Gonorrhoea diagnoses in a network of STI clinics in Spain during the period 2006-2010: differences by sex and transmission route.

BACKGROUND: Gonorrhoea infection is one of the most common bacterial sexually transmitted infections and an important cause of morbidity and serious complications. The objectives of this paper are: a) to describe gonorrhoea cases diagnosed in a network of 15 (out of 16) STI clinics in Spain during 2006-2010; b) to analyse differences among men who have sex with men (MSM), men who have sex exclusively with women (MSW) and women; and c) to evaluate factors associated to with HIV co-infection. METHODS: All gonorrhoea cases diagnosed in the network were included (25.7% of total cases notified in Spain). Data were collected by clinical staff. Descriptive/bivariate analyses were carried out stratifying by sex and transmission category; association and trends were evaluated using the chi-square test. Factors associated with HIV co-infection were estimated using a logistic regression model. RESULTS: 2385 cases were included: 55.3% among MSM, 31.3% among MSW and 13.3% among females; cases among MSM increased from 55.8% in 2006 to 62.9% in 2010 while no trends were found among the other two groups.Most MSM cases were Spaniards (72%), aged 25-34 years (46%), 49% reported previous STI and 25% concurrent STI (excluding HIV); casual partners were the commonest source of infection, and 21% of cases had rectal gonorrhoea. MSW cases did not differ from MSM by age, origin or source of infection, but frequencies of prior or concurrent STI were lower. Female cases were younger than male, were mostly foreigners (58%), and 41% were sex workers; concurrent STI (other than HIV) were diagnosed in 30%; 20.4% had symptoms (72.5% and 89.2% in MSM and MSW), and pharyngeal location was present in 30%.HIV co-infection was highest in MSM (20.9%). Co-infection was associated with age > 35 years, low educational level, being Western European or Latin-American, being MSM, having previous or concurrent STI and reporting contact with an HIV-infected partner; it was inversely associated with female sex. CONCLUSION: Differences by sex, transmission route and origin should be considered when implementing care and preventive programmes for gonorrhoea, and MSM are a priority group for intervention, in particular HIV-infected MSM.

Enfermedades de transmisión sexual. Evaluación de los objetivos del Plan de Salud de Cataluña para el año 2000 / Sexually transmitted diseases. Evaluation of the objectives of the Health Plan for Catalonia for the year 2000

Fundamento y objetivo: Las enfermedades de transmisión sexual (ETS) fueron uno de los problemas prioritarios de salud incluidos en el Plan de Salud de Cataluña en 1991. Se fijaron como objetivos de salud para el año 2000 la reducción de la incidencia de la sífilis en un 30%; la reducción de la incidencia de la gonococia en un 25%; la reducción de la proporción de gonococia causada por cepas de Neisseria gonorrhoeae productoras de ß-lactamasa en un 50%; la eliminación de la oftalmía del recién nacido y de la sífilis congénita, y la reducción de la incidencia de otras enfermedades de transmisión sexual en un 20%. El objetivo de este trabajo es evaluar hasta qué punto se han alcanzado los objetivos. Población y método: Los indicadores de la evolución de la morbilidad de las ETS utilizados para la evaluación de los objetivos propuestos en el Plan de Salud han sido los siguientes: tasas de incidencia de sífilis, gonococia, oftalmía del recién nacido, sífilis congénita y otras ETS, y proporción de gonococia causada por cepas de N. gonorrhoeae productoras de ß-lactamasa registradas durante el período 1989-2000. Resultados: La evolución de las tasas de incidencia de la sífilis y de la gonococia indica, respectivamente, una disminución del 78% (de 7,1 a 1,5 por 100.000 habitantes) y del 95% (de 78,9 a 3,6 por 100.000 habitantes) durante este período de 12 años, en la primera parte del cual ya se alcanzaron los dos primeros objetivos formulados. La proporción de gonococia causada por cepas de gonococo productoras de ß-lactamasa que alcanzaba el 20,4% en 1989 se ha situado por debajo del objetivo del 10% (el 6,1% en 2000), lo que significa una disminución del 70%. El objetivo propuesto de eliminación de la oftalmía del recién nacido no se ha alcanzado a pesar de la importante disminución de su tasa de incidencia. La eliminación de la sífilis congénita se alcanzó en 1995 y este objetivo se mantiene hasta la actualidad. La tasa de incidencia de la rúbrica de otras ETS muestra una reducción del 42% entre 1989 y 2000, por lo que el objetivo se considera alcanzado. Conclusiones: A excepción del objetivo «Del año 1989 al 2000 deberá eliminarse la oftalmía del recién nacido», todos los objetivos se han logrado, y con anterioridad al año 2000. Durante el período 1989-2000 se han desarrollado diversas estrategias en el ámbito de la prevención y control de las ETS que pueden haber contribuido a reducir la incidencia de las ETS objeto de evaluación y a que los indicadores se encuentren en los niveles actuales (AU)

Background and objective: Nowadays sexually transmitted diseases (STDs) are a priority health problem. Therefore, they were included in the Framework Document for the Development of the Health Plan for Catalonia for the year 2000. Several health objectives were fixed: 30% reduction of siphylis incidence, 25% reduction of gonorhea incidence, 50% reduction of infections caused by ß-lactamase producer strains of N. gonorrheae, the oftalmia neonatorum and congenital siphylis eradication and 20% reduction of other STDs. We have analyzed whether this aims have been accomplished or not. Subjects and method: In order to evaluate the objectives, we have use these indicators: gonorhea, siphylis, oftalmia neonatorum, congenital siphylis and other STDs incidence rates and the percentage of gonorhea caused by ß-lactamase producer strains of N. gonorrheae ocurred during the 1989-2000 period. Results: Siphylis incidence rate decreased from 7.1 to 1.5 (78%) and gonorhea incidence rate sunk from 78.9 to 3.6 (95%) in 12 months. Furthermore, these objectives were successful in the early stages of the study period. In addition, the percentage of gonorhea caused by ß-lactamase producer strains of N. gonorrheae fell from 20.4% in 1989 to 6.1% in 2000 (70% reduction). Oftalmia neonatorum have not been eradicated yet but its incidence showed a marked downward trend. Congenital siphylis eradication was achieved in 1995 and this objective remains unchanged. Other STDs incidence rates showed a 42% reduction. Conclusions: All the predicted objectives were achieved except the neoftalmia neonatorum eradication. Several new preventive strategies have been developed during the study period and this may play a role in the actual situation of these indicators (AU)