Surveillance Systems for Sexually Transmitted Diseases in Switzerland

Tracing partners of patients with syphilis infection remains challenging: experience of Geneva Hospital

Syphilis has been reinstated on the list of notifiable diseases in Switzerland since 2006 and the active management of sexual partners is encouraged to avoid reinfection. However, contact tracing has yielded unsatisfactory results and the incidence of syphilis remains important, especially in high-risk populations. The aim of this study was to compare the proportions of notified sexual partners of patients diagnosed with syphilis by the laboratories of Geneva University Hospitals (HUG) with those diagnosed in private laboratories (non-HUG) and to assess the risk factors for no notification to sexual partners. All syphilis cases notified to the Office of the Surgeon General in Geneva (Switzerland) between 1 January 2011 and 31 December 2013 were analysed. The proportions of partner notification (PN) between HUG and non-HUG laboratories were compared by Chi square test and the main risk factors for no notification to sexual partners were assessed by binomial log-linear regression. Among a total of 720 notifications reported, 244 cases were diagnosed with contagious syphilis stages and 263 with non-contagious stages (i.e. successfully treated patients with or late latent cases). Overall, PN was higher among contagious than non-contagious cases (58.4% versus 31.0%; p = 0.030) and it was significantly higher in the non-HUG compared to the HUG group (75.9% versus 50.0%, respectively; p < 0.001). Risk factors independently associated with no notification to sexual partners were the place of diagnosis (risk ratio [RR] 1.66; 95% confidence interval [CI] 1.21-2.27 for HUG versus non-HUG, respectively), age >45 years (RR 1.36; 95% CI: 1.05-1.76) and if the patient had received treatment for syphilis (RR 1.91; 95% CI: 1.38-2.66). Our results illustrate the difficulty of contact tracing in syphilis infection and the necessity to improve this crucial part of sexually transmitted infection management.

Nonprobability and probability-based sampling strategies in sexual science

With few exceptions, much of sexual science builds upon data from opportunistic nonprobability samples of limited generalizability. Although probability-based studies are considered the gold standard in terms of generalizability, they are costly to apply to many of the hard-to-reach populations of interest to sexologists. The present article discusses recent conclusions by sampling experts that have relevance to sexual science that advocates for nonprobability methods. In this regard, we provide an overview of Internet sampling as a useful, cost-efficient, nonprobability sampling method of value to sex researchers conducting modeling work or clinical trials. We also argue that probability-based sampling methods may be more readily applied in sex research with hard-to-reach populations than is typically thought. In this context, we provide three case studies that utilize qualitative and quantitative techniques directed at reducing limitations in applying probability-based sampling to hard-to-reach populations: indigenous Peruvians, African American youth, and urban men who have sex with men (MSM). Recommendations are made with regard to presampling studies, adaptive and disproportionate sampling methods, and strategies that may be utilized in evaluating nonprobability and probability-based sampling methods.

Epidemiology of syphilis, gonorrhea and chlamydia in Romania, 1980-2009

OBJECTIVES

This study aims to analyze the epidemiology of syphilis, gonorrhea and genital chlamydial infections in Romania during 1980-2009 when radical changes occurred during transition from a communist regime to a democratic society.

METHODS

Surveillance data was retrieved from the National Center for Surveillance and Control of the Communicable Disease in Romania and the World Health Organization.

RESULTS

The mean annual incidences of syphilis, gonorrhea and genital chlamydia infections in Romania were 25.2 ± 15 cases per 100,000 inhabitants (1980-2009), 33.2 ± 26.6/100,000 (1980-2009) and 0.3 ± 0.4/100,000 (1994-2009), respectively. Although the infection rates for syphilis followed a significant ascending trend over the study period (p < 0.001), they declined dramatically since 2002 (p < 0.001). There was a significant decrease in gonorrhea-affected persons over the study period (p < 0.0001), while genital chlamydia infections registered a general ascending trend (p = 0.02) with insignificant decrease since 2006.

CONCLUSIONS

The declining trend of syphilis and gonorrhea infections in the general population especially during the last years is very encouraging but should not challenge the amount of resources dedicated to sexually transmitted infections. Consequently, compelling strategies and policies based mainly on education of the population should be put forth in order to advance efficient prevention.