Incidence Of Gonorrhea Research Articles

Analysis of the sex ratio of reported gonorrhoea incidence in Shenzhen, China

ObjectiveTo assess the clinical process of gonorrhoea diagnosis and report in China, and to determine the difference of sex ratio between reported incidence based on reporting data and true diagnosis...

Association between sexually transmitted disease and church membership. A retrospective cohort study of two Danish religious minorities

ObjectivesStudies comprising Danish Seventh-day Adventists (SDAs) and Danish Baptists found that members have a lower risk of chronic diseases including cancer. Explanations have pointed to differences in lifestyle, but detailed...

Assessing Trends in Chlamydia Positivity and Gonorrhea Incidence and Their Associations With the Incidence of Pelvic Inflammatory Disease and Ectopic Pregnancy in Washington State, 1988-2010.

Chlamydia and gonorrhea screening for women is beneficial if it prevents serious reproductive sequelae, such as pelvic inflammatory disease (PID) and ectopic pregnancy (EP). We assessed trends in PID and EP among women in Washington and their association with gonorrhea incidence and chlamydia positivity in a screened population of women over a 23 year period. Using data on chlamydia positivity from the Infertility Prevention Project, gonorrhea incidence from state surveillance, and PID and EP hospitalizations from hospital discharge records, we assessed trends in each condition over time. In addition, we estimated total incidence of PID and EP by incorporating information on outpatient-treated cases in alternative populations using a Bayesian approach that accounted for uncertainty in the estimates. We assessed associations between each infection and PID/EP using a linear regression model that accounts for year-to-year correlation in data points. We observed substantial declines in both infections and in each outcome over time. For every 2% decrease in chlamydia positivity, there was a 35.7/100,000 decrease in estimated total PID incidence (P = 0.058) and 184.4/100,000 decrease in estimated total EP (P = 0.149). For every 32/100,000 decline in gonorrhea incidence, there was a 16.5/100,000 decrease in total PID (P = 0.292) and 159.8/100,000 decrease in total EP (P = 0.020). The associations with inpatient PID and EP were highly significant for both chlamydia and gonorrhea. These ecological data note concurrent and substantial declines in chlamydia positivity and gonorrhea incidence, and in PID and EP incidence in Washington from 1988 to 2010 during a time when widespread chlamydia screening was ongoing.

Seasonal variation in gonorrhoea incidence among men who have sex with men.

This study was a retrospective analysis of computerised records at the three Australian sexual health services. Potential risk factors for urethral gonorrhoea among MSM were also reviewed at the SASSH. More peaks of gonorrhoea cases were observed in the first quarter of the year in Adelaide and Sydney and in the second and fourth quarter in Melbourne. Factors independently associated with urethral gonorrhoea at the SASSH were being a young MSM, especially those aged 25-29 (odds ratio (OR) 2.66, 95% confidence interval (CI): 2.00-3.54), having more than one sexual partner (OR 1.71, 95% CI: 1.43-2.04), having had sex interstate and overseas (OR 1.52, 95% CI: 1.06-2.17), and presenting in the first quarter (OR 1.30, 95% CI: 1.10-1.55). Our data suggest that gonorrhoea among MSM occurs in a seasonal pattern, particularly late summer into early autumn. This has implications for the provision of health services over the year and for the timing of health promotion activities.

Duration of gonorrhoea and chlamydia infection at the pharynx and rectum among men who have sex with men: a systematic review.

Background Chlamydia and gonorrhoea are the two most common sexually transmissible infections (STI) among men who have sex with men (MSM) worldwide. Infections at the pharynx and rectum are usually asymptomatic; however, the natural history of these infections remains unknown. The aim of this study is to estimate the duration of both infections at the extragenital sites from published epidemiological cohort studies. English peer-reviewed articles were searched from 1 January 2000 to 12 March 2015 in three electronic databases (MEDLINE, EMBASE and Cochrane Central). The prevalence-to-incidence ratio from each study was calculated to reflect the duration of each infection. This review followed the PRISMA guidelines and was registered in PROSPERO (CRD42014007087). There were 2585 records identified, with 1721 abstracts and 52 full-text articles screened, resulting in four studies fulfilling the inclusion criteria. Pharyngeal gonorrhoea (114-138 days) had a shorter duration of infection than rectal gonorrhoea (346 days). In addition, chlamydia had a longer duration of infection at the pharynx (667 days) and rectum (579 days) compared with gonorrhoea infection. Gonorrhoea has a shorter duration of infection than chlamydia, suggesting that annual STI screening will be more effective at diagnosing chlamydia than gonorrhoea. The current STI guidelines recommend screening gonorrhoea and chlamydia at least once a year in MSM; it would only detect ~30% of incident pharyngeal gonorrhoea cases, with a mean duration of 4 months.

Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting.

BackgroundQuantifying sexually transmitted infection (STI) prevalence and incidence is important for planning interventions and advocating for resources. The World Health Organization (WHO) periodically estimates global and regional prevalence and incidence of four curable STIs: chlamydia, gonorrhoea, trichomoniasis and syphilis.Methods and FindingsWHO’s 2012 estimates were based upon literature reviews of prevalence data from 2005 through 2012 among general populations for genitourinary infection with chlamydia, gonorrhoea, and trichomoniasis, and nationally reported data on syphilis seroprevalence among antenatal care attendees. Data were standardized for laboratory test type, geography, age, and high risk subpopulations, and combined using a Bayesian meta-analytic approach. Regional incidence estimates were generated from prevalence estimates by adjusting for average duration of infection. In 2012, among women aged 15–49 years, the estimated global prevalence of chlamydia was 4.2% (95% uncertainty interval (UI): 3.7–4.7%), gonorrhoea 0.8% (0.6–1.0%), trichomoniasis 5.0% (4.0–6.4%), and syphilis 0.5% (0.4–0.6%); among men, estimated chlamydia prevalence was 2.7% (2.0–3.6%), gonorrhoea 0.6% (0.4–0.9%), trichomoniasis 0.6% (0.4–0.8%), and syphilis 0.48% (0.3–0.7%). These figures correspond to an estimated 131 million new cases of chlamydia (100–166 million), 78 million of gonorrhoea (53–110 million), 143 million of trichomoniasis (98–202 million), and 6 million of syphilis (4–8 million). Prevalence and incidence estimates varied by region and sex.ConclusionsEstimates of the global prevalence and incidence of chlamydia, gonorrhoea, trichomoniasis, and syphilis in adult women and men remain high, with nearly one million new infections with curable STI each day. The estimates highlight the urgent need for the public health community to ensure that well-recognized effective interventions for STI prevention, screening, diagnosis, and treatment are made more widely available. Improved estimation methods are needed to allow use of more varied data and generation of estimates at the national level.

Home Screening for Bacterial Vaginosis to Prevent Sexually Transmitted Diseases.

Longitudinal studies have consistently found a significant association between bacterial vaginosis (BV) and acquisition of sexually transmitted diseases. However, there are limited prospective data to confirm these findings. We conducted a prospective, randomized, open-label trial of home screening and treatment of young women with asymptomatic BV who were also at high risk for sexually transmitted diseases. These women were screened every 2 months for 12 months and randomized to treatment with oral metronidazole 500 mg twice daily for 7 days or observation alone. The primary outcome was the incidence of gonorrhea and/or chlamydia. A total of 1365 subjects were enrolled in the study across 10 sites. Adherence with mailing specimens obtained at home was excellent in both groups (84%-88%). The incidence of gonorrhea and/or chlamydia was 19.1 per 100 person-years (95% confidence interval, 15.1-22.1) for the treatment group and 18.5 per 100 person-years (15.1-22.8) for the observation arm, a difference that was not statistically significant. Young women were very amenable to home screening for BV, gonorrhea, and chlamydia. Treatment of asymptomatic BV with 1 week of oral metronidazole did not decrease the incidence of gonorrhea and/or chlamydia. NCT00667368.

LB1.4 Sti rates among gay men taking daily antiretrovirals for pre-exposure prophylaxis of hiv: the nsw demonstration project prelude

Introduction Pre-exposure prophylaxis (PrEP) prevents HIV infections but not other STIs. We assessed prevalence and incidence of STIs among PrEP users in the NSW demonstration study, PRELUDE. Methods By 14 July 2015, 268 gay and homosexually-identified men (GHM) were enrolled and started taking PrEP; 98 (36.6%) and 27 (10.1%) had reached three and six-month follow-up respectively. STI testing was conducted at baseline and quarterly follow-up visits. We calculated the baseline prevalence and incidence of STIs. The sample STI incidence will be compared with the population incidence in NSW. Results At enrolment, 17.2% of participants were diagnosed with ≥1 STI, including 10.8% with rectal gonorrhoea, rectal chlamydia and/or syphilis. The latter three STIs were diagnosed in 2.6%, 7.8%, and 1.1% of men, respectively. Among 98 men at 3-month follow-up, 17.3% were diagnosed with any of these STIs (3.1% had rectal gonorrhoea, 11.2% rectal chlamydia and 4.1% syphilis). At three months of follow-up, the incidence of these STIs was 18.4, 67.4 and 24.5 per 100 person-years (PY), respectively. By 14 July 2015, 27 PrEP users reached six months of follow-up. In this group, the incidence of rectal gonorrhoea was 29.6 per 100 PY (11.2% increase from month three follow-up, p Conclusion Among PrEP users in PRELUDE, the baseline prevalence and incidence of STIs were high and remained high in the early follow-up (indeed, the incidence of gonorrhoea has increased). Despite enrolment in a clinical study, with frequent follow-up, STI testing and treatment, PrEP users remain at very high risk of STIs. Longer follow-up is necessary to assess whether STI trends among PrEP users will change. The investigation of prophylaxis against other STIs and other methods of testing and treating STIs among these high-risk men appears to be warranted. Disclosure of interest statement The PRELUDE study is funded by the NSW Ministry of Health, with Gilead Sciences providing the study medication (Truvada).

P09.27 Epidemiology of gonorrhoea in china from 2000 to 2014

Introduction Since 1980s, sexually transmitted diseases (STD) reappeared in mainland China and the reported cases increased over years, the Ministry of Public Health set up national STD surveillance system to monitor trends. The results of surveillance showed that gonorrhoea was a prevalent STD and became an important public health issue. However, since 2000, incidence of gonorrhoea had decreased. In order to understand trends and epidemiological features of gonorrhoea recent 14 years in China, we conduct the analysis of data from the national system. Methods Through 2000 to 2014, gonorrhoea case-reporting data collected from 31 provinces, autonomous regions and municipalities in China were analysed with descriptive epidemiological methods. Results During 2000–2014, the trends of reported gonorrhoea incidence appeared declined totally, from 22.92 per 100,000 population in 2000 to 7.25 per 100,000 population in 2014, with the annual average decrease of 7.89%. There was a significant difference in gonorrhoea incidence in different regions. High incidence regions were Yangtze River delta (Zhejiang, Shanghai, Jiangsu), Zhujiang River delta (Guangdong, Guangxi, Hainan), and then the northwest minority areas (Xinjiang, Ningxia, Inner Mongolia). The gonorrhoea incidences in male were higher than that in female, and the sex ratio of male to female has been increasing, from 1.96:1 in 2000 to 4.52:1 in 2014. The incidence of gonorrhoea in 20–44 aged sex active population was peak among all age groups, maximum in 25–29 age-group for male and female, and it presented decreased in all age groups except 15–19 age-group of male with increase of 4.18%. Among 20 kinds of occupations, the proportion of the reported gonorrhoea cases for peasant workers was highest, accounting for 26.00%, and the gonorrhoea incidences in all occupation groups were downtrend. Conclusion Gonorrhoea remained being a major issue of public heath in China, the preventive measures should be effectively tailored in the light of gonorrhoea epidemiological features. Disclosure of interest statement No potential conflicts of interest.

The Incidence of Gonorrhea in Belgrade in the Period 2010 - 2014

Abstract The World Health Organization (WHO) estimated that in 2008 there were 106.1 million newly registered cases of gonorrhea among adults worldwide. Of these cases, 3.4 million were in the WHO European Region. In the European Union and European Economic Area, the overall incidence of reported cases was 15.3 per 100.000 population in 2012; the highest rate (45.4 per 100.000) was observed in the United Kingdom, while low rates (<5 per 100.000) were generally reported in the Central and Eastern Europe. In 2012, low incidence of gonorrhea (1.49/100.000) was reported in Serbia, as well. The purpose of this study was to report on the epidemiology of gonorrhea in a Belgrade population (about 1.5 million inhabitants) during the period 2010 - 2014, and to discuss data on gonorrhea rates in the European Union. In Serbia it is mandatory to report gonorrhea, and all reports of culture-proved gonorrhea are sent to the City Institute for Public Health in Belgrade. These reports were used as the source for data analysis of gonorrhea incidence. Incidence rates were calculated using data from the 2011 population census in Serbia for Belgrade population. Age-adjusted annual incidence rates were carried out by a direct method using the “world population” as a standard. During the 2010 - 2014 period, the average gonorrhea incidence in Belgrade population was 9.2 per 100.000 in men, and 1.9 per 100.000 in women. The incidence was highest in men and women aged 20 - 29 years. In all age groups gonorrhea incidence was higher in men than in women, the average male/female ratio being 4.8. In both sexes, the incidence of gonorrhea was highest in persons who had never married, with secondary education and unemployed. Out of 357 men with gonorrhea, 92 (25.77%) were self-reported homosexuals.

006.5 Periodic presumptive treatment for vaginal infections may reduce chlamydia and gonorrhoea incidence: a secondary analysis from the preventing vaginal infections trial

Background Women with bacterial vaginosis (BV) are at increased risk for sexually transmitted infections (STI), including Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Among women participating in a randomised trial of periodic presumptive treatment to reduce vaginal infections, we assessed the intervention effect on incident CT and GC infections. Methods Non pregnant, HIV-uninfected women aged 18–45 from the US and Kenya were randomised to receive intravaginal metronidazole 750 mg plus miconazole 200 mg or matching placebo for 5 consecutive nights each month for 12 months. Genital specimens were collected every other month. Baseline specimens were tested for CT/GC during the trial and follow-up specimens were tested after trial completion using the Aptima Combo-2 assay. Baseline STIs were treated according to local guidelines. Poisson regression models were used to assess the intervention effect on the outcomes separately and as a combined endpoint. Results Of 234 women enrolled, 221 (94%) had specimens available for analysis (intervention n = 110; placebo n = 111). Baseline CT and GC prevalence was 7% (n = 16) and 1% (n = 3), respectively, and similar by arm. Among 205 CT- participants, there were 21 incident CT infections during 179.6 person-years (CT incidence = 11.7/100 person-years), with lower CT incidence in the intervention arm versus placebo (7.8/100 person-years versus 15.6/100 person-years; incidence rate ratio [IRR] = 0.50, 95% CI 0.20–1.23). Among 218 GC- participants, GC incidence was 7.2/100 person-years (14 infections during 93.3 person-years) and also lower in the intervention arm (5.2/100 person-years versus 9.3/100 person-years; IRR = 0.56, 95% CI 0.19–1.67). Results were consistent when CT/GC was assessed as combined endpoint (IRR = 0.57; 95% CI 0.27–1.19). Conclusions This intervention, which significantly reduced BV over 12 months, may also reduce women’s STI acquisition risk. The small sample size in this secondary analysis precluded detection of significant associations, but generated point estimates for reductions in STIs that could inform the planning of future STI prevention trials Disclosure of interest statement R. S. M. has received honoraria for invited lectures and consulting as well as donated study product for this trial from Embil Pharmaceutical Company. R. S. M. currently receives research funding from Hologic/Gen-Probe. J. E. B. received honoraria from Symbiomix, Inc for consulting and donated reagents from Hologic/Gen-Probe. J. S. has received consultancy payments from Akesis, Hologic, Symbiomix, and Starpharma, and has grants/pending grants from Akesis, BD Diagnostic, Hologic, Cepheid, Quidel, Symbiomix, Starpharma, and Viamet. All other authors declare that they do not have a commercial or other association that might pose a conflict of interest.

S03.1 Global and regional estimates of chlamydia, gonorrhoea, trichomoniasis and syphilis in 2012

Background The World Health Organization (WHO) periodically estimates global and regional prevalence and incidence of four curable sexually transmitted infections (STIs): chlamydia, gonorrhoea, trichomoniasis and syphilis. Methods For chlamydia, gonorrhoea, and trichomoniasis, WHO estimates for 2012 were based upon literature reviews of prevalence data from 2005 through 2012 among general populations. For syphilis, nationally reported data on syphilis seroprevalence among antenatal care attendees were used. Data were adjusted for laboratory test type, geography, age, and high risk subpopulations, and combined using a Bayesian meta-analytic approach. Regional incidence estimates were generated from prevalence estimates by adjusting for average duration of infection. Results In 2012 the estimated global prevalence among women aged 15–49 years of chlamydia was 4.2% (95% uncertainty interval (UI): 3.7–4.7%), gonorrhoea 0.8% (0.6–1.0%), trichomoniasis 5.0% (4.0–6.4%), and syphilis 0.5% (0.4–0.6%); among men, estimated chlamydia prevalence was 2.7% (2.0–3.6%), gonorrhoea 0.6% (0.4–0.9%), trichomoniasis 0.6% (0.4–0.8%), and syphilis 0.48% (0.3–0.7%). These figures correspond to an estimated 131 million new cases of chlamydia (100–166 million), 78 million of gonorrhoea (53–110 million), 143 million of trichomoniasis (98–202 million), and 6 million of syphilis (4–8 million) in 2012. Prevalence and incidence estimates varied by region and sex. Conclusions Estimated global prevalence and incidence of chlamydia, gonorrhoea, trichomoniasis, and syphilis in adult women and men remain high, with nearly one million new infections each day. These estimates highlight the urgent need for well-recognized effective interventions for STI prevention, screening, diagnosis, and treatment to be made more widely available. Improved estimation methods are needed to allow use of more varied data and to generate national-level estimates.

P11.16 Denominators matter: trends inneisseria gonorrhoeaeincidence among gay, bisexual and other men who have sex with men (gbmsm) in the us – findings from the std surveillance network (ssun) 2010–2013

Introduction Inequalities in Neisseria gonorrhoeae burden by sexual minority status have been observed in the United States but are difficult to characterise. GBMSM status of gonorrhoea cases is not routinely collected for reported cases and GBMSM population estimates at the level of geography necessary to most usefully inform public health responses are not readily available. Incidence trends and inequalities among GBMSM have not been described across multiple jurisdictions. Methods A random sample of reported gonorrhoea cases was interviewed and weighted to estimate GBMSM status of all cases reported in 12 geographically disparate states and/or cities collaborating in SSuN. Census and Gallup opinion polling data were used to estimate size of GBMSM, heterosexual male and female populations by age group at the state, county and city level for 2010–2013. Incidence rates and rate-ratios were calculated comparing incidence trends among GBMSM, heterosexual males and females. Results The estimated size of GBMSM population varied across SSuN jurisdictions from 2.8% of males in Alabama to 15.4% in San Francisco. The proportion of male gonorrhoea cases attributable to GBMSM also varied by jurisdiction (range: 13.6% to 92.4%). GBMSM incidence increased in SSuN sites from 1,169.7 cases per 100,000 in 2010 to 1,474.4 in 2013, increased modestly among heterosexual men and remained stable among females at 106 cases per 100,000. The rate-ratio of GBMSM to females and to heterosexual men during the study period ranged from 10.7 to 13.9. The highest incidence among GBMSM across all sites was observed for those aged 25–29 years with estimated annual incidence exceeding 3,400 cases per 100,000 across the study period. Conclusion Gonorrhoea incidence among GBMSM is increasing in a sentinel network of US jurisdictions. Estimates of the size of this population and ascertainment of GBMSM status for reported cases are essential first steps for better understanding the changing epidemiology of gonorrhoea. Disclosure of interest statement The STD Surveillance Network (SSuN) is funded by the US Centres for Disease Control and Prevention (CDC). No pharmaceutical grants were received in the development of this study.

HIV and Sexually Transmitted Infection Incidence and Associated Risk Factors Among High-Risk MSM and Male-to-Female Transgender Women in Lima, Peru.

Men who have sex with men (MSM) and male-to-female transgender women (TW) are at increased risk of HIV and sexually transmitted infections (STIs). We evaluated factors associated with incidence of HIV, HSV-2, and chlamydia and gonorrhea (anal and pharyngeal). We used data from the Comunidades Positivas trial with MSM/TW who have sex with men in Lima, Peru. Participants were asked about sexual risk behaviors and underwent HIV/STI testing at baseline and 9- and 18-month follow-ups. We used discrete time proportional hazards regression to calculate hazard ratios for variables associated with incidence of each STI. Among 718 MSM/TW, HIV incidence was 3.6 cases per 100 person-years. HIV incidence was associated with having an incident STI adjusted hazard ratio (aHR) of 3.73. Unprotected receptive anal intercourse was associated with incident anal chlamydia (aHR 2.20). An increased number of sexual partners increased incident HSV-2 (aHR 3.15 for 6-14 partners and 3.97 for 15-46 partners compared with 0-2 partners). The risk of anal gonorrhea decreased with each sexually active year (aHR 0.94) and increased for unprotected compensated sex (aHR 2.36). The risk of pharyngeal gonorrhea also decreased with each year since sexual debut (aHR 0.95). The risk of anal chlamydia decreased with each sexually active year (aHR 0.96); the risk increased with reports of unprotected sex work (aHR 1.61) and unprotected receptive anal sex (aHR 2.63). All aHRs have P values <0.05. MSM/TW experience high incidence of HIV. Up-to-date prevalence and incidence information and identifying factors associated with infection can help develop a more effective combination prevention response.

Detection of gonorrhea among HIV infected patients by polymerase chain reaction

ObjectiveTo determine the burden of gonorrhea among HIV patients using PCR technique. MethodsA cross sectional study was carried out in a HIV clinic of Sparsha Nepal from January to March, 2011. Standard microbiological procedures were followed during collection and processing of urine samples. DNA amplification, isolation and detection were carried out. Gonorrhoea diagnosis was done by multiplex polymerase chain reaction. ResultsAmong the 119 HIV positive patients, 12 (10.08%) were positive for N. gonorrheae. The cases were more among the males than in females. The age of patients ranged from 20-45 years and the highest prevalence was among the age group 20-35 years. The distribution of gonorrhea infected patients according to marital status revealed that 8 cases were among the married patients. ConclusionsThis study revealed that the incidence of gonorrhoea was higher in males and in married people. So, the control measures should be targeted to these groups of people.

P6 Love letters – the notification game

Background In accordance with the national trend there was a perceived increased incidence of anogenital and pharyngeal gonorrhoea presenting to the sexual health (SH) department at a district general hospital (DGH) in the year March 2013–2014. Aims and objectives To establish the incidence of gonorrhoea in our SH patient population (March 2013–2014). To ensure that the SH department was compliant with BASHH standards for the management of gonorrhoea. Methods Retrospective audit of all confirmed cases of gonorrhoea presenting to SH at one DGH in the period March 2013–2014. Results 79 patients were identified; all were audited. There was a high level of adherence to BASHH standards but concern regarding partner notification. Partner notification was initiated in 86% of cases, 95% were patient led. Patient led referral resulted in poor evidence of partner notification. 71% of all cases reported more than 1 sexual partner in the previous 3 months yet 57% of the total cases notified just 1 contact. 4 patients reported 10 or more contacts; only 1 patient was recorded as having notified 10 or more partners. Discussion/conclusion Poor partner notification may be contributing to increasing gonorrhoea prevalence. It has been suggested that patients from different demographics may preferentially use different, specific communication methods for partner notification. By working with patients to individually tailor notification methods based on demographic background, notification rates may be improved. This is an approach under consideration by SH at this DGH.

Epidemiological characteristics and trends of gonorrhea in China from 2000 to 2014

Objective To investigate epidemiological characteristics and trends of gonorrhea in China, and to provide a scientific basis for the development of control strategies. Methods An epidemiological study was performed on gonorrhea cases reported from 31 provinces, autonomous regions or municipalities directly under the central government between 2000 and 2014. Results The reported incidence rate of gonorrhea decreased from 22.92 per 100 000 in 2000 to 7.25 per 100 000 in 2014, with the average annual rate of decrease being 7.89%. There was a significant difference in the incidence of gonorrhea between different regions. The regions with the highest incidence rate of gonorrhea were Yangtze River Delta region (Zhejiang, Shanghai, Jiangsu) and Zhujiang River Delta region (Guangdong, Guangxi, Hainan), followed by northwest China (Xinjiang, Ningxia, Inner Mongolia). The incidence of gonorrhea was higher in males than in females, and the average male/female ratio increased from 1.96∶1 in 2000 to 4.52∶1 in 2014. The population aged 20-44 years showed high incidence of gonorrhea, and the highest incidence rate of gonorrhea was observed in the age group 25-29 years in both men and women. The incidence of gonorrhea decreased in all the age groups from 2000 to 2014 except the age group 15-19 years with an annual growth rate of 4.18%. Of 20 occupations, peasant workers accounted for the highest proportion (26.00%) of reported gonorrhea cases, and the number of reported gonorrhea cases showed a decreasing trend in all the occupations. Conclusions Gonorrhea remains a major public health issue in China, and effective measures based on epidemiological features are urgently needed to control gonorrhea. Key words: Gonorrhea; Epidemiologic study characteristics as topic; Incidence; China; Trends

An application of propensity score weighting to quantify the causal effect of rectal sexually transmitted infections on incident HIV among men who have sex with men.

BackgroundExploring causal associations in HIV research requires careful consideration of numerous epidemiologic limitations. First, a primary cause of HIV, unprotected anal intercourse (UAI), is time-varying and, if it is also associated with an exposure of interest, may be on a confounding path. Second, HIV is a rare outcome, even in high-risk populations. Finally, for most causal, non-preventive exposures, a randomized trial is impossible. In order to address these limitations and provide a practical illustration of efficient statistical control via propensity-score weighting, we examine the causal association between rectal STI and HIV acquisition in the InvolveMENt study, a cohort of Atlanta-area men who have sex with men (MSM). We hypothesized that, after controlling for potentially confounding behavioral and demographic factors, the significant STI-HIV association would attenuate, but yield an estimate of the causal effect.MethodsThe exposure of interest was incident rectal gonorrhea or chlamydia infection; the outcome was incident HIV infection. To adjust for behavioral confounding, while accounting for limited HIV infections, we used an inverse probability of treatment weighted (IPTW) Cox proportional hazards (PH) model for incident HIV. Weights were derived from propensity score modeling of the probability of incident rectal STI as a function of potential confounders, including UAI in the interval of rectal STI acquisition/censoring.ResultsOf 556 HIV-negative MSM at baseline, 552 (99%) men were included in this analysis. 79 men were diagnosed with an incident rectal STI and 26 with HIV. 6 HIV-infected men were previously diagnosed with a rectal STI. In unadjusted analysis, incident rectal STI was significantly associated with subsequent incident HIV (HR (95%CI): 3.6 (1.4-9.2)). In the final weighted and adjusted model, the association was attenuated and more precise (HR (95% CI): 2.7 (1.2-6.4)).ConclusionsWe found that, controlling for time-varying risk behaviors and time-invariant demographic factors, diagnosis with HIV was significantly associated with prior diagnosis of rectal CT or GC. Our analysis lends support to the causal effect of incident rectal STI on HIV diagnosis and provides a framework for similar analyses of HIV incidence.Electronic supplementary materialThe online version of this article (doi:10.1186/s12874-015-0017-y) contains supplementary material, which is available to authorized users.

Uptake and population-level impact of expedited partner therapy (EPT) on Chlamydia trachomatis and Neisseria gonorrhoeae: the Washington State community-level randomized trial of EPT.

BackgroundExpedited partner therapy (EPT), the practice of treating the sex partners of persons with sexually transmitted infections without their medical evaluation, increases partner treatment and decreases gonorrhea and chlamydia reinfection rates. We conducted a stepped-wedge, community-level randomized trial to determine whether a public health intervention promoting EPT could increase its use and decrease chlamydia test positivity and gonorrhea incidence in women.Methods and FindingsThe trial randomly assigned local health jurisdictions (LHJs) in Washington State, US, into four study waves. Waves instituted the intervention in randomly assigned order at intervals of 6–8 mo. Of the state’s 25 LHJs, 24 were eligible and 23 participated. Heterosexual individuals with gonorrhea or chlamydial infection were eligible for the intervention. The study made free patient-delivered partner therapy (PDPT) available to clinicians, and provided public health partner services based on clinician referral. The main study outcomes were chlamydia test positivity among women ages 14–25 y in 219 sentinel clinics, and incidence of reported gonorrhea in women, both measured at the community level. Receipt of PDPT from clinicians was evaluated among randomly selected patients. 23 and 22 LHJs provided data on gonorrhea and chlamydia outcomes, respectively. The intervention increased the percentage of persons receiving PDPT from clinicians (from 18% to 34%, p < 0.001) and the percentage receiving partner services (from 25% to 45%, p < 0.001). Chlamydia test positivity and gonorrhea incidence in women decreased over the study period, from 8.2% to 6.5% and from 59.6 to 26.4 per 100,000, respectively. After adjusting for temporal trends, the intervention was associated with an approximately 10% reduction in both chlamydia positivity and gonorrhea incidence, though the confidence bounds on these outcomes both crossed one (chlamydia positivity prevalence ratio = 0.89, 95% CI 0.77–1.04, p = 0.15; gonorrhea incidence rate ratio = 0.91, 95% CI .71–1.16, p = 0.45). Study findings were potentially limited by inadequate statistical power, by the institution of some aspects of the study intervention outside of the research randomization sequence, and by the fact that LHJs did not constitute truly isolated sexual networks.ConclusionsA public health intervention promoting the use of free PDPT substantially increased its use and may have resulted in decreased chlamydial and gonococcal infections at the population level.Trial RegistrationClinicalTrials.gov NCT01665690

Incidence of Gonorrhea and Chlamydia in Urban Settings: The Case for Neighborhood Level Analysis in Boston

The sexually transmitted infections (STIs) gonorrhea and chlamydia are known to disproportionately affect impoverished communities and communities of color, especially in urban areas. Moreover, socioeconomic and demographic factors such as poverty and race/ethnicity may contribute to a difference in treatment setting choice as well as a delay in care seeking. In an urban metropolitan area such as Boston, the overall gonorrhea and chlamydia rates are higher than national rates, and such differences are even more marked in certain neighborhoods with greater proportions of individuals who are impoverished, young, and of color. Using a retrospective analysis of city wide data, we highlight the effects of socioeconomic and demographic variables on urban STI prevalence. High poverty rates, race/ethnicity and younger adult populations are linked to disproportionately high STI rates. Interestingly, STI rates do not appear to be influenced by the universal health care coverage offered to the whole Massachusetts’ resident populations. We examine the effects of these variables in Boston neighborhoods in conjunction to STI rates and hypothesize that the observed rates are underestimates of the true prevalence of infection. Future studies will investigate how these same socioeconomic and demographic factors influence which treatment settings are chosen and subsequently lead to a delay in treatment.