BMJ Group blogs: Sexually Transmitted Infections

No rise in UK Chlamydia; but disquieting trends for MSM

29 Jun, 11 | by Leslie Goode, Blogmaster

The annual report of the UK Health Protection Agency (17th June, 2011) offers a concise and accessible statistical overview of recent trends in STIs (not including HIV/AIDS), as well as details of the UK Chlamydia screening programme and the recent epidemic of lymphogranuloma venereum (LGV).
The overall picture suggests a slight decline (1%) in STIs in 2010, and – for the first time since records began – no rise in chlamydia diagnosis (despite the continued scale-up of testing). The overall decline conceals a continued rise in gonorrhoea (3%) and herpes (8%) diagnosis, partly attributable to more sensitive diagnostic tests.
Those aged under 25 account for 63% of chlamydia diagnosed, 54% of genital warts, 47% of gonorrhoea, 41% of genital herpes. Trends since 2008 differ somewhat according to sex. Among women the 15-24 year olds are very considerably the most severely affected group, and have seen a continued slight decline in gonorrhoea and genital warts diagnosis. Among men cases seems less unevenly spread overall, but with 20-24 years old the most affected. These have seen a continued rise in gonorrhoea diagnosis.
Men who have sex with men (MSM) are the other key population. These account for 64% of syphilis and 40% of gonorrhoea. Here there is less cause for cheer. Gonorrhoea diagnosis has continued to rise (up by a third in the past year), while Syphilis continues on its upward trajectory. Given the high risk of exposure to HIV/AIDS in the MSM population (a dimension of the STIs picture that is absent from this report, which fails to make the link between STI and HIV), these figures are particularly worrying.
The report concludes with statistics for the epidemic of lymphogranuloma venereum (LGV). This began in the late 2004 and has intensified considerably, with a third of the total number of 1,665 cases having been diagnosed since 2010 – largely among white HIV positive MSM.

HPA, Health Protection Report, HIV/Sexually Transmitted Infections (STIs), vol. 5, no.24, 17th June 2011

http://www.hpa.org.uk/hpr/infections/hiv_sti.htm

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Posted in Chlamydia Screening, Epidemiology, STI prevention and surveillance

Chlamydia screening at the crossroads

11 Jan, 10 | by Jackie Cassell, Editor of STI

As financial screws tighten, and a general election approaches, British clinical readers are expecting lean times ahead. Services for sexually transmitted infections (STI) are unlikely to get major billing in party manifestoes, and political support tends to be driven by committed individuals rather than public demand.

These are particularly interesting times for England’s National Chlamydia Screening Programme (NCSP). The programme has been the subject of a report by the National Audit Office, followed by a hearing of Parliament’s Public Accounts Committee before the Christmas break.

The NCSP was announced in 2003, and differed from pilot studies in several respects. Both English pilots^(1,2,3) had achieved high rates of coverage within their single year of operation, with general practice a predominant setting, and using some form of payment for general practitioners who participated, while only one⁽³⁾ had included males in the target group.

During the financial year April 2008-2009 an estimated 15.9% of England’s 6.7M 15-24 year old population had been tested for Chlamydia outside specialist genitourinary medicine clinics – still far short of the estimated one third which was achieved in the pilots and thought to be needed to achieve a real impact on incidence. However, whatever happens now the programme will continue to have a major impact on the organisation of sexual health services. The dissemination of testing into family planning (contraception) clinics, other young people’s services and increasingly into general practice has already mainstreamed awareness of STIs among the public and professionals. The next few months will be crucial in defining public policy on the balance and relationship between the NCSP (simple service, high throughput) and specialist STI services (complex and expensive, and focussing on the needs of individuals of higher than average risk behaviour or worse than average luck).

The NCSP was criticised by the National Audit Office⁽⁴ ⁾ for multiple and weak branding, disorganised and cost-inefficient commissioning, and highly variable partner notification (and even treatment) rates. The report is definitely worth a read, along with its sister publication – a report on the NCSP to the Department of Health by Dr Ruth Hussey. The NCSP was implemented in a period of increasing devolution of a wide range of healthcare resource decisions to local areas, with pressure applied where needed by blunt instruments such as the “Vital Signs Indicator” which last year set a standard of 17% coverage for the NCSP . In this respect, its difficulties are likely to be a wider sign of the times - as suggested by the Chair of the Public Accounts Committee, who remarked in closing: “What went wrong? You ploughed ahead with local, fragmented implementation, the programme has been inefficient, it has wasted public funds and each programme has been buying its own kit, devising its own marketing and websites.”

Although the Public Accounts Committee’s recommendations are not yet published, a flavour of what we can expect can be inferred from a webcast of the hearing at http://www.parliamentlive.tv/Main/Player.aspx?meetingId=5227 or, if you prefer the written word, at http://www.publications.parliament.uk/pa/cm/cmpubacc.htm#uncorr

A more coherent branding and commissioning of the NCSP will have implications for the branding, and prioritisation, of more specialist STI services. Clinicians and providers will need to think and advocate long and hard for a locally effective the future balance between the NCSP (whatever form it may take), and the broader picture of services for STIs, including specialist services. Who and what will they be for, if everyone offers a yearly chlamydia test?