1. The Picture regarding STIs in the Republic of Ireland Dr. Aidan O’Hora Health Protection Surveillance Centre Dublin CAWT April 27 th 2012

2. Outline Notifiable STIs in Republic of Ireland Trends and notifications in 2010 Contrasting selected infections with Europe Recent HIV data Conclusions

3. Consultant led services Satellite/NGO/non-Consultant led services Key GUM Services in Republic of Ireland

4. What is notifiable? Ano-genital warts Genital chlamydia infection Gonorrhoea Infectious Hepatitis B Non-specific Urethritis (NSU) Trichomoniasis Chancroid Genital herpes simplex Granuloma inguinale Lymphogranuloma venereum (LGV) Syphilis HIV

5. STI notifications in Ireland; 1995-2010

6. STIs in Ireland, 2010

7. n=5,016n=6,657 STI Ireland, 2010

8. STI in Ireland 2010 by age-group % 5.36.4 5.15.0 6.3 7.6 8.08.4 6.3 10.910.4

9. Chlamydia

10. Gonorrhoea

11. Syphilis

12. Indicators 2010 EuropeIreland ChlamydiaGonorrhoeaSyphilisChlamydiaGonorrhoeaSyphilis Rate per 100,000186.09.84.4116.513.613.2 Trend: 2006-2010 (%)+41-10-17+170+145+450 Male : Female ratio in reported cases 0.72.53.70.83.13.2 Percentage in young people: 15-24 yrs 764317N/A Rate for 20-24 yr olds per 100,000 population 862.028.85.5N/A Percentage in MSM52355N/A Trends in Europe and Ireland

14. 22 July 201114

15. 22 July 201115

16. Herpes Simplex

17. HIV in Republic of Ireland Q1&Q2 2011

18. HIV Trend by risk group: 2003-2011 Total MSM Heterosexual IDU

19. Probable country of infection and mode of transmission

20. CD4 count at time of diagnosis

21. Median CD4 count by risk group

22. Conclusions Chlamydia is the most commonly notified STI: 46% of total Young adults aged 20-29 years account for 59% of notifications Significant increases in gonorrhoea, syphilis HIV transmission persists The majority of new diagnoses are late presenters

23. THANK YOU The Health Protection Surveillance Centre wishes to sincerely thank all who have provided data for this report – the National Virus Reference Laboratory, microbiology laboratories, the Departments of Public Health, Consultants in Infectious Disease/GUM and all other clinicians involved.

25. Chlamydia notifications and hospital discharges for tubal ectopic pregnancy, 1997-2010

26. Health Protection Surveillance Centre Director of Public Health Patient NVRL Clinician/GP Laboratory 6 1 2a 3(x2) 4a 4b 5a 5b 2b

27. KEYAction 1 Patient attends clinician/GP for HIV test 2 (a) Specimen is sent to local laboratory for analysis, and if positive a second specimen is requested (b) In some instances, the clinician/GP may send specimens directly to the NVRL. In such instances, the NVRL is both the “local laboratory” and the “reference laboratory” 3 The local laboratory sends a second specimen to the NVRL for confirmation of HIV diagnosis. If the NVRL is the “local laboratory”, the need for a second sample will be communicated directly to the requesting clinician From January 1 st 2012, when a HIV diagnosis is confirmed core notification data are collected through CIDR and supplementary clinical data specific to HIV are collected using a paper surveillance form CIDR (electronic)Surveillance Form (paper) 4 (a) NVRL send result confirming HIV diagnosis to local laboratory via CIDR (b) The NVRL send a surveillance form to the clinician for completion 5 (a) Clinical Laboratory Director notifies Public Health via CIDR (b) The completed form is returned to the Director of Public Health 6 At the Department of Public Health, notification data and supplementary clinical data are linked and anonymised using CIDR. The data are then available to the HPSC for analysis and use in national reports. 6 Health Protection Surveillance Centre Director of Public Health Patient NVRL Clinician/GP Laboratory 1 2a 3(x2) 4a 4b 5a 5b 2b

28. Surveillance of STIs: 2005 Priority should be given to collecting timely disaggregate, person-based data on the major bacterial infections; syphilis, gonorrhoea, genital chlamydia and infectious hepatitis B The notifying clinician should indicate; – Whether partner notification (PN) has been carried out within the STI clinic or general practice, Family Planning Clinic or Student Health Service – Whether the patient is attending or been referred to an STI clinic – If not attending or referred, the notifying clinician should indicate if PN has been discussed Primary & Reference Laboratory Facilities General Practice – Access, free at the point of delivery – Guidelines and protocols – Training

29. Priorities CIDR implementation Improve Clinical, laboratory and Public Health Behavioural Surveillance Enhanced partner notification and contact tracing Chlamydia Control Detection of Gonococcal AMR resistance Syphilis Control Undiagnosed HIV HIV patients in care SurveillanceAction