The National Disease Surveillance Centre (NDSC) has this month published
the Annual STI Report 2001 (1), which reports that the total number of notified
sexually transmitted infections (STIs) increased by 9.4% from 2000 to 2001.
The highest increases recorded during 2001, compared with 2000, were for
syphilis (507%), infectious hepatitis B (160%), genital herpes simplex (23%),
Chlamydia trachomatis (23%), and gonorrhoea (20%). The three most commonly
notified STIs in 2001 were anogenital warts, Chlamydia trachomatis
and non-specific urethritis.
Fourteen sexually transmitted infections (STIs) are currently
legally notifiable in Ireland: anogenital warts, candidiasis, chancroid,
Chlamydia trachomatis, genital herpes, gonorrhoea, Granuloma inguinale,
infectious hepatitis B, Lymphogranuloma venereum, Molluscum contagiosum,
non-specific urethritis, Pediculosis pubis, syphilis, and trichomoniasis.
Data on STIs are collected mainly from STI clinics in the health boards.
Aggregate data on the number of notified STIs from Departments of Public
Health are collated quarterly.
The increase in STIs in Ireland is likely to be associated with increased
unsafe sexual behaviour, although the rise in genital chlamydia infections
may also reflect increased testing for this infection. Improved acceptability
of STI clinic services and greater public and professional awareness of
certain STIs may have also contributed to the increases.
The very large increase in reported cases of syphilis was seen mainly in
MSM in Dublin. An enhanced surveillance system was implemented by the Irish
National Disease Surveillance Centre (NDSC) to capture data on all syphilis
cases from January 2000 (2). There were 593 syphilis cases reported nationally
in the Republic of Ireland between January 2000 and December 2002 through
the enhanced syphilis surveillance system, compared with only six cases
in 1999. Four hundred and eight cases (69%), for which syphilis stage was
known, were of early or infectious syphilis. Of these, 313 (76.7%) were
in men who have sex with men (MSM) (265 homosexual and 48 bisexual). Concurrent
STIs increase the transmission probability for HIV infection (3) and it
is alarming that 73 of the 408 early syphilis cases (18%) were reported
to be HIV positive. Interventions to control the outbreak were targeted
primarily at MSM in Dublin (4).
An NDSC report in 2001, undertaken at the request of the Department of Health
and Children, recommends the institution of a new national system for surveillance
of infectious diseases of public health importance in Ireland (5). The report
recommends that there should be four categories of notifier: general practitioners,
hospital clinicians, laboratory directors, and public health doctors, and
that each of these categories of notifier would be required to notify a
specific subset of diseases contained in the list of notifiable diseases.
The report recommends the removal of candidiasis, Molluscum contagiosum
and Pediculosis pubis from the list of notifiable STIs in Ireland. In addition,
the report recommends that the system for STI surveillance should change
from collection of clinic-based aggregate data, on a quarterly basis, to
the collection of timely, non-aggregate geographic based data. A subcommittee
of the scientific advisory committee of the NDSC is currently undertaking
a review of the surveillance of STIs in Ireland.