Sexually transmitted infections:epidemiological evidence of need

Dr Kirsty FosterConsultant in Health Protection

Public Health England Centre, North East

Surveillance of Sexually Transmitted Infections

“ the continuing scrutiny of all aspects of the occurrence and spread of a disease through the systematic collection, collation and analysis of

data and the prompt dissemination of the result information so that action can result”

Genito-urinary clinical activity dataset (GUMCAD)

• Numbers / rates of STIs, • By LA of residence / gender / age group / sexual

orientation / ethnicity

• Sexual health screens / testing

• Performance monitoring / Patient flows / activity by clinic• Clinics attended by your resident population / people

attending clinics in your area

• Collected quarterly (data available ~6-8 weeks later)

• Introducing system to collect data from other services (GUMCAD2)

Chlamydia testing activity dataset (CTAD)

• Single dataset for all chlamydia testing

• Can monitor the impact of chlamydia screening through numbers screened, numbers positive and diagnostic rates

• Public health outcome framework measure – combines numbers of people screened with positive diagnoses

• Overlapping with “old” NCSP system at the moment – will “go live” in 2013

HIV data

• Overall prevalence of HIV in local area

• New diagnoses of HIV

• Deaths from / with HIV

• Late diagnosis of HIV (indicator of poorer outcome)

• Number of people accessing care

• (Anonymised surveys used nationally to estimate the proportion of people with HIV who are undiagnosed)

How do we use the data?

Epidemiology

London

Prevalence of diagnosed HIV infection by region of residence among population aged 15-59 years: United Kingdom, 2011

Less than 11-2>2

Late diagnosis1 of HIV infection by exposure group: United Kingdom, 2011

Two real-life examples

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Congenital syphilis

• The infection can be passed on from mother to baby

• Women are screened for syphilis as part of antenatal care, but if they have new “exposure” during pregnancy they can be infected and pass that infection on.

• These are preventable infections

• 4 cases of congenital syphilis in the North East in past 2 years

• Multi-professional working group to ensure that safe and robust procedures are in place at all steps of the pathway

Risk factors and case management

- Regional audit of syphilis in women

- Assessment of case management

- Can we identify “at risk” pregnant women and offer increased screening?

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Gonorrhoea

• Infections and outbreaks are usually seen in MSM

• In summer 2011, the sexual health clinic in Northumberland noticed increase in heterosexual cases of gonorrhoea

• Young adults affected – locally defined area

• Numbers of cases continue to higher than previous years – been “rumbling on” for 18 months

• Multi-agency efforts to raise awareness, promote safe sex messages, ensure joined up work between services

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Epidemic curvesNorthumberland

Apr 11 – Dec 12

Newcastle

Apr 11 – Jul 11 and

Jan 12 – Dec 12

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Summary of Gonorrhoea North of Tyne

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Data analysis

Comparisons of Northumberland and Newcastle resident cases

Summary of Gonorrhoea North of Tyne

Northumberland Newcastle

Female 57% 36%

Heterosexual 94% 63%

<20 50% 26%

Most deprived 45% 43%

Symptomatic 42% 51%

Concurrent STI 41% 27%

Re-infection 4% 5%

Return for test of cure 46% 62%

Mapping the networks

Where should we be focussing our efforts?

Partner notification

Total Traceable Attended Positive

Number 240 166 130 67

Percentage of total 100% 69% 54% 28%

Percentage of previous category

- 69% 78% 53%

total

traceable

attended

positive

Cases are increasing elsewhere:is the “outbreak” spreading or is this something new?

Cases in other parts of the region

• Different patterns of infection

• Further review of epidemiology

Molecular typing used to map cases

• Strain type G25 almost exclusively found in outbreak cases

• Other cases around region were different strain type

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Summary

• At risk groups / communities are well known to us

• Different approaches needed for different groups and infections

• How to say the simple safe sex message to different groups?

• Need to engage “new” commissioners and organisations and keep the “old” ones involved

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