1. STI surveillance Belgium Results and recommandations Ruth Verbrugge WIV-ISP 10-12-2013 10-12-2013 9 th STI-HIV seminar 9 th STI-HIV seminar

2. What ?  Monitoring trends and estimating incidence = > sentinel network of laboratories for microbiology  Identifying population groups at higher risk for specific STI’s => sentinel network of clinicians

3. Why ?  Providing essential information for prevention & control  Authorities (Regional, National, Europe, WHO)  Local non-profit organisations  Development, adaptation, finetuning of guidelines  Organisation of oriented field activities

4. 1. Trends and incidence 2. Population at risk 3. What to do? Outline

5. 1. TRENDS & INCIDENCE

6. THANKS TO THE LABORATORIES OF MICROBIOLOGY AND NRC

7. Registered STI cases, 2002-2012

8. Incidence by arrondissement, 2012 Chlamydia

9.  Chlamydia is the most frequent reported STI.  The increasing trend continues in 2012.  The increase in Flanders : probably due to sensibilisation campaign on testing  The increase in Wallonia : probably due to attention in newspapers and + 1 university laboratory

10. Chlamydia  Most affected : women; 15 to 29 years old  Man / Women : 1/1,83  Highest incidence : Brussels and Antwerp, resp.194 and 148 cases/100 000 inhab.

11. Trend in age distribution for Chlamydia by gender, Belgium, 2002-2012 WOMEN MEN

13. Incidence by arrondissement, 2012 Gonorrhoea

14. Gonorrhoae  Increasing trend  Most affected : men;15 tot 34 years old  Men/women : 3,2/1  Highest incidence : Brussels and Antwerp,  resp. 39 and 35 cases/100 000 inhabitants  Treatment : first signs of resistency against cefixime (not used in Belgium) and ceftriaxone (in other countries than Belgium)

15. Resistency? What is the best treatment for gonorrhoe?  next speakers

16. Incidence by arrondissement, 2012 Syphilis

17.  Slower increase since 2009, stabilising in Flanders and Wallonia, further increasing in Brussels  Most affected: men; 25 up to 59 years old  Men/women : 4,8/1  Highest incidence : Brussels, Arlon and Antwerp, resp. 47, 45 en 33 cases/100 000 inhabitants  Syphilis reinfection (in male) : 26%

18. Syphilis reinfection Belgium Flanders Wallonia Brussels

19. What attracks out attention?  Chlamydia => Age  Gonorrhoea => AB- Resistance  Syphilis = > Reinfection

20. WHO IS AT RISK?

21. THANKS TO THE MEDICAL DOCTORS WHO FILL OUT VOLUNTARY THE QUESTIONNAIRE FOR EACH STI PATIENT

22. Distribution of registered STI by specialisation of medical centre Mean number of STI registrations by specialisation

23. Reason for consultation

24. Percentage of STI cases diagnosed without STI complaint  Highest % of STI cases diagnosed without STI complaint:  Centres for FP (80%)  STI clinics (60%)  Gynaecologists (57%)  Lowest % of STI cases diagnosed without STI complaint:  generalists (15%) There are no official screening guidelines. Doctors ask for it, something to hold on and to be aligned.

25. Observation  2 gynaecologists:  57% (48/84) and 55% (27/49) of STI patients found thanks to screening  and 50% of those STI patients were pregnant  0,6% perinatal Chlamydia-infections ↔ Antenatal screening recommendations for Chlamydia

27. It is worthwhile to have Chlamydia prevalence trial within the 15-34 year old age group and a revision of antenatal screening recommendations

28. Country of origin

30. Partner notification 44% : YES 13% : NOT 6% of STI cases found thanks to partner notification Encourage partner notification => A key factor in prevention

31. Risk behaviour Number of sex partners < 6 m prior to the STI diagnosis

32. Risk behaviour Group sex

33. Risk behaviour Oral sex

34. Risk behaviour Condom use among registered STI patients 62% never uses a condom 80% did not use a condom during last sexual intercourse

35. Risk groups sexual orientation (among men)

36. Other risk groups Commercial sex workers PWID Travelling : 5 % of Belgian STI-patients

37. Overview BEHAVIOUR No condom use ≥2 sex partners Group sex Oral sex Not notifying sex partner Having sexual contacts abroad GROUPS Young people Young adults MSM Swingers Comm Sex workers PWID

38. HIV-STI co-infection HIV screening at STI consultation

39. HIV-STI co-infection Results of HIV test at STI consultation

41.  3% of STI patients discovered their HIV+ status together with STI diagnosis  Patients diagnosed with a STI need to be screened for HIV  Patients who ask a HIV test need to be screened for STI

42. Which HIV-STI coinfection?

43. WHAT TO DO?

44. Legitimate request from the medical corps for official screening guidelines With a special attention to Chlamydia and gonorroe, because of the asymptomatic course and the fertility consequences Heterosexual men and women (with or without complaint), worried after a sexual contact People who start a new partnership with a new partner With a special attention towards Adolescents and young adults Men and women with multiple partners Men and women practicing group sex, incl swingers MSM with multiple partners, partner exchange, practicing group sex SAM (HIV risk group) Commercial sex workers PWID Travellers who had sexual contact abroad, other than their fix partner Partners of a STI Patient Pregnant women

45. With attention to young people Integrate Chlamydia and gonorrhoe screening for young men and women within the current HPV screening recommendation for women Extend reimbursment * for Chlamydia screening (NAAT) at least up to 30 years old Extend the current prenatal syphilis and HIV screening recommendation ** with Chlamydia and gonorrhoe *Diagnosis role NAAT PCR for Chlamydia: max. twice a year if patient is younger or equal to 20 years old; or with presence of specific STI symptoms **Ref KCE report 6A, 2004

46. QUESTIONS? THANKS FOR YOUR ATTENTION