No 34-35 - 2018
Gonorrhoea diagnosed in 2017
Gonorrhoea diagnosed in 2017
In Denmark, national monitoring of gonorrhoea is performed by Statens Serum Institut (SSI) based on data extracted from the Danish Microbiology Database (MiBa); a nationwide auto-updated database of all test results from the departments of clinical microbiology (DCMs), EPI-NEWS 45/13. For gonorrhoea, this includes results from culture and/or PCR or other nucleic acid amplification technique (NAT), as all DCMs perform combined NAT for gonococci and Chlamydia trachomatis.
In case of repeated positive samples from the same person, a new gonorrhoea case is defined as the passing of more than 21 days since the latest positive finding.
For a detailed epidemiological description of the 2017 incidence, please see the 2017 annual gonorrhoea report.
Monitoring of laboratory-confirmed gonorrhoea was supplemented by submission of isolates to the Department of Bacteria, Parasites and Fungi (BPF), Infection Preparedness, SSI.
Clinical notification is statutory, and notifications are made to the Notification System for Infectious Diseases (NSID), the Department of Infectious Disease Epidemiology and Prevention (DIDEP), SSI. The clinical notifications include information that is not given as part of the laboratory data: mode of infection, sexual orientation, country of origin, country of infection, HIV status, etc.
2017 saw the recording of 3,426 gonorrhoea cases in the MiBa. To this, another 54 cases should be added that were notified to the NSID only. Thus, a total of 3,480 cases were detected. The cases affected a total of 3,263 persons, as 3,074 had a single case detected, 169 persons had two cases detected, 20 persons had three cases and two persons had four cases detected. A total of 2,092 (60%) of the cases occurred in men and 1.388 (40%) in women.
The number of gonorrhoea cases has followed an increasing trend for a number of years, but did not increase further in 2017. Several circumstances might explain this. For several years, the Danish Health Authority has been running campaigns promoting the use of condom. These campaigns have targeted young people who comprise a large share of gonorrhoea patients. Furthermore, campaigns by the Danish AIDS Foundation and the Danish Family Planning Association have encouraged frequent testing for sexually transmitted diseases in relevant risk groups. There may be other explanations why the increase has stopped, and it cannot be excluded that the incidence may start increasing again. Nevertheless, the same trend was seen for syphilis, EPI-NEWS 22/18.
A considerable part of the diagnosed cases is not notified by the treating physicians. If the frequency of notification is uneven, the reports on mode of infection, country of infection, etc., may be misleading. Physicians are therefore encouraged to notify any patients diagnosed with gonorrhoea. This can be done by downloading and filling in Form 1510-G, which can then be enclosed to an e-mail sent from a secure digital mailbox to firstname.lastname@example.org. If you do not have access to secure mail, the completed form may be printed and sent to The Department of Infectious Epidemiology and Prevention, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S. Pre-paid reply envelopes can be obtained from email@example.com or by contacting Section Secretary Linda Roth, 3268 3744.
It is worrying that, in line with 2016, several cases of gonorrhoea were observed in pregnant women. Healthcare workers are encouraged to be attentive to gonococci as a cause of conjunctivitis in neonates, particularly in the first two weeks of life. Gonorrheal conjunctivitis, which is not exclusively seen in neonates, is a potentially very serious condition that may cause destruction of the eyeball if it goes untreated. These patients must therefore be referred urgently to a specialised department for eyesight-preserving treatment.
As is the case for other sexually transmittable diseases, gonorrhoea is a so-called indicator condition for HIV, which means that more than 0.1% of patients with a sexually transmitted disease will be co-infected with HIV. It is therefore encouraging that a considerable share of the notified patients had been tested for HIV. Furthermore, physicians are encouraged to test for the other relevant sexually transmittable diseases, e.g. syphilis, chlamydia and, if relevant, lymphogranuloma venereum (LGV).
Thorough laboratory-based diagnostics is an important measure to counter further spreading of gonorrhoea. Diagnostics should include sampling from all relevant anatomical locations (urethra, rectum, throat and in women also the cervix) along with barrier protection by use of condom, and partner tracking. Gonorrhoea can show few symptoms and be asymptomatic, and this is practically always the case for gonorrhoea of the throat and rectum. If the infection is located to these anatomical sites exclusively, and if it is not diagnosed, the patient constitutes an infection reservoir.
(S. Cowan, Department of Infectious Disease Epidemiology and Prevention, K. D. Bjerre, the Data Integration and Analysis Secretariat, S. Hoffmann, Department of Bacteria, Parasites & Fungi)