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The Picture regarding STIs in the Republic of Ireland CAWT April 27th 2012 Dr. Aidan O’Hora Health Protection Surveillance Centre Dublin Outline • • • • • Notifiable STIs in Republic of Ireland Trends and notifications in 2010 Contrasting selected infections with Europe Recent HIV data Conclusions GUM Services in Republic of Ireland Key Consultant led services Satellite/NGO/non-Consultant led services What is notifiable? • • • • • Ano-genital warts Genital chlamydia infection Gonorrhoea Infectious Hepatitis B Non-specific Urethritis (NSU) • Trichomoniasis • • • • Chancroid Genital herpes simplex Granuloma inguinale Lymphogranuloma venereum (LGV) • Syphilis • HIV STI notifications in Ireland; 1995-2010 STIs in Ireland, 2010 STI Ireland, 2010 n=5,016 n=6,657 STI in Ireland 2010 by age-group % % 5.3 6.4 5.1 5.0 6.3 6.3 7.6 7.6 8.0 8.4 6.3 6.3 10.9 10.4 Chlamydia Gonorrhoea Syphilis Trends in Europe and Ireland Indicators 2010 Rate per 100,000 Europe Ireland Chlamydia Gonorrhoea Syphilis Chlamydia Gonorrhoea Syphilis 186.0 9.8 4.4 116.5 13.6 13.2 Trend: 2006-2010 (%) +41 -10 -17 +170 +145 +450 Male : Female ratio in reported cases 0.7 2.5 3.7 0.8 3.1 3.2 Percentage in young people: 15-24 yrs 76 43 17 N/A N/A N/A 862.0 28.8 5.5 N/A N/A N/A 5 23 55 N/A N/A N/A Rate for 20-24 yr olds per 100,000 population Percentage in MSM 22 July 2011 14 22 July 2011 15 Herpes Simplex HIV in Republic of Ireland Q1&Q2 2011 HIV Trend by risk group: 2003-2011 Total MSM Heterosexual IDU Probable country of infection and mode of transmission CD4 count at time of diagnosis Median CD4 count by risk group Conclusions • Chlamydia is the most commonly notified STI: 46% of total • Young adults aged 20-29 years account for 59% of notifications • Significant increases in gonorrhoea, syphilis • HIV transmission persists • The majority of new diagnoses are late presenters The Health Protection Surveillance Centre wishes to sincerely thank all who have provided data for this report – the National Virus Reference Laboratory, microbiology laboratories, the Departments of Public Health, Consultants in Infectious Disease/GUM and all other clinicians involved. THANK YOU Chlamydia notifications and hospital discharges for tubal ectopic pregnancy, 1997-2010 Patient 1 Clinician/GP 4b 5b 2b 2a Health Protection Surveillance Centre Director of Public Health 6 3(x2) NVRL Laboratory 4a 5a Patient 1 NVRL 4a 5b Clinician/GP 4b 2b 2a 3(x2) Director of Public Health Laboratory KEY Action 1 Patient attends clinician/GP for HIV test is sent to local laboratory for analysis, and if 2 (a) Specimen positive a second specimen is requested 3 6 Health Protection Surveillance Centre 5a (b) In some instances, the clinician/GP may send specimens directly to the NVRL. In such instances, the NVRL is both the “local laboratory” and the “reference laboratory” The local laboratory sends a second specimen to the NVRL for confirmation of HIV diagnosis. If the NVRL is the “local laboratory”, the need for a second sample will be communicated directly to the requesting clinician From January 1st 2012, when a HIV diagnosis is confirmed core notification data are collected through CIDR and supplementary clinical data specific to HIV are collected using a paper surveillance form CIDR (electronic) NVRL send result confirming HIV diagnosis to local laboratory via CIDR Clinical Laboratory Director notifies Public Health via CIDR Surveillance Form (paper) (b) The NVRL send a surveillance form to the clinician for completion The completed form is returned to the Director of Public Health 4 (a) 5 (a) 6 At the Department of Public Health, notification data and supplementary clinical data are linked and anonymised using CIDR. The data are then available to the HPSC for analysis and use in national reports. (b) Surveillance of STIs: 2005 • • Priority should be given to collecting timely disaggregate, person-based data on the major bacterial infections; syphilis, gonorrhoea, genital chlamydia and infectious hepatitis B The notifying clinician should indicate; – – – • • Whether partner notification (PN) has been carried out within the STI clinic or general practice, Family Planning Clinic or Student Health Service Whether the patient is attending or been referred to an STI clinic If not attending or referred, the notifying clinician should indicate if PN has been discussed Primary & Reference Laboratory Facilities General Practice – – – Access, free at the point of delivery Guidelines and protocols Training Priorities Surveillance • CIDR implementation • Improve Clinical, laboratory and Public Health • Behavioural Surveillance • Enhanced partner notification and contact tracing Action • Chlamydia Control • Detection of Gonococcal AMR resistance • Syphilis Control • Undiagnosed HIV • HIV patients in care