28 May 2019
Volume: 53 Issue: 21
- Diagnoses of STIs continue to rise in Scotland
- Gonococcal antibiotic surveillance in Scotland (GASS): prevalence, patterns and trends in 2018
- European Testing Week for HIV, hepatitis B and C, 17-24 May 2019
- Developing a reporting system for the surveillance of HIV drug resistance in Europe
- WHO Chief Scientist invites global health R&D community to contribute to Health Product Profile Directory
- Strengthening protection from female genital mutilation (FGM): analysis of consultation responses
HPS Weekly Report
28 May 2019
Volume 53 No. 21
Diagnoses of STIs continue to rise in Scotland
Two reports published by Health Protection Scotland (HPS) on 28 May 2019, reveal an increase in the number of sexually transmitted infections (STIs) diagnosed in Scotland between 2017 and 2018, specifically genital chlamydia, gonorrhoea and infectious syphilis.
Genital chlamydia remains the most frequently diagnosed STI in Scotland with 16,338 diagnoses reported in 2017, which represents a 4% increase compared to 2017. This STI predominates in women (58% of all diagnoses) and in young people (66% of all diagnoses were made in those aged less than 25 years), following on from similar patterns observed over the past decade.
In 2018, gonorrhoea diagnoses also increased with 3,233 diagnoses reported, indicating a 24% increase compared to the previous year and is the largest annual total recorded since the mid 1980s. In contrast to genital chlamydia, three quarters of gonorrhoea diagnoses were among men, 60% of whom were aged 25 and over. Since 2013, gonorrhoea diagnoses have increased by 103% (from 1,595 in 2013 to 3,233 in 2018). The increase is largely due to a 121% increase in male diagnoses (from 1,056 to 2,339) and principally, among men who have sex with men (MSM). Female diagnoses increased by 66% (from 538 to 893) during the same period. Rectal gonorrhoea, a marker of condomless anal intercourse (CAI), remained high in 2018.
Of particular concern in 2018, is the observed increase in the number of gonococcal isolates in Scotland demonstrating high-level resistance to azithromycin. This is outlined in a third report by the Scottish Bacterial Sexually Transmitted Infection Reference Laboratory (SBSTIRL) and HPS.
In addition to the increases noted in gonorrhoea and genital chlamydia infection, the number of diagnoses of infectious syphilis increased between 2017 and 2018 by 14% (from 399 to 455). This is the highest annual total recorded since the establishment of the surveillance system in 2002-2003 with the burden of infection among MSM (87% of diagnoses). The rise in infectious syphilis and gonorrhoea diagnoses mirrors the epidemiological picture in England in 2017, where increases of 20% and 12%, respectively, were reported.
Following the introduction of NHS-funded HIV pre-exposure prophylaxis (PrEP) in Scotland in July 2017, the impact of the PrEP programme on HIV and STI incidence is being monitored. During the first year of the programme, 1,872 individuals were prescribed PrEP, 99% of whom were MSM. While the impact of PrEP availability on HIV and STI incidence is not yet fully understood, it is possible that this intervention is associated with the observed increase in the incidence of STI diagnoses in MSM. Both HIV and STI incidence will continue to be monitored in the second year of the programme.
The findings of these reports highlight the continuing rates of unprotected sexual intercourse and the risk of STI infection, particularly among MSM, and underline the importance of a coordinated public health response to meet the challenges for the control and prevention of STIs in Scotland.
Gonococcal antibiotic surveillance in Scotland (GASS): prevalence, patterns and trends in 2018
The Gonococcal Antibiotic Surveillance in Scotland (GASS) report, published on 28 May 2019 by the Scottish Bacterial Sexually Transmitted Infection Reference Laboratory (SBSTIRL) and Health Protection Scotland (HPS), shows the patterns and trends of antibiotic resistance in 2018.
As outlined in the report of genital chlamydia and gonorrhoea diagnoses for 2009-2018, the number of gonorrhoea episodes reported in Scotland increased by 24% to 3,233 in 2018. From the resistance surveillance data available, it would appear that, in 2018, the proportion of isolates resistant to ciprofloxacin remained steady at 35%.
Decreased susceptibility to azithromycin was recorded in 7.0% of isolates and, of particular concern, was the increase in the proportion of isolates with high-level resistance to azithromycin (rising from 1.6% in 2017 to 2.1% in 2018). Encouragingly, however, no treatment failures have been formally reported. Also of note is one patient who was recorded as having resistance to both ceftriaxone and cefixime in 2018. This isolate was also resistant to ciprofloxacin, but susceptible to azithromycin.
Given the changing resistance patterns observed in Scotland, across the UK and in Europe particularly, UK guidelines for the treatment of gonococcal infection were updated during 2019, from azithromycin and ceftriaxone dual therapy to ceftriaxone monotherapy as the first-line treatment. Continued surveillance of antibiotic resistance is essential for guiding effective therapeutic regimens in light of the continuing rise in gonorrhoea infection.
European Testing Week for HIV, hepatitis B and C, 17-24 May 2019
Reaching and testing those at risk of infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV) is still a public health challenge across Europe. Data show that every second person living with HIV in the EU/EEA is diagnosed late in the course of their infection. Similarly, a large proportion of the estimated nine million Europeans living with chronic HBV or HCV are unaware that they are infected. In its recent evidence-based public health guidance on HIV, hepatitis B and C testing, the European Centre for Disease Prevention and Control (ECDC) advocates for integrated testing for the three viruses given that they have common modes of transmission, significant overlaps in affected population groups and high levels of co-infection.
This year, European Testing Week is focussing on scaling up testing efforts in prison settings where inmates have a higher burden of communicable diseases such as HBV, HCV, HIV, other sexually transmitted diseases (STDs) and tuberculosis (TB). Data show that among people with a positive diagnostic test in prison, sizeable proportions were unaware of their status (53% of those tested positive for HBV, 12% of those with HBC and 3% of those who were HIV positive were unaware of their infection).
Source: ECDC, 24 May 2019
Developing a reporting system for the surveillance of HIV drug resistance in Europe
The European Centre for Disease Prevention and Control (ECDC) has developed a molecular surveillance roadmap focussing on the molecular characterisation of HIV, starting with HIV drug resistance (HIVDR).
The objectives of HIVDR surveillance are to monitor the prevalence of, and trends in, HIVDR in newly diagnosed HIV patients at initiation of antiretroviral treatment, in order to inform treatment policies in the EU/EEA member states.
The ECDC intends to develop a sustainable HIVDR surveillance system that complements the overall structure of European HIV surveillance.
A pilot project was carried out to investigate the feasibility of HIVDR surveillance in EU/EEA countries and to make recommendations for the design and implementation of a potential future HIVDR surveillance system at the European level.
Source: ECDC, 23 May 2019
WHO Chief Scientist invites global health R&D community to contribute to Health Product Profile Directory
The Health Product Profile Directory currently contains 196 product profiles developed by 24 agencies, of which 191 describe a product with an infectious disease as the target. The top four diseases with product profiles are tuberculosis, malaria, HIV and Chagas.
The directory includes profiles developed by the World Health Organization (WHO), and other agencies, and can also be accessed through the WHO Global Observatory on Health R&D, where other key resources to analyze R&D can be found.
Source: WHO, 15 May 2019
Strengthening protection from female genital mutilation (FGM): analysis of consultation responses
On 24 May 2019, the Scottish Government published an analysis of responses to its consultation on strengthening protection from female genital mutilation (FGM).
The consultation, which ran from 4 October 2018 to 4 January 2019, was primarily concerned with gauging perspectives on five legislative provisions in relation to FGM already adopted in England and Wales via the Serious Crime Act 2015. These legislative provisions concerned:
- the provision of anonymity of victims of FGM
- the creation an offence of failing to protect a girl from the risk of FGM
- the introduction of FGM protection orders (FGMPO)
- the introduction of a duty to notify police of FGM
- the introduction of statutory guidance relating to FGM
The proposed creation of FGMPOs received strong support, as respondents considered this to be a fast, responsive and proven method for reducing the risk to potential victims, with reference to Forced Marriage Protection Orders (FMPO). Respondents who recommended a sentence for breach of FGMPO were split between those that thought penalties should resemble those for FMPOs, and others who supported sentences in line with grievous bodily harm (GBH).
Source: Scottish Government, 24 May 2019