Increase in Gonorrhea Incidence Associated With Enhanced Partner Notification Strategy

Abstract

Objectives Partner notification services for reportable sexually transmitted infections vary based on jurisdiction, resources, type of infection, and whether an outbreak has been reported. The objective of this study was to determine whether case finding increased after implementation of enhanced notification and follow-up activities for contacts of cases of Neisseria gonorrhoeae in Central Zone, the largest health authority in Nova Scotia, Canada. Methods Enhanced contact tracing by public health professionals was implemented in May 2015. N. gonorrhoeae multiantigen sequence typing (NG-MAST) was conducted on all positive specimens. Epidemiologic and NG-MAST information for reported gonorrhea cases were captured and analyzed. Case numbers, rates, and NG-MAST results in the preintervention and postintervention periods were compared. Laboratory testing data were extracted and analyzed for association with reported incidence. Results There was a significant increase in the number of reported gonorrhea cases per month when comparing the preintervention and postintervention periods. The reported gonorrhea rate in 2016 was 2.9 times that in 2014. This increase was not associated with changes in testing rates and was more pronounced among women than men. Larger groups of cases sharing the same NG-MAST profiles were detected postintervention. Conclusions The implementation of an enhanced contact tracing program for N. gonorrhoeae resulted in increased case finding and a notable increase in the reported rate of cases per 100,000 population. Owing to these findings, the practice of enhanced partner notification was continued as standard public health practice in Central Zone. An understanding of case finding efforts is required when interpreting observed trends in rates of N. gonorrhoeae, as early infection is highly asymptomatic in women and can be asymptomatic in men.

Effectiveness of contact tracing in the control of infectious diseases: a systematic review

“…We screened 9050 unique abstracts, yielding 361 full-text articles to be assessed for eligibility, of which 314 were excluded. Of the 47 included articles evaluating contact tracing interventions, six were focused on COVID-19 20 , 21 , 22 , 23 , 24 , 25 ( table 1 ), 20 on tuberculosis 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ( table 2 ), eight on HIV 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ( appendix pp 11–14 ), 12 on curable STIs (syphilis, 54 , 55 , 56 gonorrhea, 57 , 58 , 59 , 60 trichomoniasis, 61 chlamydia, 62 , 63 and STI syndromes; 64 , 65 appendix pp 15–19 ), and one on measles 66 ( appendix p 20 ). Included studies were conducted across five continents ( appendix p 3 ), with study years ranging from 1975 to 2020.…”

“…The 47 studies comprised 18 (38·3%) randomised controlled trials (RCTs) 26 , 28 , 29 , 36 , 38 , 41 , 43 , 46 , 47 , 48 , 50 , 51 , 56 , 58 , 61 , 63 , 64 , 65 and 29 (61·7%) observational studies. 20 , 21 , 22 , 23 , 24 , 25 , 27 , 30 , 31 , 32 , 33 , 34 , 35 , 37 , 39 , 40 , 42 , 44 , 45 , 49 , 52 , 53 , 54 , 55 , 57 , 59 , 60 , 62 , 66 40 studies compared provider-initiated contact tracing with other interventions or evaluated expansions of provider-initiated contact tracing, 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 32 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ...…”

“…20 , 21 , 22 , 23 , 24 , 25 , 27 , 30 , 31 , 32 , 33 , 34 , 35 , 37 , 39 , 40 , 42 , 44 , 45 , 49 , 52 , 53 , 54 , 55 , 57 , 59 , 60 , 62 , 66 40 studies compared provider-initiated contact tracing with other interventions or evaluated expansions of provider-initiated contact tracing, 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 32 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 55 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 and seven studies compared programmatic adaptations within provider-initiated contact tracing. 29 ,…”

“…12 studies examined provider-initiated contact tracing for curable STIs, which included 2383 index patients for syphilis, 54 , 55 , 56 45 228 for gonorrhea, 57 , 58 , 59 , 60 484 for trichomoniasis, 61 862 for chlamydia, 62 , 63 and 1446 for non-specified STIs 64 , 65 ( appendix pp 15–19 ). Five RCTs or quasi-RCTs compared provider-initiated contact tracing with control interventions.…”

“…We identified 47 empirical studies that either evaluated the effectiveness of provider-initiated contact tracing or compared programmatic adaptations within contact tracing interventions, 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 including six studies focused on COVID-19. Among the studies were a wide range of tracing strategies (including phone calls, 39 , 53 , 54 text messaging, 29 , 50 , 53 and household contact tracing 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 38 , 39 , 40 , 41 , 42 ...…”