Surveillance Systems for Sexually Transmitted Infections

A Global Review

Hamish Mohammed; Gwenda Hughes; Kevin A. Fenton

Disclosures

Curr Opin Infect Dis. 2016;29(1):64-69. 

In This Article

Abstract and Introduction

Abstract

Purpose of review Sexually transmitted infections (STIs) continue to exert a substantial public health burden globally but surveillance remains a challenge, especially in the developing world. We reviewed STI surveillance systems in various regions globally and used available data to provide an overview of recent trends in STI epidemiology.

Recent findings STI surveillance systems in the developing world are often limited and restricted to ad hoc cross-sectional surveys; however, available data suggest that these areas are disproportionately affected by STIs, with a higher burden in marginalized groups such as sex workers. Developed countries typically have established surveillance systems. Recent reports suggest many of these countries are experiencing rising diagnoses of STIs in men who have sex with men (MSM) and an increasing contribution of HIV-positive MSM to STI epidemics.

Summary There is considerable variability in the surveillance for STIs globally, ranging from active or passive, to sentinel, laboratory or clinic-based systems. Given different levels of resources and patterns of healthcare provision, it is difficult to compare surveillance data across regions; however, available data suggest that considerable inequality in STI burden exists. In resource-limited settings, syndromic surveillance with periodic laboratory assessments is recommended to monitor trends in STIs.

Introduction

Sexually transmitted infections (STIs) continue to exert a substantial burden on public health globally. It is estimated that there are half a billion cases of curable STIs worldwide, with a disproportionate burden in specific population subgroups, such as young adults, people of minority ethnic groups, men who have sex with men (MSM), sex workers and those experiencing socioeconomic disadvantage.[1–4] There are, however, major challenges in conducting STI surveillance that is representative of the population and sufficiently sensitive to detect emerging epidemics in a timely manner. Compared with other infectious diseases, STI surveillance poses unique challenges given the degree of stigma associated with the diseases, especially in regions with more conservative sexual values.[5,6] In homophobic societies, it can be particularly difficult to engage MSM in screening and prevention activities.[7] Furthermore, the aetiology of STIs is diverse, with incubation periods ranging from a week to several months, a high proportion of asymptomatic infections and varying degrees of infectious and subclinical phases.[8] Many STIs, especially in women, result in long-term sequelae including pelvic inflammatory disease, ectopic pregnancy, tubal factor infertility and cervical cancer, and these exert a substantial cost to individuals and to healthcare systems.[9,10] Infection with STIs also increases the risk of HIV transmission and acquisition.[11] Thus, there is a need to identify, treat and prevent infection, as well as to monitor incidence and determine the effectiveness of these activities. There are also concerns around the emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae with widespread concomitant increases in incidence.[12]

We reviewed the scientific and gray literature for English-language reports describing or reporting STI surveillance in selected countries and regions globally. The objective of this review is to describe surveillance of STIs across the regions of the world, with specific reference to countries with more established systems, and to use available surveillance data to summarize recent STI trends and highlight the challenges faced.

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