Download Health beliefs Satisfaction with contact tracing Lam M,Spokes P

Enhanced Surveillance of Gonorrhoea
in New South Wales
Lam M, Spokes P, Sheppeard V, Selvey C
Health Protection NSW, NSW Health
Background
Notifications of gonorrhoea in New South Wales (NSW)
and/or
•Aboriginal
Health
beliefs associated with nonHeterosex
Torres Strait
adherence
were that measles was not a
Islander
MSM
Not
Aboriginal
or
severe disease (p<0.05), and that PEP
Torres Strait
Other/unknown
would
Islander not effectively prevent measles
sexual exposure
infection (p<0.01)
(Figure
3). 100%
0% 20% 40%
60% 80%
• For women, the numbers living in inner Sydney and greater Sydney
77% in 2013 compared to the average of the previous
five years1.
were similar (107, 109). A greater proportion of women than men were
In NSW, gonorrhoea is notifiable by laboratories only,
from regional or remote NSW (24.5% vs 8.3%).
and risk factor information is not routinely collected.
Table 1: Characteristics of people notified with gonorrhoea, by
gender, NSW, 1 August to 31 December, 2013
Eastern
Sydney2,
an inner city local health district, from
1 January 2013, and was rolled out across NSW in
August 2013.
•
Age group 0-14 yrs
This paper reports on the statewide notification and
15-19 yrs
enhanced data for the period August to December 2013.
Objective
To investigate risk factors and disease characteristics
associated with notifications of gonorrhoea in NSW.
•
A
sexually
transmitted
infection
(STI)
•
•
•
40.0
714
41.8
30-39 yrs
52
17.9
427
30.1
479
28.0
40-49 yrs
23
8.0
251
17.7
274
16.0
50-59 yrs
7
2.4
83
5.9
90
5.3
29
2.0
32
1.9
Indigenous Aboriginal and/or Torres
status
Strait Islander
39
13.5
34
2.4
73
4.3
Not Aboriginal or Torres
Strait Islander
161
The form included questions about the person’s
Indigenous status, sexual history and risk behaviours,
Other/unknown
Sexual
exposure
No sexual exposure
55.5 1016
71.7 1177
31.0
368
26.0
458
26.8
107
36.9
854
60.2
961
56.3
109
37.6
430
30.3
539
31.6
71
24.5
118
8.3
189
11.1
3
1.0
16
1.1
19
1.1
0
1
0.1
1
0.1
187
64.5
313
22.1
500
29.3
4
1.4
714
50.4
718
42.0
diagnosing doctor if the initial form was not returned, and
Person(s) of the opposite
sex only
Person(s) of the same sex
only
Persons of both sexes
3
1.0
45
3.2
48
2.8
some contacted doctors by telephone.
Sexual exposure unknown
96
33.1
345
24.3
441
25.8
Some local public health units collected Indigenous
Some local public health units resent forms to the
•
using SAS and MS Excel.
‘Unknown/missing’ includes those cases for whom no
•
•
Results
Data collection
•
Of the 1710 confirmed cases of gonorrhoea notified to
NSW Health during the study period, enhanced data
was collected on 1455 (85%).
•
Indigenous
status was
collected
for 73%
of
all
notifications.
Regular
partner
300
200
Partner from
overseas
100
350
Contact tracing
300
STI screen
250
200
Symptomatic
150
Other
100
50
0
Heterosex
MSM
Sexual exposure
Two or more
reasons
Unknown
Figure 4: Number of gonorrhoea notifications by site of infection
for two sexual exposures, NSW, 1 Aug to 31 Dec, 2013
Anorectal
Genitourinary tract
Throat
MSM
Satisfaction
with contact tracingHeterosex
Two or more sites
• Contacts
rated the manner of the NSW
Other site/unknown
Health employees
conducting
contact
0
100 200 300 400 500
tracing as excellent
(55%),
very good or
Number
of notifications
good (42%) or fair or unsure (3%).
44% (759) of the gonorrhoea notifications were in men who had sex
with men (MSM), 29% (500) were in people who reported heterosexual
enhanced data was collected.
400
Figure 3: Number of gonorrhoea notifications for two main
sexual exposure groups, by reason for patient presenting, NSW,
1 Aug to 31 Dec 2013
Information Management System (NCIMS) and analysed
Sexual history and risk behaviours
Casual
partner
Heterosex
MSM
Sexual exposure
* Excludes two transgender people
# Classified by Local Health District (LHD) of residence; Inner Sydney defined as South East and Sydney LHDs
Data were entered into the NSW Notifiable Conditions
500
0
68.9
90
0
Figure 2: Number of gonorrhoea notifications for two main
sexual exposure groups, by type of partner (likely source of
infection), NSW, 1 Aug to 31 Dec, 2013
600
6.8
561
Regional/remote NSW
status from health service electronic medical records.
•
116
52.8
Place of
Inner Sydney
residence#
Greater Sydney
symptoms and diagnosing service.
4.7
153
Unknown
between 1 August and 31 December 2013.
66
1.0
surveillance form was sent by the local public health unit
notifications in NSW residents with a specimen date
17.2
Total*
(N=1708)
n
%
3
0.2
3
enhanced
to the doctor who ordered the test for gonorrhoea
50
Male
(N=1418)
n
%
1
0.1
20-29 yrs
60+ yrs
Methods
Female
(N=290)
n
%
2
0.7
Number of notifications
Short term enhanced surveillance was piloted in South
* Excludes those whose Indigenous status is missing or not stated
Number of notifications
•
• Amongst men, almost twice as many lived in inner Sydney compared
with greater Sydney (854, 430).
have risen sharply in recent years, with an increase of
•
Figure 1: Gonorrhoea notifications by Indigenous status* and
Health
beliefs
percentage by
sexual exposure, NSW, 1 Aug to 31 Dec, 2013
Infection site
•
Results (continued)
sex only (313 male, 187 female) with 26% (441) unknown.
Clinical presentation
The most common sexual exposure amongst those reported to be
•
For MSM, the most common reason for being tested was for an
Aboriginal and/or Torres Strait Islander was heterosexual contact (41
STI screen; the heterosexual group usually presented because of
cases, 56%); whereas for the non-Indigenous group, it was male to
symptoms (Fig 3).
male sex (665, 56%). (Fig 1)
•
The site of gonorrhoea infection varied according to sexual
•
72 people identified as sex workers (4%; 40 females and 32 males).
exposure. The throat was the most frequent site for MSM (249/759;
•
Infection was most likely to have been acquired from a casual partner
33%), followed by the anus/rectum (223/759; 29%) and
for 841 (59%), a regular partner for 251 (15%) and a partner from
genitourinary tract (173/759; 23%). Most of the heterosexual group
overseas for 34 (2%) (Fig 2).
were infected in the genitourinary tract (428/498; 86%) (Fig 4).
Demographics
• 1418 (83%) were male; 290 (17%) were female; and two
Conclusion
(<1%) were transgender people.
• Median age was 30 years (interquartile range of 15
years).
Short term enhanced surveillance of gonorrhoea has provided valuable epidemiological information to inform future prevention strategies in
NSW, including STI screening, testing and health promotion messaging. Although gonorrhoea is largely an infection amongst men who have sex
with men, who are in their 20s and 30s, in inner Sydney, there are other groups at risk including heterosexuals who engage in unprotected
• Seventy-three (4.3%) identified as either Aboriginal and/or
Torres Strait Islander. There were more Indigenous
sexual activity with casual partners, and Aboriginal and Torres Strait Islander people, particularly women. The high proportion of throat infections
in MSM suggests oral sex is significant in gonorrhoea transmission in this group.
women notified with gonorrhoea than Indigenous men (39
vs 34 cases).
1.
2.
Acknowledgements: We thank the medical practitioners, practice staff and NSW Public Health Units for their invaluable contributions to this project.
NSW Health. Sexually Transmitted Infections Notification Data – 1st Quarterly Report 2014. Available at http://www.health.nsw.gov.au/Infectious/reports/Documents/STI-1stquater-report-2014.pdf [Accessed 26 Sept 2014]
Ressler KA, Smedley E, Spokes P, Hockey G, Nurkic A, Ferson MJ. Enhanced Surveillance of Gonorrhoea in South Eastern Sydney. Available at
http://www.researchgate.net/publication/259843569_Enhanced_surveillance_of_gonorrhoea_in_South_Eastern_Sydney [Accessed 23 Sept 2014]