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Sexually transmitted infections: epidemiological evidence of need Dr Kirsty Foster Consultant in Health Protection Public Health England Centre, North East. Surveillance of Sexually Transmitted Infections. - PowerPoint PPT Presentation
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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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4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 122011 2012
0
5
10
15
20
25
30
FemaleMale
Year and month
Num
ber o
f cas
es
Epidemic curvesNorthumberland
Apr 11 – Dec 12
Newcastle
Apr 11 – Jul 11 and
Jan 12 – Dec 12
4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 122011 2012
0
2
4
6
8
10
12
FemaleMale
Year and month
Num
ber o
f cas
es
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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