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Gassowski M, Poethko-Müller C, Schlaud M, Sailer A, Dehmel K, Bremer V, Dudareva S, Jansen K, Baier M, Straube E, Baillot A, Bartsch P, Brüning T, Cremer J, Dallügge-Tamm H, Gröning A, Eicke S, Emrich D, Fritsche G, Gjavotchanoff R, Gohl P, Götzrath M, Meye A, Ehrhard I, Köpke B, Henrich B, Kastilan C, Lehmann S, Märzacker A, Miller B, Mohrmann G, Pache C, Pfüller R, Tiemann C, Wisplinghoff H, Müller T, Aepinus C. Prevalence of Chlamydia trachomatis in the general population in Germany – a triangulation of data from two population-based health surveys and a laboratory sentinel system. BMC Public Health 2022; 22:1107. [PMID: 35659641 PMCID: PMC9164541 DOI: 10.1186/s12889-022-13456-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background Chlamydia trachomatis (chlamydia) is a common, frequently asymptomatic, sexually transmitted infection. It can result in severe sequelae, such as ectopic pregnancy and infertility. In Germany, chlamydia is not notifiable. An opportunistic screening program for women < 25 years was introduced in 2008. The aim of this research was to triangulate different data sources to describe the epidemiological situation of chlamydia in Germany and to investigate whether the current target group of the chlamydia screening program aligns with these findings. Methods Urine specimens from participants from population-based health examination surveys of children (2014–17) and adults (2008–11) were tested for chlamydia, using nucleic acid amplification testing. These data were used to generate weighted chlamydia prevalence estimates by age group and sex. Data from a nationwide chlamydia laboratory sentinel system (2014–16) were used to calculate the positive proportion among individuals tested for chlamydia by age, sex and test reason. Results Using data from the population-based surveys, we found a chlamydia prevalence estimate of 2.8% (95% confidence interval (CI) 1.0–7.5%) among all 15- to 17-year-old girls and of 9.6% (95% CI 0.0–23) among those reporting to be sexually active. In adult women, we found the highest prevalence among 18- to 24-year-olds (all: 2.3%; 95% CI 1.0–5.3%; sexually active: 3.1%; 95% CI 1.3–7.0%). In adult men, we found the highest prevalence among 25- to 29-year-olds (all: 3.5%; 95% CI 1.6–7.7%; sexually active: 3.3%; 95% CI 1.3–7.8%). Data from the chlamydia laboratory sentinel showed the highest positive proportion among those opportunistically screened in 19-year-old women (6.1%; 95%- CI 5.9–6.4%), among those screened due to pregnancy in 15-year-old girls (10%; 95% CI 8.5–12%), and among those tested due to symptoms or a positive partner in 19-year-old women (10%; 95% CI 9.8–11%) and 19-year-old men (24%; 95% CI 22–26%). Conclusions Chlamydia seems to mainly affect adolescents and young adults in Germany, with similar overall prevalence in men and women, but with slightly different age distributions. Women at highest risk of chlamydia are covered by the current screening program but given the on-going discussions in high-income countries on cost-effectiveness and benefit-to-harm ratio of these programs, the program-aim needs reconsideration.
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Ndeikoundam Ngangro N, Pioche C, Vaux S, Viriot D, Durand J, Berat B, Hamdaoui M, Lot F. Automated surveillance for the French STI clinics: the SurCeGGID system based on routine clinical records (Preprint). JMIR Form Res 2021; 6:e31136. [DOI: 10.2196/31136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 05/05/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
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Buder S, Schöfer H, Meyer T, Bremer V, Kohl PK, Skaletz-Rorowski A, Brockmeyer N. Bacterial sexually transmitted infections. J Dtsch Dermatol Ges 2020; 17:287-315. [PMID: 30920748 DOI: 10.1111/ddg.13804] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/15/2019] [Indexed: 12/14/2022]
Abstract
Worldwide, the incidence of bacterial sexually transmitted infections (STIs) has shown a significant increase in recent years. In Germany, this circumstance is reflected by a rise in the number of reported syphilis cases. There has also been an uptick in the incidence of non-notifiable STIs such as gonorrhea and infections caused by Chlamydia trachomatis and Mycoplasma genitalium. A key factor in the spread of these infections is their varied clinical presentation, which includes urogenital, pharyngeal and rectal involvement as well as a large number of asymptomatic cases. New real-time multiplex PCR methods allow for rapid and targeted detection of STI pathogens. The most common bacterial STI is urogenital chlamydial infection caused by serovars D-K, which affects young adults in particular. Lymphogranuloma venereum (LGV) caused by L serovars often presents as chlamydial proctitis. In recent years, Neisseria (N.) gonorrhoeae has shown a significant development of resistance, with high-level monoresistance and multiresistance to antibiotics commonly used for treatment. It is therefore imperative that sensitivity testing of N. gonorrhoeae be performed in addition to nucleic acid amplification tests (NAATs). Increased drug resistance has also been observed for Mycoplasma genitalium, a fact that complicates treatment.
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Affiliation(s)
- Susanne Buder
- German Reference Laboratory for Gonococci, Department of Dermatology and Venerology, Vivantes Hospital, Berlin, Germany
| | - Helmut Schöfer
- Department of Dermatology, Venereology and Allergology, University Medical Center, Frankfurt am Main, Germany
| | - Thomas Meyer
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Viviane Bremer
- Division of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Peter K Kohl
- German Reference Laboratory for Gonococci, Department of Dermatology and Venerology, Vivantes Hospital, Berlin, Germany
| | - Adriane Skaletz-Rorowski
- WIR "Walk In Ruhr", competence network HIV/AIDS, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - Norbert Brockmeyer
- WIR "Walk In Ruhr", competence network HIV/AIDS, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
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van Gemert C, Guy R, Stoove M, Dimech W, El-Hayek C, Asselin J, Moreira C, Nguyen L, Callander D, Boyle D, Donovan B, Hellard M. Pathology Laboratory Surveillance in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmitted Infections and Blood-Borne Viruses: Protocol for a Cohort Study. JMIR Res Protoc 2019; 8:e13625. [PMID: 33932276 PMCID: PMC6786847 DOI: 10.2196/13625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/30/2022] Open
Abstract
Background Passive surveillance is the principal method of sexually transmitted infection (STI) and blood-borne virus (BBV) surveillance in Australia whereby positive cases of select STIs and BBVs are notified to the state and territory health departments. A major limitation of passive surveillance is that it only collects information on positive cases and notifications are heavily dependent on testing patterns. Denominator testing data are important in the interpretation of notifications. Objective The aim of this study is to establish a national pathology laboratory surveillance system, part of a larger national sentinel surveillance system called ACCESS (the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance). ACCESS is designed to utilize denominator testing data to understand trends in case reporting and monitor the uptake and outcomes of testing for STIs and BBVs. Methods ACCESS involves a range of clinical sites and pathology laboratories, each with a separate method of recruitment, data extraction, and data processing. This paper includes pathology laboratory sites only. First established in 2007 for chlamydia only, ACCESS expanded in 2012 to capture all diagnostic and clinical monitoring tests for STIs and BBVs, initially from pathology laboratories in New South Wales and Victoria, Australia, to at least one public and one private pathology laboratory in all Australian states and territories in 2016. The pathology laboratory sentinel surveillance system incorporates a longitudinal cohort design whereby all diagnostic and clinical monitoring tests for STIs and BBVs are collated from participating pathology laboratories in a line-listed format. An anonymous, unique identifier will be created to link patient data within and between participating pathology laboratory databases and to clinical services databases. Using electronically extracted, line-listed data, several indicators for each STI and BBV can be calculated, including the number of tests, unique number of individuals tested and retested, test yield, positivity, and incidence. Results To date, over 20 million STI and BBV laboratory test records have been extracted for analysis for surveillance monitoring nationally. Recruitment of laboratories is ongoing to ensure appropriate coverage for each state and territory; reporting of indicators will occur in 2019 with publication to follow. Conclusions The ACCESS pathology laboratory sentinel surveillance network is a unique surveillance system that collects data on diagnostic testing, management, and care for and of STIs and BBVs. It complements the ACCESS clinical network and enhances Australia’s capacity to respond to STIs and BBVs. International Registered Report Identifier (IRRID) DERR1-10.2196/13625
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Affiliation(s)
- Caroline van Gemert
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mark Stoove
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | | | | | | | | | | | - Denton Callander
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Douglas Boyle
- Department of General Practice, The University of Melbourne, Parkville, Australia
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia.,Doherty Institute, Melbourne, Australia.,Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia
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Buder S, Schöfer H, Meyer T, Bremer V, Kohl PK, Skaletz-Rorowski A, Brockmeyer N. Bakterielle sexuell übertragbare Infektionen. J Dtsch Dermatol Ges 2019; 17:287-317. [PMID: 30920739 DOI: 10.1111/ddg.13804_g] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/15/2019] [Indexed: 01/08/2023]
Abstract
Bakterielle sexuell übertragbare Infektionen (STI) zeigen seit Jahren weltweit eine deutliche Zunahme. In Deutschland wird diese Tatsache durch steigende Meldezahlen für Syphilis bestätigt. Auch für die nicht meldepflichtigen STI Gonorrhoe, Chlamydia-trachomatis- und Mycoplasma-genitalium-Infektionen wird eine zunehmende Inzidenz beobachtet. Entscheidend für die Weiterverbreitung ist, dass das breite klinische Spektrum, welches neben Urogenitalsitus auch Pharynx und Rektum einbezieht, durch eine hohe Zahl asymptomatischer Verläufe ergänzt wird. Neue Real-Time-Multiplex-Diagnostikverfahren ermöglichen einen schnellen und gezielten Nachweis von STI-Erregern. Die häufigste bakterielle STI ist die urogenitale Chlamydieninfektion mit den Serovaren D-K, die besonders bei jungen Erwachsenen auftritt. Einer Chlamydien-Proktitis kann eine Infektion mit L-Serovaren und damit eine Lymphogranuloma-venereum (LGV)-Infektion zugrunde liegen. Neisseria (N.) gonorrhoeae zeigte in den letzten Jahren eine starke Resistenzentwicklung mit Ausbildung von Einzel- und Multiresistenzen gegenüber bisher gängigen Antibiotika. Daher ist für N. gonorrhoeae zusätzlich zum nucleic acid amplification test (NAAT) eine kulturelle Empfindlichkeitstestung durchzuführen. Auch für Mycoplasma genitalium sind Resistenzentwicklungen bekannt, die eine Therapie erschweren können.
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Affiliation(s)
- Susanne Buder
- Konsiliarlabor für Gonokokken, Klinik für Dermatologie und Venerologie, Vivantes-Klinikum Region Süd, Berlin
| | - Helmut Schöfer
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Frankfurt am Main
| | - Thomas Meyer
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef Hospital, Ruhr-Universität Bochum
| | - Viviane Bremer
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin
| | - Peter K Kohl
- Konsiliarlabor für Gonokokken, Klinik für Dermatologie und Venerologie, Vivantes-Klinikum Region Süd, Berlin
| | - Adriane Skaletz-Rorowski
- WIR "Walk In Ruhr", Kompetenznetz HIV/AIDS, Zentrum für Sexuelle Gesundheit und Medizin, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum
| | - Norbert Brockmeyer
- WIR "Walk In Ruhr", Kompetenznetz HIV/AIDS, Zentrum für Sexuelle Gesundheit und Medizin, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum
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Bremer V, Dudareva-Vizule S, Buder S, An der Heiden M, Jansen K. [Sexually transmitted infections in Germany : The current epidemiological situation]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 60:948-957. [PMID: 28741188 DOI: 10.1007/s00103-017-2590-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sexually transmitted infections (STIs) can impair sexual health. Surveillance and study data were used to provide an overview over STIs in Germany. We estimated 3900 new HIV diagnoses in 2015. Of newly diagnosed infections, 57% were attributed to men who have sex with men (MSM). It was further estimated that there were 3200 new HIV infections and 84,700 people living with HIV in 2015. A total of 6834 syphilis infections were recorded in 2015, which corresponds to an increase of 149% since 2009. The incidence in men was 16-times higher than in women. Of syphilis infections, 85% could be attributed to MSM. Antimicrobial resistance of gonococci against the broad-spectrum antibiotic cefixime decreased between 2014 and 2016 after a change of therapy guidelines and remained stable on a low level regarding the antibiotic ceftriaxone. After an increase of resistance against the antibiotic azithromycin to 11.3% in 2015, we observed a decreasing trend in 2016. Between 2013 and 2015, 2,355,336 chlamydia tests were reported through the chlamydia sentinel network. Of these, 92.5% of samples were from women. Uptake for screening for women <25 years was 11.3% in 2015, with 5.0% positive chlamydia tests. In a cross-sectional study among women aged 20-25 years, a prevalence of human papilloma virus (HPV) of 38.1% was observed. A total of 30.5% of 15-year-old women were vaccinated against HPV in 2014. Data suggest that STIs represent a high burden of disease. Knowledge of STI prevention should be improved by targeted education campaigns. Extending existing offers for counselling and testing through cooperation between different health sectors would improve early diagnosis and treatment of STIs.
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Affiliation(s)
- Viviane Bremer
- Abt. für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland.
| | - Sandra Dudareva-Vizule
- Abt. für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland.,Charité Universitätsmedizin, Berlin, Deutschland
| | - Susanne Buder
- Konsiliarlabor für Gonokokken, Vivantes-Klinikum Neukölln, Berlin, Deutschland
| | - Matthias An der Heiden
- Abt. für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Klaus Jansen
- Abt. für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
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Lang AS, An der Heiden M, Jansen K, Sailer A, Bremer V, Dudareva S. Not again! Effect of previous test results, age group and reason for testing on (re-)infection with Chlamydia trachomatis in Germany. BMC Infect Dis 2018; 18:424. [PMID: 30144825 PMCID: PMC6109262 DOI: 10.1186/s12879-018-3323-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/10/2018] [Indexed: 12/01/2022] Open
Abstract
Background Infection with Chlamydia trachomatis (Ct) is the most commonly reported sexually transmitted infection in Europe. In Germany, Ct screening is offered free of charge to pregnant women since 1995 and to women < 25 years of age since 2008. For symptomatic individuals, testing is covered by statutory health insurance. Study results have shown that repeat Ct infection occurs in 10–20% of previously infected women and men. Our aim was to describe persons tested for Ct and to investigate the determinants of (repeat) Ct infection in women and men in Germany. Methods We analysed Ct test results from men and women tested between 2008 and 2014 in laboratories participating in the German Chlamydia trachomatis Laboratory Sentinel surveillance. Reinfection was defined as at least 2 positive laboratory tests within more than 30 days. We performed logistic regression stratified by sex and, for women, reason for testing to determine the effect of previous test results and age group on subsequent test results. Results In total, 2,574,635 Ct tests could be attributed to 1,815,494 women and 123,033 men. 5% of women and 14% of men tested positive at least once. 15–19- and 20–24-year-old women tested positive at least once respectively in 6.8 and 6.0%, while men respectively in 16.6 and 21.2%. Altogether, 23.1% of tested women and 11.9% of tested men were tested repeatedly between 2008 and 2014. Among those who previously tested positive, reinfection occurred in 2.0% of women and 6.6% of men. Likelihood to be tested Ct positive was higher in women and men with a positive Ct test in the past compared to previously tested Ct negative, odds ratios 4.7 and 2.6 (p < 0.01) respectively. Odds ratios ranged by age group and test reason. Conclusion A history of Ct infection increased the likelihood of infection with Ct in women and men taking into account the result of the previous test. Health education, safer sex and treatment of partners are necessary for women and men who have tested positive to prevent reinfection and complications and to interrupt the chain of transmission. To identify potential reinfection repeat testing after treatment should be performed. Electronic supplementary material The online version of this article (10.1186/s12879-018-3323-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexandra Sarah Lang
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
| | | | - Klaus Jansen
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Andrea Sailer
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Viviane Bremer
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Sandra Dudareva
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.,Charité Universitätsmedizin Berlin, Berlin, Germany
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Banhart S, Rose L, Aeberhard L, Koch-Edelmann S, Heuer D. Chlamydia trachomatis and its interaction with the cellular retromer. Int J Med Microbiol 2017; 308:197-205. [PMID: 29122514 DOI: 10.1016/j.ijmm.2017.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/16/2017] [Accepted: 10/24/2017] [Indexed: 11/26/2022] Open
Abstract
Chlamydia trachomatis is an important human pathogen. This obligate intracellular bacterium grows inside the eukaryotic cell in a membrane-bound compartment, the inclusion. Recent global approaches describe the interactions of C. trachomatis with its host cell and indicate the inclusion is an intracellular trafficking hub embedded into the cellular vesicular trafficking pathways recruiting subunits of the retromer protein complex of the host cell. Here we review these recent developments in deciphering Chlamydia-host cell interactions with emphasis on the role of the retromer complex.
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Affiliation(s)
- Sebastian Banhart
- Division "Sexually Transmitted Bacterial Infections" (FG 19), Robert Koch Institute, Berlin, Germany
| | - Laura Rose
- Division "Sexually Transmitted Bacterial Infections" (FG 19), Robert Koch Institute, Berlin, Germany
| | - Lukas Aeberhard
- Division "Sexually Transmitted Bacterial Infections" (FG 19), Robert Koch Institute, Berlin, Germany
| | - Sophia Koch-Edelmann
- Division "Sexually Transmitted Bacterial Infections" (FG 19), Robert Koch Institute, Berlin, Germany
| | - Dagmar Heuer
- Division "Sexually Transmitted Bacterial Infections" (FG 19), Robert Koch Institute, Berlin, Germany.
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