Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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]