Sharp increase in gonorrhoea notifications among young people, EU/EEA, July 2022 to June 2023

Gonorrhoea cases increased steeply in women aged 20 to 24 years across 15 EU/EEA countries in July to December 2022 and January to June 2023 with, respectively, 73% and 89% more cases reported than expected, based on historical data from 2015 to 2019. Smaller increases among men due to heterosexual transmission were observed in nine EU/EEA countries. Interventions to raise awareness among young people about sexually transmitted infection risks are needed, emphasising the benefit of safe sexual practices and testing.

First National Genomic Epidemiological Study of Neisseria gonorrhoeae Strains Spreading Across Sweden in 2016

The increasing transmission and antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global health concern with worrying trends of decreasing susceptibility to also the last-line extended-spectrum cephalosporin (ESC) ceftriaxone. A dramatic increase of reported gonorrhea cases has been observed in Sweden from 2016 and onward. The aim of the present study was to comprehensively investigate the genomic epidemiology of all cultured N. gonorrhoeae isolates in Sweden during 2016, in conjunction with phenotypic AMR and clinical and epidemiological data of patients. In total, 1279 isolates were examined. Etest and whole-genome sequencing (WGS) were performed, and epidemiological data obtained from the Public Health Agency of Sweden. Overall, 51.1%, 1.7%, and 1.3% resistance to ciprofloxacin, cefixime, and azithromycin, respectively, was found. No isolates were resistant to ceftriaxone, however, 9.3% of isolates showed a decreased susceptibility to ceftriaxone and 10.5% to cefixime. In total, 44 penA alleles were found of which six were mosaic (n = 92). Using the typing schemes of MLST, NG-MAST, and NG-STAR; 133, 422, and 280 sequence types, respectively, and 93 NG-STAR clonal complexes were found. The phylogenomic analysis revealed two main lineages (A and B) with lineage A divided into two main sublineages (A1 and A2). Resistance and decreased susceptibility to ESCs and azithromycin and associated AMR determinants, such as mosaic penA and mosaic mtrD, were predominantly found in sublineage A2. Resistance to cefixime and azithromycin was more prevalent among heterosexuals and MSM, respectively, and both were predominantly spread through domestic transmission. Continuous surveillance of the spread and evolution of N. gonorrhoeae, including phenotypic AMR testing and WGS, is essential for enhanced knowledge regarding the dynamic evolution of N. gonorrhoeae and gonorrhea epidemiology.

Process evaluation of a bio-behavioural HIV research combined with prevention among GBMSM in 13 European countries

Comparative European data using Second Generation Surveillance System (SGSS) are scarce among gay, bisexual and other men who have sex with men. This study evaluated the implementation of Sialon II, a bio-behavioural HIV research combined with targeted HIV prevention in 13 European cities conducted in collaboration with community partners. A mixed-methods process evaluation assessed the project's coverage, outputs, quality, challenges and opportunities for improvement. Data collected through structured questionnaire from 71 data collectors from community-based organisations and semi-structured interviews with 17 managers of participating gay venues were analysed. Overall implementation was successful, achieving 4901 valid behavioural questionnaires and obtaining 4716 biological samples. Challenges in conducting bio-behavioural research in gay venues related to strict research protocols and unfavourable characteristics of venues. Formative research, collaboration with community gay venues, and offering HIV prevention emerged as facilitators. Community researchers' training was crucial for fidelity to research protocols, increased trust amongst communities and enabled data collectors to effectively address practical problems in the field. Scientifically sound SGSS with community participation is feasible and allows for including 'hard-to-reach' populations. Prevention benefits include awareness raising, capacity building and sexual health promotion in gay venues. The findings are beneficial for epidemiological research among other HIV key populations.

Trends in human immunodeficiency virus diagnoses among men who have sex with men in North America, Western Europe, and Australia, 2000-2014

PURPOSE

The aim of the article was to investigate recent trends in human immunodeficiency virus (HIV) diagnosis rates among men who have sex with men (MSM) in high-income countries in North America, Western Europe, and Australia.

METHODS

Data on annual rates of HIV diagnoses among MSM aged 15 to 65 years from 2000 to 2014 were collected from 13 high-income countries. Joinpoint regression software was used to empirically determine country-specific trend periods. Trends in HIV diagnosis rates and in the proportion of diagnoses occurring in young MSM aged 15 to 24 years were analyzed using Poisson regression and log-binomial regression, respectively.

RESULTS

Six countries experienced an increasing trend from 2000 to 2007-08 followed by either a stable or declining trend through 2014. Five countries had recently increasing trends, and two countries had one stable trend from 2000 to 2014. All 13 countries experienced increases in the proportion of diagnoses occurring in young MSM.

CONCLUSIONS

Since 2008, half of the 13 high-income countries examined experienced stable or decreasing trends. Still, some countries continue to experience increasing HIV trends, and young MSM are increasingly represented among new diagnoses. Efforts to support early sexual health promotion, reduce barriers to pre-exposure prophylaxis, and improve care engagement for young MSM are critical to addressing current HIV trends.

Prevalence of drug use during sex amongst MSM in Europe: Results from a multi-site bio-behavioural survey

BACKGROUND

Substance use has been consistently reported to be more prevalent amongst Men who have Sex with Men (MSM) compared to the general population. Substance use, in particular polydrug use, has been found to be influenced by social and contextual factors and to increase the risk of unprotected intercourse among MSM. The objective of this analysis was to investigate the prevalence and predictors of drug use during a sexual encounter and to identify specific prevention needs.

METHODS/DESIGN

A multi-site bio-behavioural cross-sectional survey was implemented in 13 European cities, targeting MSM and using Time-Location Sampling and Respondent-Driven Sampling methods Multivariable multi-level logistic random-intercept model (random effect of study site) was estimated to identify factors associated with the use of alcohol, cannabis, party drugs, sexual performance enhancement drugs and chemsex drugs.

RESULTS

Overall, 1261 (30.0%) participants reported drug use, and 436 of 3706 (11.8%) reported the use of two or more drugs during their last sexual encounter. By drug class, 966 (23.0%) reported using sexual performance enhancement drugs, 353 (8.4%) - party drugs, and 142 (3.4%) the use of chemsex drugs. Respondents who reported drug use were more frequently diagnosed with HIV (10.5% vs. 3.9%) before and with other STIs during the 12 months prior to the study (16.7% vs. 9.2%). The use of all the analysed substances was significantly associated with sexual encounter with more than one partner.

DISCUSSION

Substance and polydrug use during sexual encounters occurred amongst sampled MSM across Europe although varying greatly between study sites. Different local social norms within MSM communities may be important contextual drivers of drug use, highlighting the need for innovative and multi-faceted prevention measures to reduce HIV/STI risk in the context of drug use.

Travel-associated gonorrhoea in four Nordic countries, 2008 to 2013

Travel may be associated with a higher risk of gonorrhoea and infection by antibiotic-resistant strains. The objective of this study was to estimate the risk for gonorrhoea among travellers from four Nordic European countries using surveillance data and to identify at-risk travellers to help target interventions. We retrieved gonorrhoea surveillance data from Denmark, Finland, Norway and Sweden and tourism denominator data from the Statistical Office of the European Union. A travel-associated case of gonorrhoea was defined as one for which the reported country of infection differed from the reporting country. During 2008−2013, the four countries reported 3,224 travel-associated gonorrhoea cases, of which 53% were among individuals below 35 years of age. The overall risk associated with travel abroad was 2.4 cases per million nights abroad. The highest risk was observed with travel to Asia (9.4). Cases more likely to be reported as travel-associated were: males, heterosexuals of both sexes, people older than 65 years, and foreign-born individuals. More effective interventions targeting young adults and other at-risk groups are needed. The use of travel-planning websites and social media should be explored further.

Bio-behavioural HIV and STI surveillance among men who have sex with men in Europe: the Sialon II protocols

BACKGROUND

Globally, the HIV epidemic continues to represent a pressing public health issue in Europe and elsewhere. There is an emerging and progressively urgent need to harmonise HIV and STI behavioural surveillance among MSM across European countries through the adoption of common indicators, as well as the development of trend analysis in order to monitor the HIV-STI epidemic over time. The Sialon II project protocols have been elaborated for the purpose of implementing a large-scale bio-behavioural survey among MSM in Europe in line with a Second Generation Surveillance System (SGSS) approach.

METHODS/DESIGN

Sialon II is a multi-centre biological and behavioural cross-sectional survey carried out across 13 European countries (Belgium, Bulgaria, Germany, Italy, Lithuania, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the UK) in community settings. A total of 4,966 MSM were enrolled in the study (3,661 participants in the TLS survey, 1,305 participants in the RDS survey). Three distinct components are foreseen in the study protocols: first, a preliminary formative research in each participating country. Second, collection of primary data using two sampling methods designed specifically for 'hard-to-reach' populations, namely Time Location Sampling (TLS) and Respondent Driven Sampling (RDS). Third, implementation of a targeted HIV/STI prevention campaign in the broader context of the data collection.

DISCUSSION

Through the implementation of combined and targeted prevention complemented by meaningful surveillance among MSM, Sialon II represents a unique opportunity to pilot a bio-behavioural survey in community settings in line with the SGSS approach in a large number of EU countries. Data generated through this survey will not only provide a valuable snapshot of the HIV epidemic in MSM but will also offer an important trend analysis of the epidemiology of HIV and other STIs over time across Europe. Therefore, the Sialon II protocol and findings are likely to contribute significantly to increasing the comparability of data in EU countries through the use of common indicators and in contributing to the development of effective public health strategies and policies in areas of high need.

Time Elapsed from Onset of Symptoms to Diagnosis of Gonorrhoea in Swedish Patients, 1999-2009

Background: Gonococcal infection remains an important public health problem worldwide. The incidence of reported gonorrhoea cases in Sweden raised by 32%, from 5.9 to 7.8 cases per 100,000 in 2001 to 2008.The aim of this study is to estimate the lag time or time elapsed between onset of symptoms and diagnosis of gonorrhoea, and to identify the factors associated with diagnostic delay in a sample of reported gonorrhoea cases in Sweden. Methods: A retrospective cohort study was conducted using all reported gonorrhoea cases at the Swedish Institute for Communicable Disease Control (SMI) from the time period 1999-2009. Total number of cases included in final analysis was 2161. Descriptive statistics, ANOVA, independent t-test and multiple linear regression analysis were applied for data analysis. Results: The mean lag time between onset of symptoms and diagnosis of gonorrhoea was 12.3 ± 18.8 days. There was a significant association of lag time with sex, region, type of clinics and type of specimen and year of diagnosis. In multivariate analysis with adjusted model, type of specimen was found to have independent effect on lag time and there was a significant interaction observed between region and sex indicating difference between sexes was due to difference in regions. Conclusion: The result of our study revealed a significant delay in establishing a diagnosis in Gonorrhoea patient sample in Sweden. The variables influencing this delay in diagnosis should be addressed to shorten the lag time leading to an early diagnosis and a proper treatment in our patients. However, more research needs to be carried out in this area to better understand the factors at work. DOI: http://dx.doi.org/10.3126/ajms.v5i1.8513 Asian Journal of Medical Science Vol.5(1) 2014 pp.20-28

Recent trends in gonorrhoea and syphilis epidemiology in Sweden: 2007 to 2011

Binary file ES_Abstracts_Final_ECDC.txt matches

Recent trends in gonorrhoea and syphilis epidemiology in Sweden: 2007 to 2011

Gonorrhoea incidence in Sweden continued to increase during 2007-2011, while for syphilis, there was a very minor decrease, but no clear trend. Gonorrhoea incidence increased most among heterosexually infected men and women while for syphilis, the major burden was among men who have sex with men. Neisseria gonorrhoeae resistance to first-line antimicrobials increased annually. Surveillance of infection and antimicrobial resistance along with continuous analysis are needed, to develop prevention activities to reduce risk behaviours.

The Chlamydia surveillance system in Sweden delivers relevant and accurate data: results from the system evaluation, 1997-2008

This study evaluates the ability of the Chlamydia surveillance system to provide relevant information to inform prevention and control activities in Sweden. The system was evaluated, according to the Guidelines for Evaluating Public Health Surveillance Systems from the United States Centers for Disease Prevention and Control, using surveillance data from 1997 to 2008. We interviewed staff from the Swedish Institute for Communicable Disease Control, the National Board of Health and Welfare and one county medical officer (CMO). We conducted a survey among laboratories, CMOs and a sample of clinics. Satisfaction with the system was good for 86% of CMOs, all laboratories, and 99% of clinics. The interviewed stakeholders considered the system to deliver relevant and accurate information that is useful for health policy decision making. However, the objectives for Chlamydia surveillance should be clearly defined in order to adapt the system requirements, simplify data collection and improve timeliness.

Increase in reported gonorrhoea cases in Sweden, 2001 - 2008

Gonorrhoea is on the rise in Sweden and in many other European countries. The present report describes and evaluates the gonorrhoea trends in Sweden from 2001 to 2008 when an increase of 32% was reported. Up to 86% of the cases were reported in men, with the highest proportion among heterosexually infected men (41-59% during these years). Heterosexually infected men more often acquired gonorrhoea abroad, especially in Thailand, whereas women and men who have sex with men were more likely to acquire the infection within Sweden. The recent increase in gonorrhoea cases in Sweden is most likely due to adoption of more risky sexual behaviour (e.g. an increase in the number of sexual partners and the number of new/casual sexual partners and/or low use of condoms) in the Swedish population. Further research regarding more effective identification and description of sexual transmission chains and sexual networks is needed in order to follow the spread of infection and to recognise more effective interventions to prevent the spread of gonorrhoea and also other sexually transmitted infections.

Syphilis epidemiology in Sweden: re-emergence since 2000 primarily due to spread among men who have sex with men

Syphilis has re-emerged in western Europe since 2000. Changes in sexual behaviour have facilitated the spread of syphilis especially among men who have sex with men (MSM) and improved surveillance systems and case detection have lead to an increase in the reported numbers of cases. This report describes recent trends (2000-2007) of syphilis in Sweden, where the spread among MSM, particularly in the big cities, has been a major contributor to an increase in cases. Estimated syphilis incidence among MSM was up to twenty-eight times higher than in the general Swedish male population. The most affected age group among males was 25-44 years of age. The majority of infections in men and women through heterosexual contacts were acquired abroad whereas the majority of infections attributed to sex between men were acquired in Sweden. Appropriate prevention activities are needed to reach vulnerable populations in Sweden.

Emergence and spread of Chlamydia trachomatis variant, Sweden

A variant of Chlamydia trachomatis that had escaped detection by commonly used systems was discovered in Sweden in 2006. In a nationwide study, we found that it is now prevalent across Sweden, irrespective of the detection system used. Genetic analysis by multilocus sequence typing identified a predominant variant, suggesting recent emergence.

Reasons for the sharp increase of genital chlamydia infections reported in the first months of 2007 in Sweden

After a continuous increase in the reported chlamydia incidence over the past 10 years in Sweden, the incidence decreased by 2% in 2006. A new genetic variant of Chlamydia trachomatis (nvCT) was discovered in Sweden in October 2006 that could not be detected by some of the commonly used diagnostic tests, which led to underreporting of chlamydia cases. This variant has also been called "swCT" by some authors. After the switch at the end of 2006 to other diagnostic tests that can detect nvCT, the reported incidence rose considerably (75 per 100,000 population) in the beginning of 2007. The objective of this study was to explore alternative explanations for this increase and to propose further action if needed. A data quality check was done in order to exclude double reporting and delayed reporting. To compare the incidence of chlamydia and the proportion of the population that was tested, we divided the Swedish counties into two groups, according to the diagnostic test used. We estimated the chlamydia incidence trend for January and February in the years from 2000 to 2005 by regression model, and predict the chlamydia incidence for the same period in 2006 and 2007. The age and sex distribution of the cases in January and February did not differ between the years 2000 to 2007. The proportion of tested people increased on average by 5% every year. If we assume that the percentage of the population that was tested had been 20% higher in 2007 than in 2006, the incidence predicted by the model for January and February 2007 is exactly the same as the incidence that was actually observed. The change of diagnostic test and an increase in the number of people tested, as well as the increase in the prevalence of CT have probably all contributed to the increased numbers of reported chlamydia cases in January and February 2007. These findings support the need for enhanced prevention campaigns in order to control spread of CT.

Outbreak of norovirus in Västra Götaland associated with recreational activities at two lakes during August 2004

A large community outbreak of norovirus (NV) gastrointestinal infection occurred in Västra Götaland County, Sweden in August 2004, following attendance at recreational lakes. A frequency age-matched case control study was undertaken of persons who had attended these lakes to identify risk factors. 163 cases and 329 controls were included. Analysis indicates that having water in the mouth while swimming (OR=4.7; 95% CI 1.1-20.2), attendance at the main swimming area at Delsjön Lake (OR=25.5; 95% CI 2.5-263.8), taking water home from a fresh water spring near Delsjön lake (OR=17.3; 95% CI 2.7-110.7) and swimming less than 20 m from shore (OR=13.4; 95% CI 2.0-90.2) were significant risk factors. The probable vehicle was local contamination of the lake water (especially at the main swimming area). The source of contamination could not be determined.

Tickborne encephalitis in Latvia

TBE has been notifiable in Latvia since 1955.