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Sexually transmitted infections (STIs), including HIV, pose a significant
threat to the health and wellbeing of Europeans and require concerted
and sustained intervention. Over the past decade, the number of reported
cases of STIs, including antimicrobial resistant Neisseria gonorrhoeae,
has increased appreciably (1), and outbreaks of syphilis have recently
been reported in many Member states of the European Union (EU) (2, 3).
Young people, homosexual men, and those with poor access to health care
(including preventive and educational services) seem to be particularly
affected, with increased travel and migration, high risk sexual behaviours,
and a deterioration of public health responses to STI control (for example,
partner notification) being key driving factors. Many of these demographic
and behavioural trends are similar across EU states, as is the desire
to develop and implement effective STI prevention and control programmes.
Despite this common goal, however, STI control measures still vary greatly
across the EU – from closely regulated legal approaches in some Member
states to more relaxed attitudes in others (4). STI surveillance systems
also show similar variations in their structure, processes, and outputs
(5). In some states, rudimentary STI surveillance systems provide few
data to inform public health action, whereas in others, extensive and
complex systems have developed over time (6). Some countries have scaled
down their STI surveillance programmes in response to changing public
health priorities (7). This heterogeneity results in poor comparability
of STI surveillance data and limits our ability to interpret EU-wide trends
in diseases. It also weakens our ability to draw conclusions regarding
the respective successes and failures of national (and regional) STI prevention
efforts and, consequently, to understand more about what constitutes an
effective STI control programme.
One obvious solution would be to build a network where partners contribute
to the collection, analysis, and dissemination of STI surveillance data,
as has been successfully implemented for HIV/AIDS surveillance in Europe
(8, 9). Although it may be impossible to harmonise existing systems, priority
areas for development within such a network could be identified. Firstly,
a comprehensive re-evaluation of existing EU systems and infrastructure
for STI surveillance and control is needed to document and understand
current policies and practices and assess their timeliness, appropriateness,
and effectiveness of. As a result of this evaluation, recommendations
to inform the development of minimum EU standards for collecting and disseminating
STI surveillance data across the EU may be made. Secondly, outbreaks of
STIs could benefit from a coordinated public health response to their
identification and management. The network could play a pivotal role in
this, by documenting and disseminating best practice in STI outbreak control
and prevention, thereby avoiding duplication of effort. Finally, an EU
surveillance network could work towards harmonising surveillance systems,
data sources, and data collection processes (including definitions, sampling,
and diagnostic techniques) for specific STIs. Thus, for example, Chlamydia
trachomatis infection remains the most common bacterial STI in many
countries and is associated with significant reproductive morbidity. Establishing
an EU-wide surveillance network for this disease could improve our understanding
of its epidemiology (trends, risk factors, natural history, etc) and facilitate
the sharing of laboratory and epidemiological expertise across member
states.
New challenges in STI epidemiology require new solutions. The recent
EU Network Decision (EC 2119/98) listed STIs as one of the disease groups
for which an EU-wide network should be established. Although the need
for rapid sharing of STI data between member states may be less obvious
compared with those of other outbreak prone infectious diseases, much
may be learned about the epidemiology of these infections and how they
might be controlled, by studying and understanding the differences between
countries. Establishing an EU-wide STI surveillance network would not
only increase sharing of information and experiences between countries,
but also contribute greatly to the strengthening of local, national and
regional public health responses to STI control.
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