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Eurosurveillance, Volume 7, Issue 29, 17 July 2003
Articles

Citation style for this article: Roy K, Wadd S. Genital herpes simplex, genital chlamydia, and gonorrhoea infection in Scotland: laboratory confirmations 1992-2002. Euro Surveill. 2003;7(29):pii=2258. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2258

Genital herpes simplex, genital chlamydia, and gonorrhoea infection in Scotland: laboratory confirmations 1992-2002

Kirsty Roy (Kirsty.Roy@scieh.csa.scot.nhs.uk) and Sarah Wadd on behalf of the BBV and STI unit, Scottish Centre for Infection and Environmental Health and the Scottish National Gonorrhoea Reference Laboratory, Edinburgh, Scotland.


A report published in the SCIEH Weekly Report (http://www.show.scot.nhs.uk/scieh/PDF/pdf2003/0327.pdf) described recent trends in laboratory diagnosis of sexually transmitted infections (STIs) (genital herpes simplex, genital chlamydia, and gonorrhoea) in Scotland (1).

Genital herpes simplex infection
In 2002, 940 infections were isolated; this figure compares with 1033 in 2001 and annual averages of 955 for 1999-2002, 791 for 1995-1998 and 666 for 1992-1994 (Table 1). Between the early and late 1990s, almost all of the increase in herpes simplex incidence was due to rising rates among women. In 2002, 26% of infections were isolated from persons aged under 25 years; the corresponding rate for 1992 was 31%.

Table 1. Genital herpes simplex, Scotland 1992-2002: laboratory isolates by gender and age group. Source: SCIEH.

Gender                      
Age group 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Males                      
<25
84
50
68
63
66
65
62
81
57
63
71
25-34
114
102
82
112
105
115
102
131
117
77
86
35-44
42
42
31
50
61
43
53
61
59
47
65
45-54
9
14
18
10
24
13
25
18
17
19
25
55+
4
4
5
3
4
6
3
8
5
8
7
Not known
21
24
27
21
9
6
4
2
24
117
23
Total
274
236
231
259
269
248
249
301
279
331
277
                       
Females                      
<25
187
170
192
295
268
239
247
306
301
206
269
25-34
127
119
145
175
177
171
186
204
202
128
197
35-44
36
39
49
43
57
44
69
73
50
42
90
45-54
10
10
14
14
13
19
17
28
24
27
37
55+
5
7
7
10
10
6
13
14
5
14
16
Not known
29
34
47
20
6
6
2
9
41
267
25
Total
394
379
454
557
531
485
534
634
623
684
634
 
Total*
671
634
695
820
816
740
788
937
910
1033
940

*Includes cases where gender is not known

Genital chlamydia
In 2002, 12 392 isolates were reported to SCIEH, a 16% increase on the previous year’s total (10 636), and a 62% increase on that recorded for 2000 (7654) (Table 2). As with genital herpes simplex infection, the gender distribution favours women; in 2002, they represented 71% of all infections isolated. Genital chlamydia is an infection which predominates in young people; in 2002, 52% of all infections were isolated from persons under the age of 25. The dramatic increase in the incidence of genital chlamydia diagnoses throughout Scotland over the last decade is demonstrated by comparing rates for 1992 with those for 2002 (Figure).

Table 2. Genital chlamydia infection, Scotland 1992-2002: laboratory isolates by gender and age group. Source: SCIEH.

Gender                      
Age group 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Males                      
<25
332
354
326
263
309
333
504
662
836
1114
1435
25-34
232
334
357
288
307
333
490
550
627
687
803
35-44
38
76
57
70
81
67
138
156
183
182
273
45-54
4
14
20
11
16
16
29
43
36
29
41
55+
2
4
3
1
4
6
5
6
8
10
12
Not known
144
152
129
152
157
151
181
58
160
773
696
Total
752
934
892
785
874
906
1347
1475
1850
2795
3260
                       
Females                      
<25
1340
1246
1251
1185
1385
1667
2142
2895
3547
4224
5015
25-34
500
483
505
399
510
640
757
949
1130
1265
1537
35-44
69
74
66
54
69
73
126
155
218
241
295
45-54
22
12
9
8
6
9
12
20
35
27
53
55+
6
10
6
4
4
3
3
8
11
17
11
Not known
179
202
171
232
321
391
530
160
329
1408
1282
Total
2116
2027
2008
1882
2295
2783
3570
4187
5270
7182
8193
 
Total*
2907
2973
2937
2685
3181
3705
4928
5690
7147
10,121
11,542

*Includes cases where gender is not known

 

Figure. Genital chlamydia infection, Scotland 1992-2002: laboratory isolates by gender and age group. Source: SCIEH.

Gonorrhoea
In 2002, 821 episodes of gonorrhoea were reported to SCIEH; this figure compares with 817 in 2001 and annual averages of 217 for 2000-2002, 139 for 1995-1999, and 172 for 1992-1994 (Table 3). Unlike for genital herpes simplex and genital chlamydia infections, the majority of cases are in men. The annual average number of male cases increased by 219% from 278 in 1992-1994 to 609 in 2000-2002; the corresponding increase among women was 25% (172 to 216). The considerable increase in gonorrhoea among men, seen in the late 1990s, is considered to be largely due to transmission among men who have sex with men (MSM). This is corroborated by the increase in rectal isolates of gonorrhoea from 34 in 1999 to 54 in 2000, 53 in 2001 and 78 in 2002 (2). In 2002, 67% of episodes of infection among women occurred in those under 25 years; the corresponding rate for men was 35%.

Table 3. Gonorrhoea, Scotland 1992-2002: laboratory reports (episodes) by gender and age group. Source: SCIEH.

Gender                      
Age group 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Males                      
<25
78
99
62
98
106
107
115
144
197
246
217
25-34
109
103
74
108
176
138
140
126
232
215
228
35-44
26
28
25
33
49
53
45
70
117
98
116
45-54
10
6
8
10
6
10
10
16
36
31
38
55+
2
1
4
2
4
2
2
7
14
9
10
Not known
114
52
29
24
13
12
6
8
6
9
8
Total
339
289
202
275
354
322
318
371
602
608
617
 
Females
<25
111
91
66
81
90
81
95
111
151
140
133
25-34
26
39
27
35
35
27
35
38
69
47
47
35-44
7
7
5
8
6
8
7
6
15
12
16
45-54
0
2
2
2
1
2
4
1
6
3
0
55+
1
0
1
0
0
0
0
0
1
3
2
Not known
86
28
17
12
5
1
1
4
4
1
0
Total
231
167
118
138
137
119
142
160
246
206
198
 
Total*
611
463
326
424
503
455
469
539
848
817
821

*Includes cases where gender is not known. One episode of gonorrhoea corresponds to an infected individual from whom more than one isolate could have been recovered.

Conclusion
Infections among heterosexuals
Because laboratory reports contain no information about sexual orientation, it is impossible to know whether infections in males are occurring within a certain group, for example heterosexuals, or MSM. Analysis of STI rates among women provides the best gauge of infection among heterosexual populations as a whole. Trends in herpes simplex and gonorrhoea among women should be considered true reflections of any changes in high risk sexual behaviour among heterosexual populations. Evidence suggests that there has been a modest increase in STIs among heterosexuals in Scotland in recent years.

The interpretation of trend data for genital chlamydia is difficult because chlamydia is often an asymptomatic infection, which is diagnosed through screening. Accordingly, increases in the numbers of genital chlamydia diagnoses are as likely to be due to changes in screening practice as to increases in the incidence of infection. Although it is not known whether the incidence of genital chlamydia infection has increased in recent years, there is no doubt that very large numbers of people, young adults in particular, are infected. Such data indicate that casual unprotected sexual intercourse among young heterosexuals remains a major problem in Scotland.

Infections among MSM
For MSM, the increase in rectal gonorrhoea is worrying and is consistent with the recent increase in the incidence of syphilis in this population. In 2002, there were 31 cases of syphilis among gay men, mainly in Edinburgh and Glasgow. These observations are of great concern as gay men are at high risk of acquiring HIV infection.

Acknowledgements
SCIEH wishes to thank Joan McElhinney at the SNGRL for help with database maintenance and analysis, as well as the Consultant Microbiologists and their staff who supply data to the SNGRL and SCIEH.

References:
  1. SCIEH. Genital Herpes Simplex, Genital Chlamydia and Gonorrhea infection in Scotland: laboratory confirmations 1992-2002. SCIEH Weekly Report 2003; 37: 166-71 (http://www.show.scot.nhs.uk/scieh/PDF/pdf2003/0327.pdf)
  2. Redman C, Palmer H, Young H. Laboratory confirmation of Gonorrhea in Scotland, 2002. SCIEH Weekly Report 2003; 37: 82-3 (http://www.show.scot.nhs.uk/scieh/PDF/pdf2003/0314.pdf)

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