A brief picture of gonorrhoea in New Zealand
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Transcript of A brief picture of gonorrhoea in New Zealand
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Manaaki Tangata Taiao Hoki
protecting people and their environment through science
Specialist Science Solutions
A brief picture of gonorrhoea in
New Zealand
Kerry Sexton, Public Health Physician, ESR
NZSHS conference 2012, gonorrhoea workshop, 30 August 2012
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© ESR 2012
Outline
• National burden of gonorrhoea
Historical
Recent trends
• Demographic distribution of cases
• Other risk factors for gonorrhoea
• Testing for gonorrhoea
Testing rates and test positivity
• Not going to discuss:
NAAT testing for gonorrhoea
Antimicrobial resistance
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© ESR 2012
Platts, W. M. (1979). "Epidemiology of gonorrhoea and syphilis in New Zealand." Br J Vener Dis 55: 138-141.
National burden of gonorrhoea
1976 (lab data)
208 per 100,000
6482 cases
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© ESR 2012
Lyttle, P. H. (1994). "Surveillance report: disease trends at New Zealand sexually transmitted disease clinics 1977-1993."
Genitourin Med 70: 329-335.
National burden of gonorrhoea cont...
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Gonorrhoea rates in selected DHBs, 1998-2011
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Estimated national gonorrhoea rate, 2008-2011
67 = NZ rate 2011
44 = Australia 2010
30 = UK 2010
101 = US 2010
M:F ratio 2011: 1.4
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Gonorrhoea rates by age group and sex, 2008-2011
0
50
100
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350
400
450
2008 2009 2010 2011
Cases p
er
100 0
00 f
em
ale
po
pu
lati
on
Year
Females Males
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Gonorrhoea rates by ethnicity
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Age standardised gonorrhoea incidence rates by
ethnicity and sex, Bay of Plenty, 2003 to 2007
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Gonorrhoea rates by DHB, 2011
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Other risk/protective factors
• Greater number of sexual contacts - Auckland SHS case-control study1
- Cases of gonorrhoea reported more sexual contacts in the
preceding 3 months than did controls (p=0.05)
• MSM - Gay Auckland Periodic Sex Survey2
- 3.3% reported gonorrhoea in last 12 months
- 17.3% reported a diagnosis of gonorrhoea in their lifetime
• Condom use - Auckland SHS case-control study1
- Consistent condom use was found to lower the risk of gonorrhoea
(p=0.009)
1Azariah and Perkins (2007). Risk factors and characteristics of patients with gonorrhoea presenting to Auckland Sexual Health Service,
New Zealand. NZMJ 120(1252):2491. 2Saxton, Dickson and Hughes (2006). GAPSS 2006: Findings from the Gay Auckland Periodic Sex Survey. Auckland: New Zealand
AIDS Foundation.
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© ESR 2012
Site of infection, non-urogenital gonorrhoea cases in
SHCs, males, 2006-2011
0
10
20
30
40
50
60
2006 2007 2008 2009 2010 2011
Nu
mb
er o
f cas
es
Year
anorectal epididymitis pharynx other site
80-90%
urogenital
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© ESR 2012
Relative gonorrhoea testing volumes, selected
DHBs, 2002-2011
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© ESR 2012
Gonorrhoea incidence & testing rates by age group, females, BOP,
2003-2007
Testing rates
Incidence
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© ESR 2012
Gonorrhoea incidence & testing rates by TA, Bay of Plenty, 2003 to 2007
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Summary
• National gonorrhoea burden peaked in the 1970s,
smaller peak 2006
• Estimated national rate stable over last 4 years,
67 per 100,000 in 2011
• Highest risk groups: 15-24y olds and Māori and
Pacific, MSM
• Tairawhiti DHB rate 5x national rate
• Increasing anorectal and pharyngeal positives
• Testing mismatch versus incidence
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© ESR 2012
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© ESR 2012
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© ESR 2012
Gonorrhoea testing rates/test positivity by TA, Bay of Plenty, 2003 to 2007
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© ESR 2012
Platts, W. M. (1979). "Epidemiology of gonorrhoea and syphilis in New Zealand." Br J Vener Dis 55: 138-141.
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© ESR 2012
Gonorrhoea Prevalence • MSM, phone survey, 1996
• Any gonorrhoea 16.8% (penile 13.6%, anal 4.4%, oral 3.0%; signif higher in
those HIV positive)
Dunedin cohort
• Gonorrhoea 1 (2.6) 5 (5.6) 1 (1.4) 0 (0
• Gonorrhoea up to 21 Male 1 (2.6) Female 5 (5.6) 21 to 26 Male 1 (1.4)
Female 0 (0.0) 26 to 32 Male 0 (0.0) Female 0 (0.0)
Saxton, Hughes and Robinson (2002). "Sexually transmitted diseases and hepatitis in a national sample of men who have
sex with men in New Zealand." NZMJ 115(1158).
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© ESR 2012
Gonorrhoea rates by DHB, 2007 to 2011
0
50
100
150
200
250
300
350
400
No
rth
land¹
Auckla
nd regio
n
Waik
ato
Lakes
Bay o
f P
len
ty
Tair
aw
hiti
Tara
naki²
Haw
ke's
Bay
Wh
an
ganui
Mid
Cen
tral
Wellin
gto
n regio
n
Wair
ara
pa
West C
oast
So
uth
ern
Rate
per 100 0
00 p
op
ula
tio
n
District Health Board
2007 2008 2009 2010 2011
* * * *
Note: Additional labs began reporting in 2010 in Northland and 2011 in Taranaki