Moving Forward - Sexually Transmitted Infections, including HIV, in Scotland 2005

This is the second annual report on sexually transmitted infections (STIs) in Scotland produced by the Sexually Transmitted Infection Epidemiology Advisory Group (STIEAG).  This report brings together information from a number of sources, including laboratories, genitourinary medicine (GUM) clinics, primary care, and also some of the more specialised data collection systems relating to HIV.  It is published at:   http://www.isdscotland.org/sti

The layout is similar to that of last year and includes for the first time sections on ethnicity and on two conditions which are related and may be long-term consequences of STI ? ectopic pregnancy and pelvic inflammatory disease.

During the preparation of this report, we have liaised with colleagues in the Health Protection Agency (HPA) in London and have arranged that the HPA?s UK report and our Scottish report will be published at the same time http://www.hpa.org.uk.   This will enable readers to see the Scottish information in the context of the situation in the rest of the UK.  Both reports are being published shortly before World AIDS day in order to maximize the impact of the information.

The sexual health strategy for Scotland, ?Respect and Responsibility?, recognises the importance of information as a way of describing and understanding the sexual health of the population, and also monitoring change. This report is intended to contribute to this process.

Genito-urinary Medicine (GUM) clinic workload:  there was a 10% increase in workload in GUM clincs in 2005 compared to 2004 and this is partly explained by the large increase in uptake of HIV testing. 
   
Genital chlamydia: diagnoses increased by 8% between 2004 and 2005. Around two thirds of women were diagnosed in a non-GUM setting (for example at their GP or in Community Family Planning).  Converseley two thirds of men were diagnosed in a GUM clinic setting.  Chlamydia predominantly affects the under 25s with 70% of diagnoses in this age group, with the majority of diagnoses in the 20-24 age group for both men and women.

Pelvic Inflammatory Disease and Ectopic Pregnany: chlamydia iinfection and other microrganisms and STIs may cause acute pelvic inflammatory disease (PID).  This can lead to damage of the fallopian tubes, ectopic pregnancy and infertility.  However there has been a fall in hospital admissions for PID over recent years and although some of this fall may be due to a greater proportion of patients being treated outwith hospital, there is no evidence of an increasing problem.  Ectopic pregnancies seem to have levelled off after a rise up to the mid-nineties and so despite the increase in diagnosed chlamydia there has not been an increase in these related conditions.

Gonorrhoea:  the number of diagnoses increased by 7% to 904 cases in 2005 compared to 845 cases in 2004.   This is the highest number of diagnoses recorded during the last 10 years.  Just over three quarters of the diagnoses were in men and half of these were in men who have sex with men (MSM).  The rate of gonorrhoea infection in Scotland is however lower than in the majority of English Health Authority areas.

Genital  Herpes:  this is caused by the herpes simplex virus (HSV) types 1 and 2.  It is a recurrent infection which may cause ulceration but may also be asymptomatic.  The number of diagnoses increased by 4% to 1332 in 2005.  Half the cases in women and one third of the cases in men are in the under 25 age group.

Infectious Syphilis: syphilis re-emerged in Scotland during 2000/2001 following outbreaks elswhere in the UK.  Following a steep rise in diagnoses since 2001 the numbers have levelled off to 188 cases in 2005 compared with 189 in 2004.  95% of the diagnoses were in men and of these 87% were in MSM.  A quarter of men diagnosed with syphilis, whose HIV status was known, were also HIV positive. 

Genital Warts: the number of diagnoses increased by 3% in 2005.  Genital warts are the most common diagnosed viral (as opposed to bacterial) STI  diagnosed in the GUM clinic setting.  They are the result of infection by human papilloma virus.  The majority of diagnoses are in the 20-24 age group for both men and women. 

HIV infection:  In 2005 405 new cases of HIV were identified in Scotland; most of these were new diagnoses although some had been previously diagnosed elsewhere in the UK or abroad.  This is the highest annual number of newly identified cases on record and represents an 11% increase compared to 2004. An increase in the uptake of HIV testing is considered to be the principal explanation for this increase.   Two thirds of new cases were in men and 156 of these were in MSM.  Among heterosexual men and women who were not injecting drug users (IDU) there were 184 new diagnoses; two thirds of these are considered to have probably acquired their infection outside the UK (mostly in African countries).   The number of non-IDU heterosexual men and women who are thought to have acquired their infection within the UK remains low.

Conclusions
The rise in the number of STIs continues.  Some of the rise is attributable to the success of efforts to encourage wider uptake of testing, for example chlamydia and HIV; although this does suggest a pool of otherwise undiagnosed infection for the conditions.  However much of the increase probably results from a genuine underlying increase in the incidence of STIs, for example genital warts and genital herpes.  

There are specific conditions which are particular problems for men who have sex with men and these include syphilis, gonorrhoea and HIV.  Co-infection with more than one STI is relatively high for MSM.  Young people remain particularly affected by the major acute sexually transmitted infections and should continue to be targeted for testing and prevention.

-----------------------------------------------------------------

Main Contacts:

Dr Jim Chalmers
Consultant in Public Health Medicine
Tel: 0131 275 6136
Email: jim.chalmers@isd.csa.scot.nhs.uk


Anne Leigh-Brown
Programme Principal, Women & Children?s Health Information Programme
Tel: 0131 275 6481
Email: anne.leigh-brown@isd.csa.scot.nhs.uk


Etta Shanks
Maternity & Neonatal Team Leader
Tel: 0131 275 6761
Email: etta.shanks@isd.csa.scot.nhs.uk

-----------------------------------------------------------------

Glossary:
STI ? sexually transmitted infection
GUM ? genitor-urinary medicine
HIV ? human immunodeficiency virus
AIDS ? acquired immunodeficiency syndrome
PID ? pelvic inflammatory disease
MSM ? men who have sex with men
HSV ? herpes simplex virus
IDU ? injecting drug users
HPA ? Health Protection Agency

Pre-release preview access to this release was given to:
Sexually Transmitted Infection Epidemiology Advisory Group
SEHD
NHS Board Chief Executives
Directors of Public Health
Lead Genitourinary Medicine Consultants at Clinics

This report is also available on the website of Health Protection Scotland: http://www.hps.scot.nhs.uk