EPI-NEWS

About diseases and vaccines

No 34-35 - 2018

 

Gonorrhoea 2017

Gonorrhoea diagnosed in 2017

  • A total of 3,480 cases were recorded, 2,092 men and 1,388 women, in 3,263 persons.
     
  • Among 2,009 cases that were notified clinically to the SSI, 1,230 were men, 488 of whom stated having become infected by men, and 43 who stated being bisexual. In all, 779 were women of whom 18 stated that they had become infected by women; 14 who stated being bisexual.
     
  •  Two cases of gonorrheal eye inflammation were seen, both in neonates. Additionally, ten children below 15 years of age had sexually transmitted gonorrhoea.
     
  • The most frequently occurring age group was 20-24 years, and the City of Copenhagen was the area where most cases occurred.
     
  • The occurrence of ciprofloxacin resistance increased.
     
  • 2017 brought one report of a case of ceftriaxone resistance, but not of treatment failure.
     
  • Standard treatment remains ceftriaxone + azithromycin.
     
  • Using a condom prevents gonorrhoea, and relevant testing with complete microbiological diagnostics, treatment with recommended antibiotics and partner tracking can break transmission chains. 

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 22/2018.

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 .

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  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)

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29 August 2018

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Department of Infectious Disease Epidemiology
Editor: Peter Henrik Andersen

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- ISSN: 1396-4798