Surveillance systems for STIs in the European Union: facing a changing epidemiology

Abstract

Objectives: To characterise the nature, content, and performance characteristics of existing national STI surveillance systems in the European Union (EU) and Norway, to facilitate collection of comparable surveillance data. Methods: Cross sectional survey using a structured questionnaire. Results: Case reporting from clinicians and/or laboratories is the mainstay of EU surveillance systems for bacterial STIs. Coverage of case reporting varies from less than 10% to over 75%, and lack of and/or heterogeneity in case definitions affect the relative specificity and sensitivity of reporting systems. Considerable variations also exist in STI care sites; the populations who use these services; and in partner notification practices, STI screening practices, and STI laboratory diagnostic tests employed, affecting the representativeness of reported data and the sensitivity of surveillance systems for detecting the true number of STI cases. Conclusions: The heterogeneity of current surveillance systems complicates direct comparison of STI incidence rates across Europe. Introduction of standardised case definitions for reporting, and increased coverage of mandatory reporting systems where necessary, are needed. Definition of standardised minimum datasets and use of sentinel and enhanced surveillance systems to supplement universal case/ laboratory notification data, could improve our understanding of the distribution and determinants of STIs across Europe, and aid in the design of effective public health responses. In the context of the changing epidemiology of STIs, systems for detection and monitoring of localised outbreaks of acute bacterial STIs (syphilis and antimicrobial resistant gonorrhoea), as well as prevalence monitoring systems for frequently asymptomatic STIs (chlamydial infection and viral STIs), are also necessary. S ince the mid-1990s, and after a decade and a half of declines, the European Union (EU) has experienced significant and sustained increases in the incidence of STIs.1 2 This is especially the case for the acute bacterial STIs gonorrhoea, syphilis, and genital chlamydial infection, where increases have been concentrated in young people, ethnic minorities, and men who have sex with men (MSM). These increases in STI incidence are occurring within a context of continuing transmission of HIV, with sexual transmission assuming increasing importance, and an increasing prevalence of HIV because of the success of highly active antiretroviral therapy. 3This changing epidemiology presents challenges to European countries, both in terms of understanding the distribution and determinants of STIs, as well as in terms of service provision and implementation of appropriate primary and secondary prevention measures.Given that similar changes in STI epidemiology are occurring across the EU, and given the increasing fluidity of national borders both within and outside this region, there is a need for Europe-wide collaboration on STI surveillance, prevention, and control. 4 This would enable comparison of disease rat...

Underreporting of communicable diseases in the prefecture of Achaia, western Greece, 1999-2004 – missed opportunities for early intervention

“…Given the fact that more than one third of the cases (38%) identified in the hospitals included in the study was not reported to the public health authorities, the corresponding incidence of notifiable infectious diseases for the study period would be at least 1.5 times higher. Several studies have shown that undernotification is observed for most of the notifiable diseases in the majority of Member States in the European Union [8][9][10][11][12][13][14] and worldwide [15]. According to our findings, the rate of undernotification was higher for patients from outside the prefecture even though every case should have been notified to the local PHD.…”

“…International literature has shown that undernotification of communicable diseases, and the resulting underestimation of the disease burden is a major flaw of many surveillance systems, because undernotification limits the efficacy of these systems especially concerning the early identification of possible outbreaks [8][9][10][11][12][13][14][15]. Any surveillance system can only be useful and cost effective if directly linked to the decision-making authorities of the respective country.…”

Syphilis and gonorrhoea in men who have sex with men: a European overview

“…Interpretation of trends in incident STI diagnoses across Europe has been hindered by the heterogeneity of surveillance systems, the lack of standardised case definitions, as well as different approaches to screening, testing and data collection [11].…”

“…While surveillance data on STI had been collected at the European level for some time by both the World Health Organization (WHO) and, more recently, the European Centre for Disease Prevention and Control (ECDC), until recently data on diagnoses in MSM had not been routinely collected. ESSTI has prioritised the development of minimum standards for collecting and disseminating STI surveillance data [11]. New and historic data on diagnoses in MSM have been collected by the network since 2006.…”

Defizite in den Angeboten zur STI-Diagnostik für Männer mit gleichgeschlechtlichen Sexualkontakten in deutschsprachigen Städten

“…weitere Fachdisziplinen von Patienten mit STI-bedingten Beschwerden konsultiert. Die STI-Versorgung erfolgt in Europa durch niedergelassene Ärzte, spezielle STI-Sprechstunden in Klinikambulanzen und in kommunalen Gesundheitsämtern oder -wie in Irland oder Großbritannien -in Genitourinary-medicine (GUM)-Kliniken [7]. Alle diese Einrichtungen unterscheiden sich hinsichtlich der anfallenden Kosten und Gebühren, Untersuchungs-und Behandlungsangebote und ihre Zugänglich-keit.…”