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STI surveillance Belgium Results and recommandations

STI surveillance Belgium Results and recommandations. Ruth Verbrugge WIV-ISP 10-12-2013 9 th STI-HIV seminar. What ?. Monitoring trends and estimating incidence

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STI surveillance Belgium Results and recommandations

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  1. STI surveillance Belgium Results and recommandations Ruth Verbrugge WIV-ISP 10-12-2013 9th STI-HIV seminar

  2. What ? • Monitoring trends and estimating incidence = > sentinel network of laboratories for microbiology • Identifying population groups athigherrisk for specificSTI’s => sentinel network of clinicians

  3. Why ? • Providing essential information for prevention & control • Authorities (Regional, National, Europe, WHO) • Local non-profit organisations • Development, adaptation, finetuning of guidelines • Organisation of orientedfieldactivities

  4. Outline 1. Trends and incidence 2. Population at risk3. What to do?

  5. 1. Trends & incidence

  6. THANKS to the laboratories of microbiology and NRC

  7. RegisteredSTI cases, 2002-2012

  8. Chlamydia • Chlamydia is the most frequent reported STI. • The increasing trend continues in 2012. • The increase in Flanders : probablyduetosensibilisationcampaign on testing • The increase in Wallonia : probablydueto attention in newspapersand+ 1university laboratory

  9. Chlamydia • Most affected : women; 15 to 29 yearsold • Man / Women : 1/1,83 • Highestincidence : Brussels andAntwerp, resp.194 and148 cases/100 000 inhab.

  10. Trend in agedistributionfor Chlamydia by gender, Belgium, 2002-2012 WOMENMEN

  11. Trend in agedistributionfor Chlamydia by gender, Belgium, 2002-2012 WOMENMEN

  12. Gonorrhoae • Increasing trend • Most affected : men;15 tot 34 yearsold • Men/women : 3,2/1 • Highestincidence : Brussels andAntwerp, • resp. 39 and 35 cases/100 000 inhabitants • Treatment : first signs of resistencyagainstcefixime(notused in Belgium) andceftriaxone(in othercountriesthan Belgium)

  13. Resistency?What is the best treatment for gonorrhoe? • next speakers

  14. Syphilis • Slower increase since 2009, stabilising in Flanders and Wallonia, further increasing in Brussels • Most affected: men; 25 up to 59 years old • Men/women : 4,8/1 • Highest incidence : Brussels, Arlon and Antwerp, resp. 47, 45 en 33 cases/100 000 inhabitants • Syphilisreinfection(in male) : 26%

  15. Syphilis reinfection Wallonia Belgium Flanders Brussels

  16. What attracks out attention? • Chlamydia => Age • Gonorrhoea => AB- Resistance • Syphilis = > Reinfection

  17. Who is at risk?

  18. THANKS to the Medical doctors who fill out voluntary the questionnaire for each STI patient

  19. Distribution of registered STI by specialisation of medical centre Mean number of STI registrations by specialisation

  20. Reason for consultation

  21. Percentage of STI cases diagnosed without STI complaint • Highest% of STI cases diagnosed without STI complaint: • Centresfor FP (80%) • STI clinics (60%) • Gynaecologists (57%) • Lowest% of STI cases diagnosed without STI complaint: • generalists (15%) There are no official screening guidelines. Doctors ask for it, something to hold on and to be aligned.

  22. Observation • 2 gynaecologists: • 57% (48/84) and 55% (27/49) of STI patients found thanks to screening • and 50% of those STI patients were pregnant • 0,6% perinatal Chlamydia-infections ↔ Antenatal screening recommendations for Chlamydia

  23. It is worthwhile to have Chlamydia prevalence trial within the 15-34 year old age group and a revision of antenatal screening recommendations

  24. Country of origin

  25. Country of origin

  26. Partner notification • 44% : YES • 13% : NOT • 6% of STI cases found thanksto partner notification Encourage partner notification => A key factor in prevention

  27. Risk behaviourNumber of sex partners < 6 m prior to the STI diagnosis

  28. Risk behaviourGroup sex

  29. Risk behaviourOral sex

  30. Risk behaviourCondom use among registered STI patients 62% never uses a condom 80% did not use a condom during last sexual intercourse

  31. Risk groupssexual orientation (among men)

  32. Other risk groups • Commercial sex workers • PWID • Travelling : 5 % of Belgian STI-patients

  33. Overview BEHAVIOUR No condomuse ≥2 sex partners Group sex Oralsex Notnotifyingsex partner Havingsexualcontactsabroad GROUPS Young people Young adults MSM Swingers CommSexworkers PWID

  34. HIV-STI co-infectionHIV screening at STI consultation

  35. HIV-STI co-infectionResults of HIV test at STI consultation

  36. HIV-STI co-infectionResults of HIV test at STI consultation

  37. 3% of STI patients discovered their HIV+ status together with STI diagnosis • Patients diagnosed with a STI need to be screened for HIV • Patients who ask a HIV test need to be screened for STI

  38. Which HIV-STI coinfection?

  39. What to do?

  40. Legitimaterequestfrom the medicalcorps forofficial screening guidelines With a special attention to Chlamydia and gonorroe, because of the asymptomatic course and the fertilityconsequences Heterosexual men andwomen (with or without complaint), worriedafter a sexual contact People who start a new partnership with a new partner With a special attention towards • Adolescentsandyoungadults • Men andwomenwith multiple partners • Men andwomenpracticinggroupsex, inclswingers • MSM with multiple partners, partner exchange, practicinggroupsex • SAM (HIV risk group) • Commercial sexworkers • PWID • Travellerswho had sexual contact abroad, otherthantheir fix partner • Partners of a STI Patient • Pregnant women

  41. With attention to young people IntegrateChlamydia andgonorrhoe screening foryoung men andwomenwithin the current HPV screening recommendationforwomen Extendreimbursment * for Chlamydia screening (NAAT) at leastup to 30 yearsold Extendthe currentprenatalsyphilisandHIV screening recommendation ** withChlamydia andgonorrhoe *Diagnosis role NAAT PCR for Chlamydia: max. twice a yearifpatient is younger or equalto 20 yearsold; or withpresence of specific STI symptoms **Ref KCE report 6A, 2004

  42. THANKS FOR YOUR ATTENTION QUESTIONS?

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