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Sexually Transmitted Diseases Act) Europe’s journal on infectious disease epidemiology, prevention and control © Science Photo Special edition: Sexually transmitted infections August 2012 • Reports highlighting increasing trends of gonorrhoea and syphilis and the threat of drug-resistant gonorrhoea in Europe. www.eurosurveillance.org Editorial team Editorial advisors Based at the European Centre for Albania: Alban Ylli, Tirana Disease Prevention and Control (ECDC), Austria: Reinhild Strauss, Vienna 171 83 Stockholm, Sweden Belgium: Koen De Schrijver, Antwerp Telephone number Belgium: Sophie Quoilin, Brussels +46 (0)8 58 60 11 38 or +46 (0)8 58 60 11 36 Bosnia and Herzogovina: Nina Rodić Vukmir, Banja Luka Fax number Bulgaria: Mira Kojouharova, Sofia +46 (0)8 58 60 12 94 Croatia: TBC, Zagreb Cyprus: Chrystalla Hadjianastassiou, Nicosia E-mail Czech Republic: Bohumir Križ, Prague [email protected] Denmark: Peter Henrik Andersen, Copenhagen Editor-in-chief England and Wales: TBC, London Ines Steffens Estonia: Kuulo Kutsar, Tallinn Finland: Outi Lyytikäinen, Helsinki Scientific editors France: Judith Benrekassa, Paris Kathrin Hagmaier Germany: Jamela Seedat, Berlin Williamina Wilson Greece: Rengina Vorou, Athens Karen Wilson Hungary: Ágnes Csohán, Budapest Assistant editors Iceland: Haraldur Briem, Reykjavik Alina Buzdugan Ireland: Lelia Thornton, Dublin Ingela Söderlund Italy: Paola De Castro, Rome Associate editors Kosovo (under UNSCR 1244/99): Lul Raka, Pristina Andrea Ammon, Stockholm, Sweden Latvia: Jurijs Perevoščikovs, Riga Tommi Asikainen, Frankfurt, Germany Lithuania: Milda Zygutiene, Vilnius Mike Catchpole, London, United Kingdom Luxembourg: Thérèse Staub, Luxembourg Denis Coulombier, Stockholm, Sweden The FYR of Macedonia: Elisaveta Stikova, Skopje Christian Drosten, Bonn, Germany Malta: Tanya Melillo Fenech, Valletta Karl Ekdahl, Stockholm, Sweden Netherlands: Paul Bijkerk, Bilthoven Johan Giesecke, Stockholm, Sweden Norway: Hilde Klovstad, Oslo Herman Goossens, Antwerp, Belgium Poland: Malgorzata Sadkowska-Todys, Warsaw David Heymann, London, United Kingdom Portugal: Isabel Marinho Falcão, Lisbon Heath Kelly, Melbourne, Australia Romania: Daniela Pitigoi, Bucharest Irena Klavs, Ljubljana, Slovenia Serbia: Tatjana Pekmezovic, Belgrade Karl Kristinsson, Reykjavik, Iceland Scotland: Norman Macdonald, Glasgow Daniel Lévy-Bruhl, Paris, France Slovakia: Lukáš Murajda, Martin Richard Pebody, London, United Kingdom Slovenia: Alenka Kraigher, Ljubljana Panayotis T. Tassios, Athens, Greece Spain: Elena Rodríguez Valín, Madrid Hélène Therre, Paris, France Sweden: Christer Janson, Stockholm Henriette de Valk, Paris, France European Commission: Paolo Guglielmetti, Luxembourg Sylvie van der Werf, Paris, France World Health Organization Regional Office for Europe: Nedret Emiroglu, Copenhagen Design / Layout Fabrice Donguy / Arne Haeger www.eurosurveillance.org © Eurosurveillance, 2012 Contents Sexually transmitted infections Focus on recent trends in gonorrhoea and Clamydiosis, Gonorrhoea, syphilis Lymphogranuloma venereum, Shigellosis Editorial Research article Increasing trends of gonorrhoea and syphilis and Epidemiology of Chlamydia trachomatis the threat of drug-resistant gonorrhoea in Europe 2 endocervical infection in a previously unscreened M Van de Laar et al. population in Rome, Italy, 2000 to 2009 21 V Marcone et al. Rapid communications Syphilis on the rise again in Germany – results from surveillance data for 2011 5 Rapid communications V Bremer et al. Identification of Neisseria gonorrhoeae isolates Recent trends in gonorrhoea and syphilis with a recombinant porA gene in Scotland, United epidemiology in Sweden: 2007 to 2011 10 Kingdom, 2010 to 2011 29 I Velicko et al. K Eastick et al. Rapid increase in gonorrhoea and syphilis diagnoses in England in 2011 16 Clinical Neisseria gonorrhoeae isolate EJ Savage et al. with a N. meningitidis porA gene and no prolyliminopeptidase activity, Sweden, 2011 Letters - danger of false-negative genetic and culture diagnostic results 33 Syphilis and the Internet 20 D Golparian et al. M Noll-Hussong Treatment failure of pharyngeal gonorrhoea with internationally recommended first-line ceftriaxone verified in Slovenia, September 2011 36 M Unemo et al. Lymphogranuloma venereum: a hidden emerging problem, Barcelona, 2011 40 H Vargas-Leguas et al. First detection of Chlamydia trachomatis LGV biovar in the Czech Republic, 2010–2011 D 43 Vanousova et al. Ongoing outbreak of Shigella flexneri serotype 3a in men who have sex with men in England and Wales, data from 2009–2011 46 ML Borg et al. © Science Photos, Syphilis bacterium (Treponema pallidum) www.eurosurveillance.org 1 Editorials Increasing trends of gonorrhoea and syphilis and the threat of drug-resistant gonorrhoea in Europe M Van de Laar ([email protected])1, G Spiteri1 1. Programme on STIs, including HIV/AIDS and blood-borne infections, European Centre for Disease Prevention and Control, Stockholm, Sweden Citation style for this article: Van de Laar M, Spiteri G. Increasing trends of gonorrhoea and syphilis and the threat of drug-resistant gonorrhoea in Europe. Euro Surveill. 2012;17(29):pii=20225. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20225 Article submitted on 18 July 2012 / published on 19 July 2012 Sexually transmitted infections (STI) notifications have risk behaviour among both MSM and young adults may been on the rise in several European countries since have contributed to these changes. The rise in gonor- the early 2000s, most likely due to multiple factors rhoea among heterosexuals in Sweden and the UK in like increased screening, use of more sensitive diag- particular cannot be linked solely to increased testing, nostics, improved reporting and also due to high levels and unsafe sexual behaviour is an important contribu- of unsafe sexual behaviour among certain subpopu- tor. In addition, Velicko and Unemo [5] report that half lations. Across Europe, 32,000 cases of gonorrhoea, of the diagnoses among heterosexual men in Sweden 18,000 cases of syphilis and over 345,000 cases of appear to be acquired outside Sweden; this adds to the chlamydia were reported in 2010 [1]. Certain sub- risk of importation of resistant strains. These obser- populations appear to be more affected than others: vations indicate the need to implement behavioural Men who have sex with men (MSM) are disproportion- surveillance in addition to biological surveillance as a ately affected by gonorrhoea and syphilis, and young useful tool to gain more insight into current trends of people between 15 and 24 years of age are affected unsafe sexual behaviour. mainly by chlamydia and gonorrhoea. The increases in gonorrhoea and syphilis reported in this edition of Effective control of gonorrhoea relies entirely on suc- Eurosurveillance are worrying as they are identified cessful antimicrobial treatment. Untreated infections in MSM and young adults and seem to be associated can lead to severe secondary sequelae, including pel- with high levels of unsafe sexual behaviour and co- vic inflammatory disease, first trimester abortions, infection with human immunodeficiency virus (HIV). ectopic pregnancy and infertility, and may contribute The increases in gonorrhoea are of particular concern to facilitating HIV transmission. Current treatment as they coincide with decreasing susceptibility of guidelines in Europe recommend the use of single- Neisseria gonorrhoeae to currently used antimicrobial dose injectable (ceftriaxone) or oral third-generation drugs in England [2] and across Europe [3]. cephalosporins (cefixime) [7]. The increases reported in this edition can be partly The upward trend in gonorrhoea cases is particularly explained by increased testing of risk groups. Bremer worrying as it comes at a time when treatment fail- et al. [4] report that the increase in syphilis diagno- ures with third generation cephalosporins are being ses in Germany could be linked to increased uptake reported, also in Europe. In June this year, the World of screening by HIV-negative MSM and incorporation Health Organisation has warned that drug-resistant of syphilis testing in the clinical monitoring of HIV- gonorrhoea is becoming a major public health crisis positive MSM. In Sweden, the increase in gonorrhoea [8]. The European Centre for Disease Prevention and seen over the last five years, particularly among young Control (ECDC) has recently launched the first regional women (who are more often asymptomatic than men) is public health response plan to control and manage the similarly linked to the increasing use by youth clinics of threat of resistant gonorrhoea. [9] nucleic acid amplification tests which are more sensi- tive and test for both chlamydia and gonorrhoea in the N. gonorrhoeae has developed resistance to most of same sample [5]. Similarly, increased testing of MSM the antimicrobial drugs successively introduced for in the United Kingdom (UK) due to the recent increases treatment over the years. The first treatment failures in lymphogranuloma venereum (LGV), and new testing to the less potent cephalosporins were reported in guidance is thought to have contributed to the increase 2000 in Japan [10] and other countries [11] with recent in gonorrhoea notification there [6]. reports from Norway [12], England [13,14] and Austria [15]. The emergence of a highly ceftriaxone-resistant Intensified testing does not, however, completely strain H041 in Japan in 2011 [16] triggered worldwide explain the reported rises in STI notifications. Increased
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