Surveillance System Details – BBV/STI

Surveillance System Details - BBV/STI

You might feel embarrassed, but there’s no need – the staff at these clinics are used to testing for all kinds of infections. You may be offered a Quick Check if you are coming to see us for a routine check up and don’t have any symptoms or signs of infection. Otherwise, symptoms may include pain when you urinate, unusual discharge and, in women, bleeding between periods or after sex. You can go to a sexual health clinic whether you’re male or female, whatever your age, regardless of whether or not you have STI symptoms. If you’re under 16, the service is still confidential and the clinic won’t tell your parents. You don’t have to give your real name if you don’t want to. If you do, it will be kept confidential.

Your GP won’t be told about your visit without your permission. That is why as the article pointed out, research is ongoing. Note that records of infection in those aged under 10 years are not reported. If you’re not sure about anything, ask them to explain. Tests for herpes aren’t usually done unless you have sores on your genitals or anus. In this case, a swab will be taken from a sore. This will be uncomfortable for a moment.

With some tests, you can get the results – and treatment, if you need it – on the same day. The ratio of female to male diagnoses in 2011 was 2.2:1, which has been a consistent finding over the past ten years. There were similar numbers of type 1 and 2 infections reported (Figure 1). In men, 59% of infections (for which typing data were available) were type 2 compared to 42% in women, in whom type 1 infections predominate. Some infections, such as HIV, have no cure, but there are treatments available. Outwith the island NHS boards, the lowest rates of genital herpes infections were recorded among men in Borders NHS Board and among women in Lanarkshire NHS Board (Table 3, Figure 2). In 2011, 64% of infections were diagnosed among persons aged under 30, following the pattern over the last decade (Table 4).

The clinic can give you some condoms so you can practice safer sex. In 2011, 18,961 diagnoses of genital chlamydial infection were reported to HPS, which compares with 19,054, 18,277, and 18,561 reported in 2008, 2009 and 2010, respectively (Table 5). The improved data capture of laboratory test results via ECOSS means that the data in recent years have been subject to more extensive validation particularly with regard to removing repeat samples taken for the same episode, data suggest that of 18,961 positive diagnoses received via ECOSS during 2011, 552 individuals had more than one episode, with a fraction of these having more than two episodes. During the past five years (2007-2011), the number of diagnoses has stabilised at between around 18,000 to 19,000, with a mean of 18,539 annual diagnoses – representing a mean of 11,510 in women and 6,824 in men during this time. As is the case with genital herpes infection, the majority of diagnoses (63%) were made in women (Table 6). I guess that it could,”eliminate allergic symptoms”. Outwith the island NHS boards, the lowest rates for males and females were observed in NHS Dumfries & Galloway and NHS Highland, respectively: in the latter NHS board these data were thought to reflect an underrepresentation of diagnoses as Highland residents living in areas which were part of the former Argyll & Clyde NHS Board may actually have been diagnosed in, and thus reported from, Greater Glasgow & Clyde.

In women aged under 25, the highest rates per 100,000 – all greater than 3000 per 100,000 population aged less than 25 – were observed in Tayside, Dumfries & Galloway, and Forth Valley NHS Board areas; for corresponding males, the highest rates were recorded in Tayside and Forth Valley NHS Boards (1799 and 1437 per 100,000 population, respectively) (Figure 3, Table 7). As with genital herpes, genital chlamydia is an infection which predominates in young people; in 2011, 73% of all diagnoses (63% and 78% of all male and female diagnoses, respectively) were made in persons aged under 25 (Table 8); the majority among women and men aged 20-24. Lymphogranuloma venereum (LGV) infection, caused by the L type serovar of Chlamydia trachomatis, re-emerged during 2003/2004 when outbreaks were reported in many European cities. LGV diagnoses have been made predominantly in MSM with high levels of concurrent STIs, in particular HIV, and are associated with multiple anonymous partners and high risk sexual behaviour. Since its re-emergence, over 1900 cases have been reported in the UK.1 In Scotland, during 2011, six diagnoses were recorded, all of which were made in MSM, compared to four in 2009 and 10 in 2010. In addition, data on tests performed using commercially available chlamydia test kits (Clamelle®) indicate that 833 kits were sold in Scotland between November 2008 and December 2011, 5.7% of the UK total (14,495). Updated data are awaited on the positivity rate and gender breakdown.

Since 2006, an increasing number of laboratories have adopted the routine use of nucleic acid amplification tests (NAATs) for the diagnosis of gonorrhoea infection. These tests have a greater sensitivity than standard culture and isolation techniques for the detection of gonorrhoea infection, and it is expected that most laboratories be using them in the near future. In 2011, 1547 diagnoses of gonorrhoea were reported to HPS, representing a 12% increase on the 2010 total of 1378. From the ten year trend data, as shown in Table 9, this is the highest number of episodes recorded. Note, however, that the totals during the past four years (2008-2011) are not comparable to previous years due to the increase in gonorrhoea testing and diagnosis which has resulted from the introduction of NAATs for routine testing in several laboratories. When compared to 2010 data, the gender totals observed during 2011 reflect a 5% increase in the number of diagnoses among women (from 446 to 468) and a 16% increase in those among men (from 930 to 1077) (Table 9). It should be noted that there is variability from year to year in the number of diagnoses in each NHS board; thus, for some NHS boards, clear trends as to whether the incidence is increasing or decreasing are not always evident (Table 10, Figure 4).

In 2011, however, the most notable changes were an increase in episodes in NHS Lothian and NHS Tayside and a decrease in NHS Greater Glasgow & Clyde. The data indicate that, for those cases for whom the referral source was known, 83% (890/1075) and 62% (291/467) of men and women, respectively, were diagnosed in the sexual health clinic setting. A trial at Vienna Medical School found that stimulating immunity and blood flow reduced healing time for sores by up to half. In contrast to genital herpes and genital chlamydial infections, the majority (70%) of gonorrhoea cases were among men (Table 9). In females, infection with gonorrhoea is associated predominantly with a young age group – 74% of female, compared to 46% of male, diagnoses occurred in those aged under 25 – a pattern similar to that of preceding years (Table 11). The increase in gonorrhoea among males, observed between the late 1990s to 2006, is considered to be due, largely, to transmission among men who have sex with men (MSM). While a decrease in diagnoses was recorded between 2007 and 2009, the subsequent increase observed in the past three years may also be due to a rise in infection in this group.

Rectal gonorrhoea is a key marker for unprotected anal intercourse. In 2011, 27% (288/1077) of men had a rectal swab positive for gonorrhoea, the highest proportion recorded over the past ten years (Table 12). Overall, the number of laboratory positive diagnoses for genital herpes simplex types 1/2 (as reported to HPS), genital chlamydia and gonorrhoea have increased between 2010 and 2011. Note that in the last three to four years, HPS has been refining the ECOSS data collection system to improve the quality and quantity of the laboratory diagnoses dataset, thus, it is not possible to make direct comparisons with previous years’ data. It should be noted that much of the increase in chlamydia diagnoses in the past ten years is due to a combination of issues including: increased opportunistic testing,2,3 the use of more sensitive diagnostic tests, increased awareness through health promotion campaigns, and latterly improvements in data collection. Publication of the Sexual Health and Blood Borne Virus Framework (2011-2015)4 has re-focused attention on the public health challenges for Scotland presented by sexual health, HIV and hepatitis B and C, building on the foundations of the sexual health strategy Respect and Responsibility,5 the HIV Action Plan in Scotland6 and the Hepatitis C Action Plan for Scotland.7 Outcomes are monitored against a set of indicators. While an indicator relating to chlamydia diagnoses will require further discussion, diagnoses of gonorrhoea infection, including levels of rectal infection in men, are being measured.

Surveillance System Details - BBV/STI
Information about sexual orientation is not available from laboratory reports to SBSTIRL and HPS, and it is impossible to know if infections in men are occurring among those who have sex with women or those who have sex with other men. Therefore, to ascertain information about heterosexual transmission, the analysis of STIs in women can be used to provide an insight. Trends in genital herpes and gonorrhoea among females, however, could be considered true reflections of any changes in high risk sexual behaviour among heterosexual populations. In this respect, there have been, in general, increases in the incidence of these infections over the last five years. For genital herpes, caution should be applied in interpreting the data as these do not necessarily reflect incident infection. With respect to gonorrhoea, in 2011, twice as many diagnoses were observed among females compared to pre-2006. I’ll assume that the MediBeam is the same device as the BioBeam refered to at the cited conference.

Nevertheless, the data continue to indicate that young people, in particular women, are acquiring STIs at an early age. While it is not possible to use the data to determine if the incidence of genital chlamydia infection has increased in recent years, there is no doubt that very large numbers of people are infected – particularly affected are those in the younger age groups. Evidence of re-infection among some individuals with chlamydial infection underlines the importance of ongoing health education around safe-sex. The discrepancy between the numbers of male and female chlamydial infections is almost certainly due to more women than men undergoing testing. In summary, the evidence suggests that the incidence of STIs among young heterosexuals through casual unprotected sexual intercourse remains a problem in Scotland. It is imperative that efforts to effect behavioural change amongst this group, through positive sexual health messages and awareness raising, continue, and the testing and treatment of those at risk of STIs is encouraged. Surveillance data indicate that the number of newly diagnosed HIV cases among MSM has remained stable between 2010 and 2011 (158 and 156 diagnoses, respectively), compared with a peak number of 207 cases in 2007.10 Although the estimated incidence of infection in those undergoing repeat HIV testing has remained unchanged since the late 1980s at 15 per 1000 person years,11 and analyses of data from the Medical Research Council’s triennial cross-sectional surveys of men in gay bars in Glasgow and Edinburgh, indicate that there has been no significant increase in risk-taking behaviour among gay men between 2002 and 2008,12 a high proportion of HIV infection in this group is acquired in Scotland and, thus, HIV transmission among this group remains a serious public health concern.

In summary, information from both infection data, particularly the increase in rectal gonorrhoea, and behavioural studies suggest that rates of unprotected sexual intercourse, and thus the risk of STI, among MSM, continue despite initiatives to raise awareness and levels of knowledge. Challenges for control and prevention of STIs in this group continue. Health Protection Agency. Epidemic of lymphogranuloma venereum (LGV) in men who have sex with men in UK intensifies. Health Protection Report 2011; 5(24). Available at http://www.hpa.org.uk/hpr/archives/2011/hpr2411.pdf. Scottish Intercollegiate Guidelines Network.

Management of genital Chlamydia trachomatis infection. No. 42. Edinburgh: SIGN, March 2000. Scottish Intercollegiate Guidelines Network. Management of genital Chlamydia trachomatis infection. No.

109. Edinburgh: SIGN, March 2009. Available at http://www.sign.ac.uk/guidelines/fulltext/109/index.html. Scottish Government. Sexual Health and Blood Borne Virus Framework (2011-2015). Edinburgh: Scottish Government, 2011. Available at http://www.scotland.gov.uk/Publications/2011/08/24085708/0.

Scottish Government. Respect and Responsibility: Strategy and Action Plan for Improving Sexual Health. Edinburgh: Scottish Government, 2005. Available at http://www.scotland.gov.uk/Publications/2005/01/20603/51182. Scottish Government. HIV Action Plan in Scotland (2009-2014). Edinburgh: Scottish Government, 2009.

Available at http://www.scotland.gov.uk/Publications/2009/11/24105426/0. Scottish Government. Hepatitis C Action Plan for Scotland (2008-2011). Edinburgh: Scottish Government, 2008. Available at http://www.scotland.gov.uk/Publications/2008/05/13103055/0. Scottish Microbiology Forum, British Association of Sexual Health and HIV, Health Protection Scotland. Guidance on the use of molecular testing for Neisseria gonorrhoeae in diagnostic laboratories 2011.

Molecular testing for gonorrhoea working group. Edinburgh, Scottish Bacterial Sexually Transmitted Infection Reference Laboratory, 2012. Health Protection Scotland. Syphilis in Scotland 2011: update. HPS Weekly Report 2011; 46(31): 265-268. Available at http://www.hps.scot.nhs.uk/ewr/redirect.aspx?id=52238. Health Protection Scotland.

ANSWER: HIV infection and AIDS: quarterly report to 31st December 2011. HPS Weekly Report 2011; 46(8): 62-67. Available at http://www.hps.scot.nhs.uk/ewr/redirect.aspx?id=50639. McDonald SA, Hutchinson SJ, Wallace LA, Cameron SO, Templeton K, McIntyre P, Molyneaux P, Weir A, Codere G, Goldberg DJ. Trends in the incidence of HIV in Scotland, 1988-2009. Sex Transm Infect 2012; 88(3): 194-199. Knussen C, Flowers P, McDaid LM, Hart GJ.

HIV-related sexual risk behaviour between 1996 and 2008, according to age, among men who have sex with men (Scotland). Sex Transm Infect 2011; 87(3): 257-259. HPS wishes to thank Janis Shade at the SBSTIRL for help with database maintenance and analysis, as well as the consultant microbiologists, consultant virologists and their staff who supply data to the SBSTIRL and to HPS.

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Surveillance System Details – BBV/STI

Surveillance System Details - BBV/STI

Diagnoses of genital herpes have increased in 2013; diagnoses of genital chlamydia and gonorrhoea have decreased in 2013. Young people, particularly women aged less than 25, are the group most at risk of being diagnosed with an STI. These data should be distinguished from those reported to the Information Services Division of National Services Scotland (NSS) by genitourinary medicine (GUM) clinic staff using the web-based STI Surveillance System (STISS). Literature on the subject of repeated surveys in different regions of the world has been reviewed in detail. The model was used to estimate the impact of a change in testing strategy from baseline (16.8% overall testing coverage; 0.4 partners notified and tested/treated per treated positive index) on PID and TFI cases. (eds.) Nasopharyngeal carcinoma: etiology and control. All three datasets are extracted from laboratory diagnoses reported to Health Protection Scotland (HPS) (herpes simplex and chlamydia) and the Scottish Bacterial Sexually Transmitted Infection Reference Laboratory (SBSTIRL) (gonorrhoea).

Genital herpes and gonorrhea are also on the rise. Disease or morbidity definitions recorded are those used in clinical practice. Note that records of infection in those under 10 years of age are not reported. Similar to previous years, slightly more type 1 than type 2 infections (ratio 1.2:1) were reported (Figure 1). Note that records of infection in those aged under 10 years are not reported. In 2012, 2812 reports of laboratory diagnosed genital herpes infection were received; this is higher than that reported in 2011 (2588) (Table 1); however, it should be noted that the laboratory reports do not distinguish between primary and recurrent infections and, thus, these data reflect all cases tested and diagnosed with genital herpes during 2012. In women, type 1 infections were predominant (57% of infections for which typing data were available) and in men, type 2 infections were predominant (60% of infections for which typing data were available).

Similar numbers of herpes simplex type 1 and type 2 infections were reported in 2014 (Figure 1). In women, 61% infections were type 1 compared to 38% in men. In men, 57% of infections (for which typing data were available) were type 2 compared to 43% in women, in whom type 1 infections predominate. Diagnoses are highest among young people [3]. (1988): Cancer of the larynx/ hypopharynx, tobacco and alcohol: IARC international case-control study in Turin and Varese (Italy), Zagarossa and Navarra (Spain), Geneva (Switzerland) and Calvados (France) – Int. These findings are similar to those of 2011. They are very proud.

Overall, males outnumbered females by 1.2 to 1, but among patients under 20 years, who made up 12% of episodes, females outnumbered males by 2.2 to 1. In 2012, 18,200 diagnoses of genital chlamydial infection were reported to HPS, compared to 18,277, 18,561 and 18,961 reported in 2009, 2010 and 2011, respectively (Table 5). In 2005, a further increase in diagnoses of genital chlamydia infection was observed: 17,289 were reported to HPS, a 7.6% increase on the previous year’s total (16 069), and a 62% increase on that recorded for 2001 (10 638) (Table 5, Figure 3). In 2010, 18,561 diagnoses of genital chlamydial infection were reported to HPS, compared with 17,841, 19,054, and 18,277 reported in 2007, 2008 and 2009, respectively (Table 5). As is the case with genital herpes infection, the majority of diagnoses (63%) were made in women (Table 6). NHS Highland data are thought to reflect an underrepresentation of diagnoses, as Highland residents living in areas which were part of the former NHS Argyll & Clyde may have been diagnosed in and reported from NHS Greater Glasgow & Clyde. In 2014, for women, the highest rates of diagnoses per 100,000 population were observed in NHS Lothian, NHS Tayside and NHS Grampian (over 600 diagnoses per 100,000 population) (Table 7a).

42, (March 2000)1. Analysis of postcode data suggests, however, that approximately 0.6% (13) of Greater Glasgow & Clyde diagnoses (where postcode information is available) may be attributable to Highland residents. Recently statistical modelling approaches have been applied to better quantify the risks of long-term outcomes associated with chlamydia, based on observed data, but with adjustment for inherent weaknesses of observational studies [17]. As with genital herpes, genital chlamydia is an infection which predominates in young people: in 2012, 73% of all diagnoses (63% and 79% of all male and female diagnoses, respectively) were made in persons aged under 25 (Table 8), the majority being made among women and men aged 20-24. This has been a consistent finding for several years. Lymphogranuloma venereum (LGV) infection, caused by a serovar of Chlamydia trachomatis, re-emerged during 2003/2004 when outbreaks were reported in many European cities. LGV diagnoses have been made predominantly in men who have sex with men (MSM) with high levels of concurrent STIs, in particular HIV, and are associated with multiple anonymous partners and high risk sexual behaviour.

Since its re-emergence, over 2300 cases have been reported in the UK.1 In Scotland, during 2012, ten diagnoses were recorded, all of which were made in MSM, compared to eight in 2010 and six in 2011. This represents a 7% increase on that for 2004 (845) and is the highest number of diagnoses recorded during the past ten years (Table 9, Figure 4). Since 2006, nucleic acid amplification tests (NAATs) are being used routinely by an increasing number of laboratories for the diagnosis of gonorrhoea infection. Note, however, that the totals during the past five years (2008-2012) are not comparable to previous years due to the increase in gonorrhoea testing and diagnosis which has resulted from the introduction of NAATs for routine testing in several laboratories. Since 2006, nucleic acid amplification tests (NAATs) have been used routinely by an increasing number of laboratories for the diagnosis of gonorrhoea infection. LGV infection occurs predominantly in men who have sex with men (MSM) and is associated with high levels of concurrent STIs, in particular HIV, and with multiple anonymous partners and high risk sexual behaviour. The gender totals observed during 2006 reflect an increase in the number of diagnoses in males (3.8%) and a decrease in those among females (12.8%).

The data indicate that, for those cases for whom the referral source was known, 82% (1059/1290) and 61% (372/614) of men and women, respectively, were diagnosed in the sexual health clinic setting. The model population was stratified by sexual activity class i but not sex, with outputs then scaled to the numbers of females and males aged 15–24 years in Scotland, NTARGET_F and NTARGET_M. In contrast to genital herpes and genital chlamydial infections, the majority (68%) of gonorrhoea cases were among men (Table 9). In females, infection with gonorrhoea is associated predominantly with a young age group, 72% of female, compared to 45% of male, diagnoses occurring in those aged under 25; relative rates similar to those seen in previous years (Table 11). The increase in gonorrhoea among males, observed between the late 1990s to 2006, is considered to be due, largely, to transmission among MSM. While a decrease in diagnoses was recorded between 2007 and 2009, the subsequent increase observed in the past three years may also be due to a rise in infection in this group. Rectal gonorrhoea is a key marker for unprotected anal intercourse, and in 2012, 28% (362/1290) of men had a rectal swab positive for gonorrhoea.

In females, infection with genital gonorrhoea is associated predominantly with a young age group: 70% of female, compared to 40% of male, diagnoses occurred in those aged less than 25; this observation being similar to corresponding ones seen in previous years, (Table 11). The increase in gonorrhoea among males, observed between the late 1990s and 2006, is considered to be due, largely, to transmission among men who have sex with men (MSM). Note that in the last three to four years, HPS has been refining the ECOSS data collection system to improve the quality and quantity of the laboratory diagnoses dataset, thus, it is not possible to make direct comparisons for genital herpes and genital chlamydia with data prior to 2009. This is similar to that recorded in 2012 – the highest recorded level in over ten years. The male:female ratio was 3:1, which is higher than the ratio seen in recent years (2:1 male:female) and reflects an increase in diagnoses among men in 2014 with a concomitant decrease in diagnoses among women. In 2006, there was a 15% increase in number of diagnoses in men aged less than 25. Therefore, to ascertain information about heterosexual transmission, the analysis of STIs in women can be used to provide an insight.
Surveillance System Details - BBV/STI

Individuals are infected with chlamydia according to the per-susceptible force of infection λi. In particular, testing for chlamydia infection, which is asymptomatic in up to 80% of individuals, has probably increased during this time, initially as a result of the SIGN guideline recommendations,7 and now as a result of the provision of NAAT testing platforms which allow samples to be tested for both chlamydia and gonorrhoea.2 This latter change in testing practice has also probably resulted in an increase in gonorrhoea diagnoses. Trends in genital herpes and gonorrhoea among females, however, could be considered true reflections of any changes in high risk sexual behaviour among heterosexual populations. In this respect, there have been, in general, increases in the incidence of these infections over the last five years. For genital herpes, caution should be applied in interpreting the data as these do not necessarily reflect incident infection. With respect to gonorrhoea, the incidence has been increasing since the early part of the first decade of the 21st century. Trends in herpes simplex and gonorrhoea among females, however, could be considered true reflections of any changes in high risk sexual behaviour among heterosexual populations.

This is re-inforced by the sexual health service standards, developed by NHS Quality Improvement Scotland (now NHS Healthcare Improvement Scotland), which focus on chlamydia testing in young men and women aged under 25 years.4 Specifically, Standard 3 (Services for Young People) describes testing rates of 300 per 1000, and 100 per 1000, for females and males aged 20-24, respectively. Nevertheless, the data continue to indicate that young people, in particular women, are acquiring STIs at an early age. While it is not possible to use the data to determine if the incidence of genital chlamydia infection has increased in recent years, there is no doubt that very large numbers of people are infected – particularly among those in the younger age groups. HPS is unable to measure the extent of opportunistic testing with our current data collection systems but it may be that levels of testing have decreased resulting in lower numbers of diagnoses. While the data are unable to determine if the incidence of genital chlamydia infection has increased in recent years, there is no doubt that very large numbers of young people, in particular, are infected. Thus, it is imperative that efforts to effect behavioural change amongst this group through positive sexual health messages are continued while encouraging individuals to undergo testing when at risk of infection and thus, receive the appropriate treatment. This assumption was informed by discussion with Scottish genitourinary medicine clinicians.

In summary, information from both infection data, particularly the increase in rectal gonorrhoea, and behavioural studies suggests that rates of unprotected sexual intercourse, and thus the risk of STI, among MSM, continue despite initiatives to raise awareness and levels of knowledge. Challenges for control and prevention of STIs in this group continue. Public Health England. Lymphogramuloma venereum (LGV) data tables. Accessible at: http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/LGV/. However, observations on the transmission of HIV among this group are of serious concern: fifteen new cases (as indicated by HIV seroconversion in a calendar year) being detected during 2004 – compared to an annual average of four new cases between 2001-20033. Nevertheless, the data continue to indicate that young people, in particular women, are acquiring STIs at an early age.

Molecular testing for gonorrhoea working group. The Scottish Bacterial Sexually Transmitted Infection Reference Laboratory (SBSTIRL), details available at: http://www.hps.scot.nhs.uk/reflab/RefLabDetail.aspx?id=20. Thus, it is essential that efforts to affect behavioural change in this group through positive sexual health messages are continued while encouraging individuals to undergo testing when at risk of infection and so receive appropriate treatment. A total of 11 confirmed cases were reported at March 2006; however, reports of recent cases indicate that vigilance is still required. Edinburgh: Scottish Government, 2011. However, the time taken is predicted to be reasonably quick (the time taken is dependent on the scale of the change, but generally speaking most of the impact is realised within five years). Scottish Government.

Respect and Responsibility: Strategy and Action Plan for Improving Sexual Health. Edinburgh: Scottish Government, 2005. http://www.scotland.gov.uk/Publications/2005/01/20603/51182. Scottish Government. HIV Action Plan in Scotland (2009 – 2014). No. http://www.scotland.gov.uk/Publications/2009/11/24105426/0.

Respect and Responsibility: Strategy and Action Plan for Improving Sexual Health. No.109. Edinburgh: Scottish Government, 2008. http://www.scotland.gov.uk/Publications/2008/05/13103055/0. The total annual cost of testing and treatment at this level is estimated from the model to be about £5.4 million. Management of genital Chlamydia trachomatis infection. No.

109. Edinburgh: SIGN, March 2009. http://www.sign.ac.uk/guidelines/fulltext/109/index.html. Health Protection Scotland. HPS Weekly Report 2011; 45(31): 283-286. HPS Weekly Report 2013; 47(26): 214-217. No.109.

PLOS ONE March 2014; 9 (3) 390805. ANSWER HIV infection and AIDS: quarterly report to 31st March 2013. HPS Weekly Report 2013; 47(21): 182-184. The cost per QALY gained increases with increased testing coverage, and decreases with decreased testing coverage. McDonald SA, Hutchinson SJ, Wallace LA, Cameron SO, Templeton K, McIntyre P, Molyneaux P, Weir A, Codere G, Goldberg DJ. Trends in the incidence of HIV in Scotland, 1988-2009. Sex Transm Infect 2012; 88(3): 194-199.

Wallace LA, Li J, McDaid LM. HIV prevalence and undiagnosed infection among a community sample of gay and bisexual men in Scotland, 2005-2011: implications for HIV testing and prevention. PLOS ONE (under review). HPS wishes to thank Janis Shade at the SBSTIRL for help with database maintenance and analysis, as well as the consultant microbiologists, consultant virologists and their staff who supply data to the SBSTIRL and to HPS.

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Surveillance System Details – BBV/STI

Surveillance System Details - BBV/STI

Rectal gonorrhoea is a key marker for unprotected anal intercourse. Young people, particularly women aged under 25, are the group most at risk of being diagnosed with an STI. Rectal gonorrhoea in men, a marker of unprotected anal intercourse, has increased since 2013 to a new high level. The laboratory diagnostic dataset comprises all laboratory-confirmed diagnoses made in Scotland; while the STISS dataset includes diagnoses made in the GUM clinic setting. The need for a prevalence study from the south of the British Isles has been emphasised in order to enable one to judge if the increase in Scotland is in keeping with the pattern in the whole of the British Isles. Cost-effectiveness calculations informed by best-available estimates of the quality-adjusted life years (QALYs) lost due to PID and TFI were also performed. Lyons: IARC Scientific Publication 20, pp.

The laboratory diagnostic dataset comprises all laboratory-confirmed diagnoses made in Scotland, while the STISS dataset includes diagnoses made in the GUM clinic setting. Between 2005 and 2010, there has been a 33 per cent increase in the number of people diagnosed with herpes in Scotland. Each week, SCIEH receives reports of laboratory confirmed diagnoses of STIs (including gonorrhoea, genital Chlamydia trachomatis, and genital Herpes simplex) from all public laboratories in Scotland. However, it should be noted that only those diagnoses which can be clearly identified as genital infection are flagged in the datasets at HPS and reported here, which may result in some under-reporting. Between the early and late 1990s, almost all of the increase in herpes simplex incidence occurred among females and this trend has continued (Table 1). In addition, the now universal use of ECOSS (the Electronic Communication of Surveillance Scotland) by testing laboratories has resulted in a greater quantity and better quality of data which is subject to further cleaning and refinement at HPS. During the past five years, diagnoses of genital herpes have increased by approximately 45% in men (588 to 853) and by 56% in women (1251 to 1945).

In 2013, the highest rates for women were observed in NHS Tayside and NHS Dumfries & Galloway (more than 150 diagnoses per 100,000 population) (Table 3). In women, type 1 infections were predominant (58% of infections for which typing data were available) and in men, type 2 infections were predominant (52% of infections for which typing data were available). The ratio of female to male diagnoses in 2006 was 2.3:1. The ratio of female to male diagnoses in 2010 was 2.3:1; this has been a consistent finding over the past seven years. In 2010, a quarter of young women (25.6%) and 8.3% of young men aged 15–24 years were tested for chlamydia (16.8% average coverage between women and men) [4, 5]. J. In 2010, for women, the highest rates per 100,000 population were observed in Dumfries & Galloway and Tayside NHS Boards (>130 reports per 100,000), and for men in Tayside and Greater Glasgow & Clyde NHS Boards (>50 per 100,000, Table 3).

Last month, she was accepted to the first Royal Society of Edinburgh Young Academy of Scotland, which means she is considered to be one of the best young minds of her generation. The rates of diagnosis of gonorrhoea in males and females were 21 and 7 per 100 000 population aged 15 to 59 years, respectively. The largest number of diagnoses was observed among women aged 15-24 and men aged 20-29 – this too has been a consistent finding over the past ten years. As with genital herpes simplex infection, the gender distribution favours females (Table 6). The improved data capture of laboratory test results via ECOSS means that the data in recent years have been subject to more extensive validation particularly with regard to removing repeat samples taken for the same episode. In 2012, for women, the highest rates per 100,000 population were observed in NHS Dumfries & Galloway, NHS Lothian, and NHS Tayside (> 700 per 100,000 population) and for men, in NHS Tayside, NHS Dumfries & Galloway, and NHS Greater Glasgow & Clyde ( > 400 per 100,000) (Table 7). Excepting the island NHS boards, among women aged under 25, the highest rates of diagnoses per 100,000 population were observed in NHS Dumfries & Galloway, NHS Lothian, NHS Ayrshire & Arran and NHS Tayside (greater that 2500 diagnoses per 100,000 population) (Table 7b).

For men, the highest rates were seen in NHS Tayside, NHS Lothian and NHS Greater Glasgow & Clyde (over 400 diagnoses per 100,000 population). Most (eight of fifteen) NHS boards reported an increase in genital chlamydia diagnoses between 2005 and 2006 – the largest increases being 30% (704 to 916) in Forth Valley, 21% in Dumfries & Galloway (494 to 598) and 18%, (1299 to 1534) in Lanarkshire. In the latter NHS board, however, these data may reflect an underrepresentation of diagnoses as it is likely that Highland residents living in areas which were part of the former Argyll & Clyde NHS Board may actually have been diagnosed in, and thus reported from, Greater Glasgow & Clyde. Most European guidelines for chlamydia management include treatment, partner notification and health promotion, and in some instances, recommendation of retesting of positives after three months [18–20]. For corresponding males, the highest rates (greater than 1400 per 100,000 population) were recorded in the same NHS Boards (Figure 3, Table 7). As with genital herpes, genital chlamydia is an infection which predominates in young people: in 2010, 74% of all diagnoses (65% and 80% of all male and female diagnoses, respectively) were made in persons aged under 25 (Table 8), the majority among women aged 15-19 and men aged 20-24. In addition, data on tests performed using commercially available chlamydia test kits (Clamelle®) indicate that there were a total of 329 and 268 test kits purchased during 2009 and 2010, respectively, in Scotland.

The number of kits sold in Scotland (668) between November 2008 and March 2011 represents 5.8% of the UK total (11,574). Of those individuals tested, in 2009, 4% (9/232) of women and 7% (7/97) of men were found to have genital chlamydia infection compared to 7% (12/173) of women and 4% (4/95) of men in 2010. Following a 57% rise observed between 1999 and 2000, the overall incidence of infection between 2001 and 2004 remained stable. These tests have a greater sensitivity than standard culture and isolation techniques for the detection of gonorrhoea infection, and it is expected that most laboratories will start using them in future years. When compared to 2011 data, the gender totals observed during 2012 reflect a 31% increase in the number of diagnoses among women (from 468 to 614) and a 20% increase in those among men (from 1077 to 1290) (Table 9). These tests have a greater sensitivity than standard culture and isolation techniques for the detection of gonorrhoea infection.4 Therefore, the totals during the past six years (2008-2013) are not comparable to preceding years due to the increase in gonorrhoea testing and diagnosis resulting from the introduction of NAATs for routine testing in all laboratories. Since its re-emergence, over 3000 diagnoses have been reported in the UK.

Increases in four of the thirteen NHS boards reporting cases were observed; the largest occurring in Ayrshire and Arran (250% (8 to 28)), Lanarkshire (109%, (35 to 73)), and Fife (62%, (37 to 60)). It should be noted that there is variability from year to year in the number of diagnoses in each NHS board; thus, for some NHS boards, clear trends as to whether the incidence is increasing or decreasing are not always evident (Table 10, Figure 4). The reason for this approach is that incorporation of sex would have necessitated complex model fitting to fit to the unequal observed chlamydia prevalence, testing coverage and test positivity between women and men. The data indicate that, for those cases for whom the referral source was known, 84% (770/918) of men and 61% (261/428) and women were diagnosed in the GUM clinic setting. In 2010, the highest rates of gonorrhoea infection (at >50 per 100,000 population) for men were seen in Greater Glasgow & Clyde and Lothian NHS Boards and, for women (at >25 per 100,000 population), in Greater Glasgow & Clyde and Lanarkshire NHS Boards (Table 13). In contrast to genital herpes and genital chlamydial infections, the majority (68%) of gonorrhoea cases were among men (Table 9). In females, infection with gonorrhoea is associated predominantly with a young age group: 75% of female, compared to 46% of male, diagnoses occurred in those aged less than 25.

Surveillance System Details - BBV/STI
This observation is similar to corresponding ones seen in previous years (Table 11). The increase in number of diagnoses during 2005 was predominantly in those aged less than 25. The increase noted in the last two years may also be due to a rise in infection in this group – reversing the trend observed between 2006 and 2008. It should be noted that much of the increase in chlamydia diagnoses in the past twelve years is due to a combination of issues including: increased opportunistic testing, the use of more sensitive diagnostic tests, increased awareness through health promotion campaigns, and latterly improvements in data collection. Overall, the number of laboratory positive diagnoses for genital herpes simplex types 1/2 has increased, while those for genital chlamydia and gonorrhoea have decreased between 2012 and 2013. The data indicate that, for those cases for whom the referral source was known, an estimated 85% were diagnosed in the sexual health clinic setting, 11% in primary care and the remainder in other settings including family planning and hospital. The introduction of a PCR test in recent years has increased the sensitivity of gonorrhoea diagnosis; a further 22 (i.e.

Whilst it is encouraging that increased testing and detection of chlamydia is occurring, further developments in surveillance will facilitate the monitoring of testing practices at local, regional and national levels. Recovered individuals remain equally susceptible to infection (Susceptible-Infected-Susceptible (SIS) model). These data are now collected annually to provide insights into the levels of testing in men and women across Scotland and to monitor trends. Data collected from the chlamydia testing laboratories for 2010 indicate that the majority of testing (73%) is performed on women, and, overall, 52% of tests are performed on those aged over 25. However, more than three times as many positive diagnoses were made in women aged under 25 who underwent testing compared to older women. Despite more testing being performed among women, a higher prevalence of genital chlamydia infection was observed in men overall, and in those aged under 25, 14% of men were diagnosed positive compared to 10% of young women. In light of these findings, a refocusing of chlamydia testing among young people is needed.

In this respect, there have been increases in the incidences of these infections over the last decade. Information about sexual orientation is not available from laboratory reports to SBSTIRL and HPS, and it is impossible to know if infections in men are occurring among those who have sex with women or those who have sex with other men. While it is not possible to use the data to determine if the incidence of genital chlamydia infection has increased in recent years, there is no doubt that very large numbers of people are infected – particularly affected are those in the younger age groups. The discrepancy between the numbers of male and female chlamydial infections is almost certainly due to more women than men undergoing testing. Information about sexual orientation is not available from laboratory reports to SBSTIRL or in ECOSS and it is impossible to know if infections in men are occurring among those who have sex with women or those who have sex with men. The discrepancy between the numbers of male and female chlamydia infections is almost certainly due to more women than men undergoing screening, following the implementation of the recommendations of the SIGN guideline1. While it is not possible to use the data to determine if the incidence of genital chlamydia infection has increased in recent years, there is no doubt that very large numbers of people are infected – particularly affected are those in the younger age groups.

Full model equations are given in the Additional file 1, along with the equations for the model outputs (Additional file 1: Table S1). Trends in genital herpes and gonorrhoea among females, however, could be considered true reflections of any changes in high risk sexual behaviour among heterosexual populations. In this respect, there have been, in general, increases in the incidence of these infections over the last five years. For genital herpes, caution should be applied in interpreting the data as these do not necessarily reflect incident infection. With respect to gonorrhoea, the incidence increased during the late 1990s reaching a peak of 244 diagnoses in 2000.5 Since this time, the incidence has varied with around 200 diagnoses per year up to 2006 and then over 300 diagnoses per year in the last four years. However, it should be noted that the introduction of NAATs has resulted in increased detection of infection and, therefore, 2007-2010 data are not directly comparable to those for previous years. Whilst it is encouraging that the European outbreak of lymphogranuloma venereum (LGV) infection, caused by a serovar of Chlamydia trachomatis, occurring in other areas of the UK, predominantly in London and Brighton4, has not spread rapidly in Scotland, the number of cases has increased (from two case reports in January 2005 to 11 confirmed cases at March 2006) and vigilance is required.

Surveillance data also indicate a decrease in the number of newly diagnosed HIV cases among MSM in 2010 (147) from a peak number of 207 cases in 2007.7 While this decline is encouraging, it is too early to comment on whether this reflects any change in the incidence of infection among this group. Edinburgh, Scottish Bacterial Sexually Transmitted Infection Reference Laboratory, 2012. Public Health England. As laboratory data contain no information on sexual orientation, rectal infections may be used as a surrogate marker for gonococcal infection in MSM. Challenges for control and prevention continue:health promotion and education activities are still required to address the burden of infection in this group. Scottish Intercollegiate Guidelines Network. In practice, “real-world” factors such as speed of policy implementation, and other factors such as age-dependent sexual mixing, will likely more strongly influence time taken to reach full impact of changing testing strategy.

No. 42. Edinburgh: SIGN, March 2000. http://www.sign.ac.uk/guidelines/fulltext/42/index.html Scottish Intercollegiate Guidelines Network. Management of genital Chlamydia trachomatis infection. No. 109.

Scottish Government. 2005. Edinburgh: SIGN, March 2009. Edinburgh: St Andrew’s House, 2005. http://www.scotland.gov.uk/Resource/Doc/35596/0012575.pdf NHS Quality Improvement Scotland. In the model, increasing testing coverage by 50% from baseline to 25.2% results in fewer outcomes per year (703 fewer PID, 88 fewer TFI: a 21% decrease in the number of cases occurring, or 34% increase in the number of cases prevented, compared to baseline) (Additional file 1: Figures S1a and S1b). http://www.nhshealthquality.org/nhsqis/files/SEXHEALTHSERV_STANF_MAR08.pdf Health Protection Scotland.

Genital herpes simplex, genital chlamydia and gonorrhoea infection in Scotland: laboratory diagnoses 2000-2009. HPS Weekly Report 2010; 44(34): 331-338. http://www.hps.scot.nhs.uk/ewr/redirect.aspx?id=45605 Health Protection Scotland. Syphilis in Scotland 2010: update. HPS Weekly Report 2011; 45(31): 283-286. http://www.hps.scot.nhs.uk/ewr/redirect.aspx?id=48653 Health Protection Scotland. http://www.hps.scot.nhs.uk/ewr/redirect.aspx?id=55318.

2009. Accessible from: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0090805. HIV-related sexual risk behaviour between 1996 and 2008, according to age, among men who have sex with men (Scotland). Sex Transm Infect 2011; 87(3): 257-259. This is because increasing testing coverage means increasing the number of additional tests among young people generally: all those seeking treatment (who have higher test positivity) are already being tested.

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Surveillance System Details – BBV/STI

Surveillance System Details - BBV/STI

Young people, particularly women, aged under 25, are the group most at risk of being diagnosed with an STI. In 2012, 28% (362/1290) of men had a rectal swab positive for gonorrhoea; this is the highest annual proportion recorded over the past ten years. Rectal gonorrhoea in men, a marker of unprotected anal intercourse, was maintained at its highest level in the last ten years during 2013. The data associated with the laboratory diagnoses are restricted to age, gender and the NHS board where the clinical specimen originated. Although the STISS dataset is more comprehensive, including epidemiological data such as sexual orientation, the laboratory dataset is characterised by complete geographical coverage. The familial incidence of the disease was noted to be virtually unchanged between the three surveys. Increasing overall testing coverage by 50% from baseline to 25.2% is estimated to result in 21% fewer cases in young women each year (PID: 703 fewer; TFI: 88 fewer).

347–357. In 2005, 1677 reports of laboratory diagnosed infections were received. The majority of those were women under 24. The data are known to be incomplete, as not all laboratory diagnoses are reported to SCIEH (4). Between the early and late 1990s, almost all of the increase in herpes simplex incidence occurred among females and this trend has continued (Table 1). The ratio of female to male diagnoses in 2005 was 2.4:1. Thus, the trends observed in recent years are not directly comparable to those prior to 2007.

The ratio of female to male diagnoses in 2012 was 2.3:1, which has been a consistent finding over the past ten years. For men the highest rates were observed in NHS Tayside, NHS Greater Glasgow & Clyde and NHS Grampian (more than 60 diagnoses per 100,000 population). Cases of genital herpes were detected in all NHS boards (Table 2 and Figure 2) with large increases (greater than 20%) seen in 2014 compared to 2013, in NHS Highland, NHS Fife, NHS Grampian and NHS Lothian. Between 2002 and 2006, the number of herpes diagnoses has almost doubled in both men (274 to 539), and women (634 to 1261). For males, the lowest rates were noted in Lanarkshire, Fife and Argyll & Clyde, all with less than 10 reports per 100 000 population (Table 3). Of these, 10.6% of females and 15.4% of males were positive for chlamydia infection: an average positivity of 11.8% [3, 4]. Cancer 41: 482–491.

In 2005, 61% of infections were diagnosed among persons aged less than 30; this having been the pattern over the last decade with the corresponding rate in 1997 being the highest at 66% (Table 4). For both males and females the largest number of diagnoses were observed among those aged 20-24. The rates of diagnosis of genital chlamydia infection were 54 in males and 65 in females per 100 000 aged 15 to 59 years, respectively. As with genital herpes simplex infection, the gender distribution favours females (Table 6). In 2005, 64% of infections were diagnosed in females. As is the case with genital herpes infection, the majority of diagnoses (62%) were made in women (Table 6). Outside the island NHS boards, the lowest rates for males were observed in NHS Borders and NHS Highland, and the lowest rates for females were observed in NHS Highland and NHS Fife.

Among young men, the highest rates of diagnoses were recorded in NHS Dumfries & Galloway and NHS Tayside (greater than 1400 diagnoses per 100,000 population). Outside the island NHS boards, the lowest rates for females were observed in NHS Highland and NHS Lanarkshire; while the lowest rates for males were observed in NHS Highland, NHS Lanarkshire and NHS Borders. In 2006, for both males and females, the highest rates per 100 000 were seen in Tayside, Lothian, Greater Glasgow and Dumfries & Galloway. For corresponding males, the highest rates were recorded in Tayside and Lothian. National screening programmes exist in some European countries (England: opportunistic screening programme; the Netherlands: population register screening) while others have high levels of opportunistic testing in the absence of an organised national programme (Denmark, Estonia, Iceland, Latvia, Norway and Sweden). As for genital herpes simplex, genital chlamydia is an infection which predominates in young people: in 2005, 73% of all diagnoses (78% and 64% of all female and male diagnoses respectively) were made in persons under the age of 25 (Table 8); while among both males and females, the majority were made among those aged 20-24. This observation partly reflects screening policy.

Surveillance System Details - BBV/STI
In 2005, 904 diagnoses of gonorrhoea were reported. This represents a 7% increase on that for 2004 (845) and is the highest number of diagnoses recorded during the past ten years (Table 9, Figure 4). Following a 57% rise observed between 1999 and 2000, the overall incidence of infection between 2001 and 2004 remained stable. The increase observed during 2005 reflects an increase in the number of diganoses in both males (5.6%) and females (9.7%). In 2010, 1378 diagnoses of gonorrhoea were reported to HPS; this represents a 35% increase on the 2009 total of 1021. It should be noted that there is variability from year to year in the number of diagnoses in each NHS board, so that, for some NHS boards, clear trends as to whether the incidence is increasing or decreasing are not always evident (Table 10, Figure 4). Additional data cleaning at HPS has resulted in a different number of episodes compared to those reported in the GASS 2013 report (HPS Weekly report, this edition).

The UK now has the largest documented outbreak of LGV among MSM in Europe.3 In Scotland during 2014, eight LGV diagnoses were recorded, all of which were made in men, compared to eleven in 2013, ten in 2012, six in 2011 and eight in 2010. In contrast, decreases in numbers of diagnoses were observed in Greater Glasgow (14%, (341 to 293)), and Lothian (9%, (226 to 205)) – the two NHS board areas where most diagnoses are made. In contrast to genital herpes simplex and genital chlamydia infections, the majority (75%) of cases were among males. Most likely this would have necessitated making additional assumptions for the pattern of sexual mixing between different sexual activity classes by sex, the way in which the numbers of partnerships between the sexes are balanced, treatment seeking behaviour between the sexes, and the transmission probabilities for women and men, and hence, introducing even greater uncertainty in the model. The increase in gonorrhoea among males, observed since the late 1990s, is considered to be due, largely, to transmission among men who have sex with men. The percentage of males with a rectal swab positive for gonorrhoea doubled from 53 in 2001 to 112 in 2003 but decreased to 80 in both 2004 and 2005. (Table 12).

In females, infection with genital gonorrhoea is associated predominantly with a young age group: 70% of female, compared to 40% of male, diagnoses occurred in those aged less than 25; this observation being similar to corresponding ones seen in previous years, (Table 11). The increase in number of diagnoses during 2005 was predominantly in those aged less than 25. In addition, although the numbers are small, there was an almost three-fold increase in diagnoses among females aged 30-34 (from 6 in 2004 to 17 in 2005). Rectal gonorrhoea is a key marker for unprotected anal intercourse: in 2010, 24% (227/930) of men had a rectal swab positive for gonorrhoea, the highest proportion recorded in the last ten years (Table 12). Publication of the Sexual Health and Blood Borne Virus Framework (2011-2015)3 has refocused attention on the public health challenges for Scotland presented by sexual health, HIV and hepatitis B and C, building on the foundations of the sexual health strategy Respect and Responsibility,4 the HIV Action Plan in Scotland5 and the Hepatitis C Action Plan for Scotland.6 Outcomes are monitored against a set of indicators; while an indicator relating to chlamydia diagnoses awaits further discussion, diagnoses of gonorrhoea infection, including levels of rectal infection in men, are being measured. As HPS has been refining the ECOSS data collection system over the past four years to improve the quality and quantity of the laboratory diagnoses dataset, it is not possible to make direct comparisons for genital herpes and genital chlamydia with data prior to 2009. In 2014, the highest rates of gonorrhoea infection (at over 100 per 100,000 population) for men were seen in NHS Greater Glasgow & Clyde and for women (at over 30 per 100,000 population) in NHS Lothian (Table 11).

a 2.4% increase) diagnoses (16 in males and 6 in females) being detected by PCR. 42, March 2000) recommendations on chlamydia testing1 and increased awareness through health promotion campaigns and the use of more sensitive diagnostic tests. A proportion of females with incident chlamydia infection progresses to PID at rate PID_risk, and a smaller proportion progresses to TFI at rate TFI_risk. Information about sexual orientation is not available from laboratory reports to SNGRL and HPS, and it is impossible to know if infections in males are occurring among those who have sex with women or those who have sex with other men. Therefore, to ascertain information about heterosexual transmission, the analysis of STIs in women can be used to provide an insight. In addition, it is important to note two things when interpreting these data: firstly, the adoption of nucleic acid – based tests in all laboratories for genital chlamydia and in many laboratories for genital herpes since 2000/2001 means that only limited comparisons of the data can be made over the ten-year period presented and, secondly, that screening for chlamydia, which is asymptomatic in up to 80% of individuals, has probably increased as a result of the SIGN guideline recommendations as described above. Trends in herpes simplex and gonorrhoea among females, however, could be considered true reflections of any changes in high risk sexual behaviour among heterosexual populations.

In this respect, there have been increases in the incidences of these infections over the last decade. For genital herpes, female diagnoses have continued to increase each year, resulting in the highest number of annual reports in 2005 (1152). Therefore, to ascertain information about heterosexual transmission, the analysis of STIs in women can be used to provide an insight. The discrepancy between the numbers of male and female chlamydial infections is almost certainly due to more women than men undergoing testing. In summary, the evidence suggests that the incidence of STIs among young heterosexuals through casual unprotected sexual intercourse remains a problem in Scotland. Therefore, to ascertain information about heterosexual transmission, the analysis of STIs in women can be used to provide an insight. Such data indicate that casual unprotected sexual intercourse among young heterosexuals remains a problem in Scotland.

Such data indicate that casual unprotected sexual intercourse among young heterosexuals remains a major problem in Scotland. The model parameters are detailed in Table . It is unclear whether these decreases will be sustained and whether this observation indicates a reduction in high risk sexual behaviour. Behavioural studies, involving cross-sectional surveys of men in gay bars, indicate an increase in risk-taking behaviour among gay men between 1999 and 2002. This parallels the increase in infections observed during these years2. However, observations on the transmission of HIV among this group are of serious concern: fifteen new cases (as indicated by HIV seroconversion in a calendar year) being detected during 2004 – compared to an annual average of four new cases between 2001-20033. Whilst it is encouraging that the European outbreak of lymphogranuloma venereum (LGV) infection, caused by a serovar of Chlamydia trachomatis, occurring in other areas of the UK, predominantly in London and Brighton4, has not spread rapidly in Scotland, the number of cases has increased (from two case reports in January 2005 to 11 confirmed cases at March 2006) and vigilance is required.

Some of the decrease in the incidence of rectal gonorrhoea and possibly syphilis infection may reflect ongoing health promotion and education activities; however, caution is required in interpreting this new observation. The estimated incidence of infection in those undergoing repeat HIV testing has remained unchanged since the late 1980s at 15 per 1000 person years, and analyses of data from the Medical Research Council’s triennial cross-sectional surveys of men in gay bars in Glasgow and Edinburgh, indicate that there has been no significant increase in risk-taking behaviour among gay men between 2002 and 2008.8 Nonetheless a high proportion of HIV infection in this group is acquired in Scotland and thus, HIV transmission among this group remains a serious public health concern.

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