Prevalence of latent tuberculosis, syphilis, hepatitis B and C among asylum seekers in Malta.

BACKGROUND: In the last few years, Malta has witnessed increasing immigration flows from the Libyan coasts. Public health policies are focused on screening migrants for tuberculosis, whereas no systematic actions against STIs are implemented. The aim of this study is to define the epidemiological profile of asylum seekers in Malta as regards syphilis, hepatitis B, C and latent tuberculosis, thus supporting screening policies. METHODS: Five hundred migrants living in open centres were screened between December 2010 and June 2011. RESULTS: 83.2% of people was from Somalia, 81.2% males, average age 26.5 years. The tuberculin skin test (TST) was positive in 225 migrants (45%). Latent syphilis was diagnosed in 11 migrants, hepatitis C in 3 and 31 migrants were HBsAg positive. CONCLUSION: Systematic screening for asymptomatic migrants in Malta is not recommended for hepatitis C and syphilis, given the low prevalence observed. On the contrary, it should be considered for hepatitis B. TST could be indicated as the first step of a two step screening for migrants from countries with high TB incidence. Efficacy and cost-effectiveness could be achieved by further targeting screening to specific subgroups at higher risk of reactivation, such as people living with HIV and subjects affected by chronic diseases.

Setting up the first genitourinary clinic in Malta and an audit of the initial performance.

BACKGROUND: The first genitourinary (GU) clinic was set up in Malta in January 2000. An audit was conducted to evaluate the demand for such a service and its effectiveness during the first 6 years after its introduction. METHOD: Case notes from the first 6 years were reviewed, and data were collected for gender, age, sexual orientation, symptoms, diagnosis, condom use, referral source, total number of attendances, and contact tracing. RESULTS: The total number of attendances increased from 760 in the first year to 1832 in 2005. The male to female ratio decreased from 2.3 in 2000 to 1.6 in 2005, as more females attended. The number of partners treated per index case was 0.25. Eighty per cent of attendees were self-referred; 16% were referred by their general practitioner (GP). Only 10% admitted to using a condom regularly. Twenty-nine per cent of asymptomatic attendees in 2005 were diagnosed with a sexually transmitted infection (STI). Fifty-three cases of gonorrhoea were diagnosed by the GU clinic during the first 6 years, with 17% of isolates showing resistance to ciprofloxacin in 2005. A total of 38 cases of syphilis were diagnosed compared to only a handful of cases reported in the 25 years prior to the introduction of the service. CONCLUSIONS: The increasing attendance, as revealed by this audit, reflects a growing demand for the service offered by the GU clinic in Malta. Numerous STIs are being diagnosed and treated, including syphilis, which has re-emerged in Malta as it has in the rest of Europe. The prevalence of ciprofloxacin-resistant gonorrhoea has been increasing, a trend that has also been documented in other European countries. In addition to successful management of STIs, the GU clinic would further benefit from a public health campaign aimed at encouraging asymptomatic sexually active individuals to attend for an STI screen, while simultaneously promoting responsible sexual behaviour.