Sexually Transmitted Infections Surveillance System Research Articles

Factors associated with bacterial sexually transmitted infections among people of South Asian ethnicity in England

ObjectivesDespite being the largest ethnic minority group in England, South Asians have historically had low levels of utilisation of sexual health services (SHS) and sexually transmitted infection (STI) diagnoses, although...

Epidemiology and determinants of reemerging bacterial sexually transmitted infections (STIs) and emerging STIs in Europe.

In this scoping review, we offer a comprehensive understanding of the current and recent epidemiology, challenges, and emerging issues related to bacterial sexually transmitted infections (STIs) in the WHO European Region. We endeavour in collating data from both EU/EEA and non- EU/EEA countries, thereby giving a complete picture of the region which highlights the higher notification rates in Northern and Western countries than other regions, likely due to differences in testing, access to testing, and surveillance capacity. We provide an up-to-date review on the current knowledge of determinants and persistent inequities in key populations as well as the use of molecular epidemiology for identifying transmission networks in gonorrhoea and syphilis, and detecting chlamydia mutations that evade molecular diagnosis. Finally, we explore the emerging STIs in the region and the evolving transmission routes of food and waterborne diseases into sexual transmission. Our findings call for harmonized STI surveillance systems, proactive strategies, and policies to address social factors, and staying vigilant for emerging STIs.

Evaluation of the national clinical sentinel surveillance system for sexually transmitted infections in South Africa: Analysis of provincial and district-level data.

Globally, >1 million new cases of curable sexually transmitted infections (STIs) are estimated to occur daily, an alarming rate that has prevailed for over a decade. Modelled STI prevalence estimates for South Africa (SA) are among the highest globally. Robust STI surveillance systems have implications for policy and planning, antimicrobial stewardship and prevention strategies, and are critical in stemming the tide of STIs. To evaluate the STI clinical sentinel surveillance system (STI CSSS) in SA, to describe the population incidence of four designated STI syndromes in males and females ≥15 years, and to provide recommendations for strengthening the STI CSSS. This was a retrospective analysis of the STI CSSS in SA. Distribution of the primary healthcare facilities designated as STI CSSS sites was described, taking into account provincial population distribution and headcount coverage of STI CSSS facilities. Reporting compliance was evaluated to determine completion of data reporting. Further analysis was undertaken for those provinces that had good reporting compliance over a 12-month period. Population-level and demographic STI syndrome incidence were estimated from CSSS data using case reports of male urethritis syndrome (MUS) as a proxy for data extrapolation. Reporting compliance exceeded 70% for seven of the nine provinces. STI syndromes with the highest incidence were MUS and vaginal discharge syndrome (VDS). The 20 - 24 years age group had the highest STI incidence, at least double the incidence estimated in the other two age groups. Overall STI incidence in females was higher than among males in all provinces, except Limpopo and Western Cape. The 15 - 19 years age group had the most prominent gender disparity, with the national STI incidence in females 70% higher than in males. District-level analysis revealed high regional STI incidence even in provinces with lower overall incidence. The STI CSSS is pivotal to epidemiological monitoring and proactive management of STIs, especially in view of the high HIV prevalence in SA. CSSS processes and facility selection should be reviewed and revised to be representative and responsive to the current STI needs of the country, with biennial analysis and reporting to support evidence-based policy development and targeted implementation.

High burden of self-reported sexually transmitted infections among key populations in Mozambique: the urgent need for an integrated surveillance system

BackgroundKey populations - men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID) – are at high risk for sexually transmitted infections (STI) given their sexual risk behaviours along with social, legal and structural barriers to prevention, care and treatment services. The purpose of this secondary analysis is to assess the prevalence of self-reported STIs and to describe associated risk factors among participations of the first Biological Behavioural Surveillance (BBS) in Mozambique.MethodsResponses from the first BBS surveys conducted in 2011–2014 were aggregated across survey-cities to produce pooled estimates for each population. Aggregate weighted estimates were computed to analyse self-reported STI prevalence. Unweighted pooled estimates were used in multivariable logistic regression to identify risk factors associated with self-reported STI.ResultsThe prevalence of self-reported STI was 11.9% (95% CI, 7.8–16.0), 33.6% (95% CI, 29.0–41.3), and 22.0% (95% CI, 17.0–27.0) among MSM, FSW and PWID, respectively. MSM who were circumcised, had HIV, reported drug use, reported receptive anal sex, and non-condom use with their last male partner had greater odds of STI self-report. STI-self report among FSW was associated with living in Beira, being married, employment aside from sex work, physical violence, sexual violence, drug use, access to comprehensive HIV prevention services, non-condom use with last client, and sexual relationship with a non-client romantic partner. Among PWID, risk factors for self-reported STI included living in Nampula/Nacala, access to HIV prevention services, and sex work.ConclusionThe high-burden of STIs among survey participants requires integrated HIV and STI prevention, treatment, and harm reduction services that address overlapping risk behaviours, especially injection drug use and sex work. A robust public health response requires the creation of a national STI surveillance system for better screening and diagnostic procedures within these vulnerable populations.

The association between region of birth and sexually transmitted infections among people of black Caribbean ethnicity attending sexual health services in England, 2015.

Background/IntroductionIn England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STIs), but it is unclear whether this varies by their region of birth.Aim(s)/ObjectivesTo examine differences in STI diagnoses among UK- and Caribbean-born BC people.MethodsData on STI diagnoses in BC people attending specialist sexual health services (SHSs) during 2015 and living in England were obtained from the GUMCAD STI surveillance system, the national surveillance system for STIs in England. Associations between being UK- or Caribbean-born and each of several STI diagnoses were examined, using univariate and multivariable generalised estimated equations logistic regression models adjusted for sexual orientation, place of residence (London vs. non-London), HIV status, area-level deprivation, and STI diagnosis in the last year. All analyses were stratified by age (<25 vs. ≥25 years).ResultsIn 2015, 63,568 BC people made 108,881 attendances at specialist SHSs; 81.9% of these attendances were made by UK-born BCs. The median age (years) was 26 for UK-born and 35 for Caribbean-born people (p≤0.001). Chlamydia, gonorrhoea and non-specific genital infection (NSGI) were the most commonly diagnosed STIs among UK- (5.8%, 2.1% and 2.8%) and Caribbean-born people (4.5%, 1.7% and 3.5%) respectively. Among BCs aged under 25, no significant differences in STIs were found between UK- and Caribbean-born people. Among BCs aged ≥25, compared to Caribbean-born people, those who were UK-born were more likely to be diagnosed with chlamydia (AOR 1.15 [95%C.I. 1.04–1.27]); gonorrhoea (AOR 1.23 [95%C.I. 1.06–1.45]) and genital herpes (AOR 1.23 [95% C.I. 1.10–1.56]) and less likely to be diagnosed with NSGI (AOR 0.89 [95% C.I. 0.80–0.99]) and Trichomoniasis (AOR 0.84 [95% C.I. 0.71–0.99]).Discussion/ConclusionSTI diagnoses in BC people aged ≥25 attending specialist SHSs vary by region of birth. Country of birth may have an influence on social and sexual networks and therefore transmission of STIs.

Sera selected from national STI surveillance system shows Chlamydia trachomatis PgP3 antibody correlates with time since infection and number of previous infections.

BackgroundSeroprevalence surveys of Chlamydia trachomatis (CT) antibodies are promising for estimating age-specific CT cumulative incidence, however accurate estimates require improved understanding of antibody response to CT infection.MethodsWe used GUMCAD, England’s national sexually transmitted infection (STI) surveillance system, to select sera taken from female STI clinic attendees on the day of or after a chlamydia diagnosis. Serum specimens were collected from laboratories and tested anonymously on an indirect and a double-antigen ELISA, both of which are based on the CT-specific Pgp3 antigen. We used cross-sectional and longitudinal descriptive analyses to explore the relationship between seropositivity and a) cumulative number of chlamydia diagnoses and b) time since most recent chlamydia diagnosis.Results919 samples were obtained from visits when chlamydia was diagnosed and 812 during subsequent follow-up visits. Pgp3 seropositivity using the indirect ELISA increased from 57.1% (95% confidence interval: 53.2–60.7) on the day of a first-recorded chlamydia diagnosis to 89.6% (95%CI: 79.3–95.0) on the day of a third or higher documented diagnosis. With the double-antigen ELISA, the increase was from 61.1% (95%CI: 53.2–60.7) to 97.0% (95%CI: 88.5–99.3). Seropositivity decreased with time since CT diagnosis on only the indirect assay, to 49.3% (95%CI: 40.9–57.7) two or more years after a first diagnosis and 51.9% (95%CI: 33.2–70.0) after a repeat diagnosis.ConclusionSeropositivity increased with cumulative number of infections, and decreased over time after diagnosis on the indirect ELISA, but not on the double-antigen ELISA. This is the first study to demonstrate the combined impact of number of chlamydia diagnoses, time since diagnosis, and specific ELISA on Pgp3 seropositivity. Our findings are being used to inform models estimating age-specific chlamydia incidence over time using serial population-representative serum sample collections, to enable accurate public health monitoring of chlamydia.

Anorectal swabs as a marker of male-to-male sexual exposure in STI surveillance systems.

Identification of priority populations such as men who have sex with men (MSM) is important in surveillance systems to monitor trends of sexually transmitted infections (STIs). We explored using routinely collected non-behavioural data as a means to establish MSM status in surveillance by assessing anorectal swab as a marker of male-to-male sexual exposure. We used chlamydia testing data from a sexual health clinic, 2007-2012. Men reporting any male sexual partner(s) in the previous 12 months were considered MSM. The dataset was split into development and validation samples to develop a univariate predictive model and assess the model fit. The dataset included 30 358 individual men and 48 554 episodes of STI testing; 45% were among reported MSM and an anorectal swab was performed in 40% of testing episodes. Anorectal swabbing had good diagnostic performance as a marker for MSM status (sensitivity = 87%, specificity = 99%, positive predictive value = 98·6%, negative predictive value = 90·3%). The model showed good fit against the internal validation sample (area under the curve = 0·93). Anorectal swabs are a valid marker of MSM behaviour in surveillance data from sexual health clinics, and they are likely to be particularly useful for monitoring STI trends among MSM with higher risk behaviour.

Full House: A Retrospective Analysis of High Sexually Transmitted Infection Prevalence among Adult Film Actors at a Singular Residence.

During a routine human immunodeficiency virus (HIV) investigation, Florida Department of Health staff identified a house (house A) in which over 150 individuals had resided at least briefly. Further investigation revealed that house A is used by the producer of a small adult film production company to board his actors. This report describes sexually transmitted infection (STI) prevalence among male actors in gay adult films residing in a common Florida residence. LexisNexis Accurint was used to identify house A residents since October 2002 when the producer arrived. Information on STIs and interview data were obtained from Florida's STI surveillance system. An infection was considered to be associated with residence in house A if the date of diagnosis occurred 6 months before an individual's residence start date through 6 months after his residence end date. Excluding the producer, 150 men resided in house A starting from September 2003 to July 2015. Forty-six individuals had a reported case of HIV, syphilis, gonorrhea, and/or chlamydia with 92 infections total. Forty-two (46%) infections among 24 men were considered associated with residence in house A. LexisNexis Accurint was a useful tool for identifying house A residents, a highly mobile and highly sexually active population. There is a high prevalence of STIs among residents, but it is unclear where transmission is occurring. Settings like house A are good candidates for HIV pre-exposure prophylaxis and active STI screenings and may be an opportunity for public health officials to intervene in high-risk groups to reduce STI rates in the community.

P068 Inequalities in sexually transmitted infection risk among black and minority ethnic men who have sex with men in England

Background/introduction Sexually transmitted infection (STI) diagnoses are increasing in men who have sex with men (MSM) in England. While black and minority ethnic (BME) populations bear a disproportionate burden of STIs overall, it is unclear whether this inequality persists among MSM. Aim(s)/objectives To assess the likelihood of an STI diagnosis among BME MSM relative to other MSM attending genitourinary medicine (GUM) clinics in England. Methods We included data from the GUM clinic activity dataset (GUMCADv2), the national STI surveillance system in England. All attendances by MSM in 2014 were analysed using univariate and multivariable generalised estimating equations logistic regression. Separate models, adjusted for age, sexual orientation (homosexual/bisexual), residence (London/non-London), area-level deprivation, HIV positivity and history of HIV testing in the past year, were run for each STI. Results BME men accounted for 5.6% of the 326,820 attendances by MSM in 2014. An STI was diagnosed at 12.5% of attendances by MSM, ranging from 11.1% in Asian non-Indian/Pakistani/Bangladeshi to 17.7% in mixed white and black African MSM. Compared to white British MSM, black Caribbean MSM were most likely to be diagnosed with chlamydia (aOR [95% CI]:1.34 [1.18–1.52]) and rectal gonorrhoea (1.31 [1.08–1.60]), while those of mixed white and black African ethnicity were most likely to be newly diagnosed with HIV (1.90 [1.14–3.17]). Discussion/conclusion Among MSM attending GUM services, BME MSM are most likely to be diagnosed with bacterial STIs and HIV. Culturally appropriate prevention messages must be developed to address this inequality and reduce the higher burden of STIs among BME MSM.

Surveillance systems for sexually transmitted infections

Sexually transmitted infections (STIs) continue to exert a substantial public health burden globally but surveillance remains a challenge, especially in the developing world. We reviewed STI surveillance systems in various regions globally and used available data to provide an overview of recent trends in STI epidemiology. STI surveillance systems in the developing world are often limited and restricted to ad hoc cross-sectional surveys; however, available data suggest that these areas are disproportionately affected by STIs, with a higher burden in marginalized groups such as sex workers. Developed countries typically have established surveillance systems. Recent reports suggest many of these countries are experiencing rising diagnoses of STIs in men who have sex with men (MSM) and an increasing contribution of HIV-positive MSM to STI epidemics. There is considerable variability in the surveillance for STIs globally, ranging from active or passive, to sentinel, laboratory or clinic-based systems. Given different levels of resources and patterns of healthcare provision, it is difficult to compare surveillance data across regions; however, available data suggest that considerable inequality in STI burden exists. In resource-limited settings, syndromic surveillance with periodic laboratory assessments is recommended to monitor trends in STIs.

The epidemiology of sexually transmitted infections in the UK: impact of behavior, services and interventions.

Sexually transmitted infections (STIs) are a major public health concern. The UK has some of the most advanced STI surveillance systems globally. This article uses national surveillance data to describe remarkable changes in STI epidemiology in the UK over the last century and explores the behavioral and demographic shifts that may explain these trends. The past 10 years have seen considerable improvements in STI service provision and the introduction of national public health interventions. However, sexual health inequalities persist and men who have sex with men, young adults and black ethnic minorities remain a priority for interventions. Technological advances in testing and a shift in sexual health service commissioning arrangements will present both opportunities and challenges in future.

Increasing sexually transmitted infection rates in young men having sex with men in the Netherlands, 2006-2012.

BackgroundMen having sex with men (MSM) remain the largest high-risk group involved in on-going transmission of sexually transmitted infections (STI), including HIV, in the Netherlands. As risk behaviour may change with age, it is important to explore potential heterogeneity in risks by age. To improve our understanding of this epidemic, we analysed the prevalence of and risk factors for selected STI in MSM attending STI clinics in the Netherlands by age group.MethodsAnalysis of data from the national STI surveillance system for the period 2006–2012. Selected STI were chlamydia, gonorrhoea, infectious syphilis and/or a new HIV infection. Logistic regression was used to identify factors associated with these selected STI and with overall STI positivity. Analyses were done separately for MSM aged younger than 25 years and MSM aged 25 years and older.ResultsIn young MSM a significant increase in positivity rate was seen over time (p < 0.01), mainly driven by increasing gonorrhoea diagnoses, while in MSM aged 25 and older a significant decrease was observed (p < 0.01). In multivariate analyses for young MSM, those who were involved in commercial sex were at higher risk (OR: 1.5, 95% CI: 1.2-1.9). For MSM aged 25 years and older this was not the case. Having a previous negative HIV test was protective among older MSM compared to those not tested for HIV before (OR: 0.8, 95% CI: 0.8-0.8), but not among younger MSM.ConclusionsMSM visiting STI clinics remain a high-risk group for STI infections and transmission, but are not a homogenous group. While in MSM aged older than 25 years, STI positivity rate is decreasing, positivity rate in young MSM increased over time. Therefore specific attention needs to be paid towards targeted counselling and reaching particular MSM sub-groups, taken into account different behavioural profiles.

P3.324 A Population-Based Assessment of Racial/Ethnic Disparities in Gonorrhoea Rates

BackgroundMeasured incidence rates of Sexually Transmitted Infections (STIs) are substantially higher among blacks compared to whites in the US. However, population-based data sources, such as routine STI surveillance systems, often...

P3.142 Epidemiology of STI in Men Having Sex with Men in Italy, 1991–2010

BackgroundIn recent years, sexually transmitted infections (STI) have been increasing among men who have sex with men (MSM) in several industrialised countries. The objective of this study was to assess...

P1-S5.46 Assessing the relationship between sexually transmitted infection rates, ethnic group and socio-economic deprivation in England

BackgroundDisparities in the distribution of sexually transmitted infections (STIs), especially gonorrhoea, across ethnic groups in England are well recognised. Socio-economic deprivation (SED) is also a known determinant of poor health...

Sexually Transmitted Infections (STIs) among young adult in Italy

Sexually transmitted infections (STIs) include a large group of widespread infectious diseases, which may cause acute symptoms, chronic infections and severe long term complications.The control and prevention of these infections are public health priorities for several reasons: • the large number of people that acquire an STI per year; • the major proportion of asymptomatic infected individuals; • the high circulation in patients with sexual risk behavior (young adults, pluripartner, men who have sex with men, foreigners, commercial sex workers); • increased biological susceptibility of some subjects, such as young adults (immature genital tissues and more receptive to pathogens), women (genital apparatus more complex and extended in which pathogens are more likely to settle), or individuals carrying states of severe immunodeficiency; • the serious complications in the event of failure or incorrect diagnosis and treatment (chronic disease, infertility, oncogenic transformation, synergy with HIV infection); • the possibility of preventing and treating many of these infections. Therefore, recent guidelines from international agencies have recommended countries from the European Union to improve epidemiological STI surveillance systems in order to standardize data collection to facilitate their comparability between different geographical areas and to improve the information flow for faster tracking of the impact; furthermore, to extend surveillance to widespread, but often asymptomatic, disease (e.g. Chlamydia trachomatis), to conduct behavioural surveillance in patients with STIs, to increase public awareness of the role of STIs in the transmission/acquisition of HIV, and to increase the commitment of institutions in the prevention and control of STIs.

Is STI surveillance in England meeting the requirements of the 21st century? An evaluation of data from the South West Region

This study evaluates two sexually transmitted infections (STI) surveillance systems' ability to provide relevant, accurate, and timely information to inform prevention and control activities in England, using data from the South West, the largest of the country's nine regions. The systems were evaluated in terms of timeliness of reporting to subsequent levels; frequency of reporting and feedback; completeness of information in the reports; and representativeness of the reports to the resident population. To determine the usefulness of the system for those responsible for taking public health action, semi-structured interviews of a sample of users of surveillance information were conducted. Timeliness of the two main surveillance systems, laboratory reports and returns from genito-urinary medicine clinics were poor. Completeness of the laboratory system was good for date of birth and sex, but poor for geographical markers. Of the 27 respondents that participated in the survey, only eight were satisfied with the level of detail in the surveillance data they received. Most stakeholders felt that the STI data they received was not representative of the population they served and not useful in responding to emerging problems. Faced with increasing incidence of STIs, existing STI surveillance systems in England are unable to provide adequate epidemiological data for the fulfilment of basic uses of public health surveillance at the local level. Surveillance is inadequate in timeliness, geographical coverage, representativeness, does not allow for the identification of risk factors and conceals variations in sex, ethnicity, and sexual behaviour. Disaggregate data with some geographical and risk-factor information would greatly enhance the usefulness of the data. The goal should be of access to real-time data.

Differences between nonnational and indigenous patients with sexually transmitted infections in Italy and insight into the control of sexually transmitted infections.

To determine the health needs non-nationals, information on disease occurrence is fundamental. GOALS The goal of this study was to assess the clinical and behavioral characteristics of non-Italians with a new sexually transmitted infection (STI). Data were taken from Italy's National STI Surveillance System (1991-1999). Of the 61,798 STI cases reported from January 1991 to December 1999, 6847 (11.2%) were diagnosed among non-Italians, 47.1% of whom were Africans. Being a non-Italian patient with an STI was associated with male gender (adjusted odds ratio [AOR], 1.19; 95% confidence interval [CI], 1.11-1.27), youngest age (AOR, 1.71; 95% CI, 1.43-2.04), no formal education (AOR, 20.25; 95% CI, 17.51-23.42), and having contracted the STI abroad (AOR, 13.98; 95% CI, 12.59-15.54). The HIV-1 prevalence among non-Italian patients with STIs was 5.5% (95% CI, 4.9-6.2), with large differences by continent of origin. The highest prevalence was found among European injecting drug users (54.1%; 95% CI, 37.1-70.1), South American homosexual men (41.6%; 95% CI, 32.0-51.8), and heterosexuals from Sub-Saharan Africa (8.9%; 95% CI, 7.2-10.8). Non-Italian patients with STIs seem to consist mainly of migrants, and STI transmission patterns differ from those among Italians; this information is important for developing targeted STI prevention efforts.

Surveillance of sexually transmitted infections in England and Wales.

Surveillance of sexually transmitted infections (STIs) in England and Wales has, in the past, relied principally on aggregated statistical data submitted by all genitourinary medicine clinics to the Communicable Disease Surveillance Centre, supplemented by various laboratory reporting systems. Although these systems provide comparatively robust surveillance data, they do not provide sufficient information on risk factors to target STI control and prevention programmes appropriately. Over recent years, substantial rises in STIs, the emergence of numerous outbreaks of STIs, and changes in gonococcal resistance patterns have necessitated the introduction of more sophisticated surveillance mechanisms. This article describes current STI surveillance systems in England and Wales, including new systems that have recently been introduced or are currently being developed to meet the need for enhanced STI surveillance data.