Dataset Information

Trends in Adult Chlamydia and Gonorrhea Prevalence, Incidence and Urethral Discharge Case Reporting in Morocco over 1995-2015-Estimates Using the Spectrum-Sexually Transmitted Infection Model.

ABSTRACT:

Background

Evolving health priorities and resource constraints mean that countries require data on sexually transmitted infections (STI) trends to inform program planning and resource allocation.

Methods

The Spectrum modeling tool estimated prevalence and incidence of gonorrhea and chlamydia in Morocco's 15- to 49-year-old population, based on prevalence surveys. Incident cases, broken down between symptomatic and asymptomatic, and treated versus untreated, were compared with urethral discharge (UD) case reports, to estimate reporting completeness among treated UD cases.

Results

Gonorrhea prevalence was estimated at 0.37% (95% confidence interval [CI], 0.14-1.0%) in women and 0.32% (0.12-0.87%) in men in 2015; chlamydia prevalences were 3.8% (95% CI, 2.1-6.4%) and 3.0% (95% CI, 1.7-5.1%). Corresponding estimated numbers of new cases in women and men in 2015 were 79,598 (95% CI, 23,918-256,206) and 112,013 (95% CI, 28,700-307,433) for gonorrhea, and 291,908 (95% CI, 161,064-524,270) and 314,032 (95% CI, 186,076-559,133) for chlamydia. Gonorrhea and chlamydia prevalence had declined by an estimated 41% and 27%, respectively, over 1995 to 2015. Prevalence declines probably related to improved STI treatment coverage, and decreasing risk behaviors. Reporting completeness among treated UD cases was estimated at 46% to 77% in 2015. Reported UD cases corresponded to 13% of all estimated (symptomatic and asymptomatic) gonorrhea and chlamydia cases.

Conclusions

STI declines and improvements in treatment coverage are consistent with Morocco's introduction of syndromic management in 2000, scale-up of prevention, and declining human immunodeficiency virus incidence. While gonorrhea is four-fold more common as cause of clinical UD cases than chlamydia, Morocco continues to suffer a large, untreated burden of chlamydia. Reliable monitoring of both STIs requires new periodic surveys and/or novel forms of affordable surveillance beyond high-risk populations.

SUBMITTER: El-Kettani A

PROVIDER: S-EPMC5559184 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Trends in Adult Chlamydia and Gonorrhea Prevalence, Incidence and Urethral Discharge Case Reporting in Morocco over 1995-2015-Estimates Using the Spectrum-Sexually Transmitted Infection Model.

El-Kettani Amina A Mahiané Guy G Bennani Aziza A Abu-Raddad Laith L Smolak Alex A Rowley Jane J Nagelkerke Nico N El-Rhilani Houssine H Alami Kamal K Hançali Amina A Korenromp Eline E

Sexually transmitted diseases 20170901 9

<h4>Background</h4>Evolving health priorities and resource constraints mean that countries require data on sexually transmitted infections (STI) trends to inform program planning and resource allocation.<h4>Methods</h4>The Spectrum modeling tool estimated prevalence and incidence of gonorrhea and chlamydia in Morocco's 15- to 49-year-old population, based on prevalence surveys. Incident cases, broken down between symptomatic and asymptomatic, and treated versus untreated, were compared with uret ...[more]

PMID: 28806354

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Project description:BackgroundQuantifying sexually transmitted infection (STI) prevalence and incidence is important for planning interventions and advocating for resources. The World Health Organization (WHO) periodically estimates global and regional prevalence and incidence of four curable STIs: chlamydia, gonorrhoea, trichomoniasis and syphilis.Methods and findingsWHO's 2012 estimates were based upon literature reviews of prevalence data from 2005 through 2012 among general populations for genitourinary infection with chlamydia, gonorrhoea, and trichomoniasis, and nationally reported data on syphilis seroprevalence among antenatal care attendees. Data were standardized for laboratory test type, geography, age, and high risk subpopulations, and combined using a Bayesian meta-analytic approach. Regional incidence estimates were generated from prevalence estimates by adjusting for average duration of infection. In 2012, among women aged 15-49 years, the estimated global prevalence of chlamydia was 4.2% (95% uncertainty interval (UI): 3.7-4.7%), gonorrhoea 0.8% (0.6-1.0%), trichomoniasis 5.0% (4.0-6.4%), and syphilis 0.5% (0.4-0.6%); among men, estimated chlamydia prevalence was 2.7% (2.0-3.6%), gonorrhoea 0.6% (0.4-0.9%), trichomoniasis 0.6% (0.4-0.8%), and syphilis 0.48% (0.3-0.7%). These figures correspond to an estimated 131 million new cases of chlamydia (100-166 million), 78 million of gonorrhoea (53-110 million), 143 million of trichomoniasis (98-202 million), and 6 million of syphilis (4-8 million). Prevalence and incidence estimates varied by region and sex.ConclusionsEstimates of the global prevalence and incidence of chlamydia, gonorrhoea, trichomoniasis, and syphilis in adult women and men remain high, with nearly one million new infections with curable STI each day. The estimates highlight the urgent need for the public health community to ensure that well-recognized effective interventions for STI prevention, screening, diagnosis, and treatment are made more widely available. Improved estimation methods are needed to allow use of more varied data and generation of estimates at the national level.

Project description:BACKGROUND:Bacterial sexually transmitted infections may facilitate HIV transmission. Bacterial sexually transmitted infection testing is recommended for sexually active HIV-infected patients annually and more frequently for those at elevated sexual risk. We estimated percentages of HIV-infected patients in the United States receiving at least one syphilis, gonorrhea, or chlamydia test, and repeat (?2 tests, ?3 months apart) tests for any of these sexually transmitted infections from mid-2008 through mid-2010. DESIGN:The Medical Monitoring Project collects behavioral and clinical characteristics of HIV-infected adults receiving medical care in the United States using nationally representative sampling. METHODS:Sexual activity included self-reported oral, vaginal, or anal sex in the past 12 months. Participants reporting more than 1 sexual partner or illicit drug use before/during sex in the past year were classified as having elevated sexual risk. Among participants with only 1 sex partner and no drug use before/during sex, those reporting consistent condom use were classified as low risk; those reporting sex without a condom (or for whom this was unknown) were classified as at elevated sexual risk only if they considered their sex partner to be a casual partner, or if their partner was HIV-negative or partner HIV status was unknown. Bacterial sexually transmitted infection testing was ascertained through medical record abstraction. RESULTS:Among sexually active patients, 55% were tested at least once in 12 months for syphilis, whereas 23% and 24% received at least one gonorrhea and chlamydia test, respectively. Syphilis testing did not vary by sex/sexual orientation. Receipt of at least 3 CD4+ T-lymphocyte cell counts and/or HIV viral load tests in 12 months was associated with syphilis testing in men who have sex with men (MSM), men who have sex with women only, and women. Chlamydia testing was significantly higher in sexually active women (30%) compared with men who have sex with women only (19%), but not compared with MSM (22%). Forty-six percent of MSM were at elevated sexual risk; 26% of these MSM received repeat syphilis testing, whereas repeat testing for gonorrhea and chlamydia was only 7% for each infection. CONCLUSIONS:Bacterial sexually transmitted infection testing among sexually active HIV-infected patients was low, particularly for those at elevated sexual risk. Patient encounters in which CD4+ T-lymphocyte cell counts and/or HIV viral load testing occurs present opportunities for increased bacterial sexually transmitted infection testing.

Project description:ImportanceThe timing of sexual partnerships is important for sexually transmitted infection (STI) transmission potential. Studies often measure timing as whether partnerships overlap in time (concurrency), but this measure does not account for how STI risk from previous partners can be carried forward into future partnerships even when there is a time gap between them (serial monogamy) if the infectious period is greater than this time gap.ObjectiveTo examine the association of the timing of partnerships, measured as the time gap or time overlap between partners, and perceptions of partners' concurrency with STI transmission.Design, setting, and participantsThis survey study that was conducted in 2017 included 8867 participants in Britain aged 16 to 44 years who reported 1 or more sexual partners in the 5 years before the interview. Data were collected from 2010 to 2012 from Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a large probability survey (response rate, 57.7%) designed to be broadly representative of the general population.ExposuresGaps between participants' 3 or fewer most recent partners in the past 5 years were calculated from dates of the last sexual encounter with former partners and the first sexual encounter with subsequent partners. Negative gaps denote overlapping partnerships (concurrency); positive gaps denote serial monogamy. Participant perception of most recent partner concurrency was proxied by asking participants whether they knew or thought that their partners had had sex with other partners since their first sexual encounter together.Main outcomes and measuresReported STI diagnosis in the past 5 years.ResultsOf 8867 participants eligible for this analysis, 3509 (39.6%) were male and 5158 (58.2%) were female, with a mean age of 28 years. Overall, 48.1% of males and 39.5% of females reported 2 or more partners and 1 or more time gaps. The median time gap was 2 months (interquartile range, -3 months to 8 months). Although 67.0% of the time gaps were 1 month or more, many were sufficiently short time gaps for STI transmission. The time gap was independently associated with STI diagnosis, without a significant decrease in likelihood until the time gap was 4 months or more for females (adjusted odds ratio [OR]: 0.39, 95% CI, 0.19-0.81) and 6 months or more for males (adjusted OR: 0.42, 95% CI, 0.20-0.85) compared with time overlaps of 2 years or more. Participant perception of partners' concurrency (reported by half of the participants) was independently associated with STI diagnosis among females (reporting no partner concurrency vs reporting partner concurrency: adjusted OR, 0.32; 95% CI, 0.22-0.49).Conclusions and relevanceThe findings suggest that the gap between partners is often sufficiently small to permit STI transmission and that many people, although themselves monogamous, have partners who are not, which itself is associated with an increase in the risk of STI acquisition. Public health practitioners should communicate these epidemiological facts, and researchers should develop measures that better capture the risk of STI transmission from partners.

Dataset Information

Trends in Adult Chlamydia and Gonorrhea Prevalence, Incidence and Urethral Discharge Case Reporting in Morocco over 1995-2015-Estimates Using the Spectrum-Sexually Transmitted Infection Model.

Background

Methods

Results

Conclusions

Publications

Trends in Adult Chlamydia and Gonorrhea Prevalence, Incidence and Urethral Discharge Case Reporting in Morocco over 1995-2015-Estimates Using the Spectrum-Sexually Transmitted Infection Model.

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