratory (n = 14), all consultants in communicable disease control (n = 5), and to epidemiologists of the National Public Health Service (n = 4).Results26 (76%) of 34 survey recipients responded. Of these, 17 (65%) ranked the investigation of STI outbreaks as important or very important, and 19 (73%) perceived participation in the investigation of an STI outbreak as part of their responsibility. Only six (25%) respondents had actively searched their computer system or patient records for a possible STI outbreak in the previous twelve months, and 15 (63%) had never looked for an outbreak. Of seven GUM physicians who said they had identified at least one STI outbreak, three had never informed public health authorities.ConclusionPrompt identification and coordinated investigation of outbreaks, usually through a multidisciplinary outbreak control team, is central to the control of many infectious diseases. This does not appear to be the case for STIs, which we believe represents a lost opportunity to reduce transmission. Besides improved surveillance methods, a change in culture towards STI outbreaks is needed among health professionals in Wales.
Highlights
Current routine surveillance schemes for sexually transmitted infections (STIs) in the United Kingdom (UK) are not designed for outbreak identification
Each year more than 1.5 million new episodes of STIs are seen in genitourinary medicine (GUM) clinics[1], an increasing number are diagnosed in primary care in the UK [2]
A questionnaire with a prepaid reply envelope, and a reminder letter three weeks later, was sent to all consultants in GUM (n = 11), to all consultants in communicable disease control (CCDC, n = 5), to a consultant microbiologist of each laboratory (n = 14), and to four senior epidemiologists working at the Communicable Disease Surveillance Centre of the National Public Health Service, including the three regional epidemiologists for Wales
Summary
Current routine surveillance schemes for sexually transmitted infections (STIs) in the United Kingdom (UK) are not designed for outbreak identification. The mainstay of current surveillance of STIs in the UK is a quarterly statistical return (the KC60 form) completed by all GUM clinics [3] This includes aggregate data on numbers of new patients seen by diagnostic category but is insufficiently detailed or timely for outbreak identification. Data are available from voluntary laboratory reporting of confirmed STIs, but not all laboratories report, clinical information on cases is often very limited, and subtyping of isolates is not routinely available. This means that recognising possible STI outbreaks depends almost entirely on the alertness of health professionals
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