STI surveillance in England has taken a major step forward with the first publication of STI data based on GUMCAD (Genitourinary Medicine Clinic Activity Dataset). For the first time, the genitourinary medicine(GUM) clinic data are based on a disaggregate dataset, using pseudonymised individual level data, rather than an aggregate summary. As a consequence, we now have the ability at local, regional and national level to interrogate the dataset for rates of co-infection, re-infection rates and attendance data. While this dataset is still confined to the specialist clinics, it is a huge step forward in surveillance. It remains to be seen how we will develop surveillance spanning the primary care/specialist interface. Disaggregate datasets in primary care (such as the General Practice Research Database) have been around for a long time, and have been used to explore STI and HIV diagnoses and management. Although they have been linked to hospital and cancer registry data, a link to specialist GUM services is unlikely to happen in the foreseeable future, so we will continue to rely on a complex admixture of GUMCAD, chlamydia screening, laboratory and ad hoc datasets. Compared to many other countries, this is pretty good – but a real assessment of what is delivered by our National Health Service will require a bit more “joining the dots”.
Inevitably, diagnoses of chlamydia have increased with the National Chlamydia Screening Programme. This is a success story, indicating increased reach of services. However, the publication of data by primary care trust of residence presents traps for the unwary. Chlamydia diagnoses really do relate to increased testing, are measurable and positivity rates are thought to have limited variation between populations of a given age. However it is much harder to determine the “reach” of the testing needed for higher risk individuals – men who have sex with men, who also need to be proactively offered testing for HIV, hepatitis B, syphilis and gonorrhoea; and urban ethnically mixed populations.
Interestingly, epidemiological treatment of suspected gonorrhoea has risen over the past decade – suggesting either better documentation ofpartner notification, or truly improved partner notifications. Given that the rate of partner change needed to maintain gonorrhoea in a population with developed services and effective antibiotics, this is an important finding. It may be part of the explanation for declining gonorrhoea diagnoses, since a 2002 peak.