Epidemiology & impact of Sexually Transmitted Infections in Ireland
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Epidemiology & impact of Sexually Transmitted Infections in Ireland

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A lecture I gave recently for a Masters in Public Health & Epidemiology course: ...

A lecture I gave recently for a Masters in Public Health & Epidemiology course:
'Epidemiology & impact of Sexually Transmitted Infections in Ireland'

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  • 1. Epidemiology & Impact of STIs in Ireland Cian O’Brien BSc, RGN, NQEMT, MPH -Student
  • 2. Sex = Awesome
  • 3. STIs ≠Awesome
  • 4. Overview • What is an STI? • Public Health Importance • The most common STIs in Ireland • Epidemiology of STIs • Sex Education in Ireland • The impact of STIs
  • 5. What is an STI? • A Sexually Transmitted Infection (STI) is any kind of bacterial or viral infection that can be spread through sexual contact. • This does not just mean unprotected sex – Some STIs can be passed on through oral sex and some can be passed through touching and skin-to-skin contact (Mettey et al, 2003)
  • 6. What is epidemiology? • Distribution and determinants of disease within a population – Who, what and where • Why is epidemiology important? – Lets us know where disease is occurring and who is getting it – Lets us plan for control and prevention activities • Part of the core function of public health – Assessment – Policy development (Bonita et al. 2006)
  • 7. Epidemiology of STIs in Ireland • Changes in sexual behaviour, new diagnostic techniques and social, economic and demographic shifts within society have seen remarkable changes in STI incidence rates
  • 8. Public Health Importance • STIs place a significant burden on healthcare resources • Directly Individuals seeking treatment & care • Indirectly Management of complications of untreated disease • STIs are unequally distributed, disproportionately affect men who have sex with men, young people
  • 9. Risk Factors for STIs • Having unprotected sex • Having sexual contact with multiple partners • Having a history of STIs • Abusing alcohol/Using recreational drugs • Adolescent female (Balfe & Brugha, 2009 & Svare et al. 2002)
  • 10. Health Surveillance
  • 11. Objectives of STI Surveillance • Detection of changes in disease patterns to enable action to be taken when appropriate – Determine the extent of the problem – Monitor trends – Identification of ‘at risk’ groups – Identify unusual increases and conduct investigations • Evaluation of disease control measures – Monitor public health interventions – Monitor targets set out by government • Provision of data for health service planning – Inform service/policy developments – Local/national campaigns (raising awareness, targeting groups) (Lowndes & Fenton, 2004)
  • 12. Common STIs in Ireland Bacteria • Chlamydia • Gonorrhoea • Syphilis Viruses • Herpes • Genital warts (HSPC, 2014)
  • 13. @CianSOBrien #STIEpidemiology
  • 14. 70%
  • 15. ♂ ♂ ♂ ♂ ♀ ♀ ♀ ♀
  • 16. Q. 2 Q. 4
  • 17. 25%
  • 18. Chlamydia • Caused by bacterium, Chlamydia trachomatis • Most commonly diagnosed STI • 2/3 of diagnoses made in the less than 25 years • Most individuals (70% female, 50% male) asymptomatic • May cause serious complications PID in women (lead to ectopic pregnancy,urethritis, & epididymitis) • Untreated infected pregnant women can pass the infection on to the baby • Once diagnosed, chlamydia is easy to treat and cure with antibiotics
  • 19. Epidemiology of Chlamydia • Incidence – Most frequently notified STI, accounting for 66.7% of notifications in 2013 (N=6267) – The notification rate is 134.3 per 100,000 population • Rates 1.25 higher in females – Higher screening rates in women – But male screening is increasing due to urine-based testing
  • 20. Gonorrhoea • Caused by bacterium, Neisseria gonorrhoeae • Second most common bacterial STI in Ireland • 50% of those diagnosed under 25 years old • Proportion of cases asymptomatic (higher in women) • Can lead to serious complications – PID in women • Treated with antibiotics – problem with development of resistance
  • 21. Epidemiology of Gonorrhoea • Incidence – Number of gonorrhoea notifications continued to increase +32.9% in 2013 (N=1294) – Notification rate is now 24.1 per 100,000 population which is the highest rate ever recorded in Ireland • This rate is also much higher than the latest data available from Europe; 12.6 per 100,000 population for 28 EU Member States in 2011
  • 22. Herpes • Caused by herpes simplex virus (HSV) • Two types of HSV. Both types can cause genital herpes • Most common ulcerative STI in Ireland • Efficiency of sexual transmission is greater from men to women than from women to men • No cure – infection is lifelong • Antiviral drugs can reduce the length and severity of the infection
  • 23. Epidemiology of Genital Herpes • Incidence – Accounts for 12.11% of all STI notifications (N=1138) – Notifications of herpes simplex (genital) decreased by 16.5% between 2012 and 2013 • The notification rate was 25.29 per 100,000 population
  • 24. Syphilis • Caused by bacterium, Treponema pallidum • Uncommon but diagnoses are increasing • High % of cases in MSM (men who have sex with men) • Number of stages of infection (late stages – problems with cardiac, respiratory & CNS) • Infection during pregnancy may cause miscarriage, still birth or foetal abnormality if untreated • Treated with antibiotics
  • 25. Epidemiology of Syphilis • Incidence – Accounts for 6.6% of notifications in 2013 (N=616) – An increase of 19% in notifications since 2012 • The notification rate is 13.43 per 100,000 population
  • 26. Genital Warts • More than 100 types of human papillomavirus (HPV), 40 can infect the genital tract and are sexually acquired • HPV types 6 & 11 cause the majority of genital warts • HPV types 16 & 18 are associated with genital cancers • Most common viral STI diagnosed in Ireland • Most cases are diagnosed in those under 25 years • Treated warts can reoccur
  • 27. Epidemiology of Genital warts • Incidence – Accounts for 15.6% of notifications in 2012 (N=1981) – An decrease of 24% in notifications since 2011 • The notification rate is 44.02 per 100,000 population
  • 28. • Ireland's 'hit and miss' approach to sex education has failed • Many young people reach adulthood without a proper understanding of how their body work • The Dept. of Education needs to develop a more comprehensive sex education programme that informs young people about sexuality and reproduction
  • 29. Personal Impact of STIs • Impact of stigma associated with having an STI • Impact of STI on sexuality • Impact of STI on relationships • Feelings about disclosing STI to a regular/casual partner
  • 30. STIs Impact Women Differently from Men • STIs can lead to serious health complications and affect a woman’s future reproductive plans • HPV is the most common sexually transmitted infection in women, and is the main cause of cervical cancer • Women who are pregnant can pass STIs to their babies
  • 31. What Factors Influence STI trends? • Testing volume – Test venue – GUM clinics, GPs – Screening of asymptomatics – Acceptability: non-invasive • Diagnosis test – Sensitivity:↑ detection of positives – Specificity:↓ false positives • Sexual behaviour – Health promotion, education • Access to care Case Detection Infection Transmission
  • 32. 2 1 1 2 1 1
  • 33. Chris and Claire • Chris and Claire had been attracted to each other for a long time. When they finally began to going out, things moved very quickly and they decided to have sex. Almost a month after having unprotected sex with Clare, Chris developed small, fluid-filled blisters on his genitals.
  • 34. 1. What should Chris do? – Attend an STI clinic or visit his GP 2. What STI might Chris have? – Herpes 3. How can this STI be treated? – There is no cure for herpes. Medication can heal sores more quickly and to reduce multiplication of the virus 4. How can Claire be protected from getting this STI? – Use condoms and don’t have sex when sores are present or signs of an outbreak
  • 35. • Greg recently started at UCC. He began to visit Rearden’s on weekends. One night, Greg went home with Sarah, who he had just met at the bar and they had unprotected sex. A few weeks later, Greg experienced pain with urination and discharge from his penis.
  • 36. 1. What should Greg do? – Attend an STI clinic or visit his GP 2. What STI might Greg have? – Gonorrhea/chlamydia 3. How can this STI be treated? – Antibiotics 4. What will happen if Greg does not get treated? – May transmit gonorrhea/chlamydia to his sexual partner(s) or become infertile
  • 37. Take Home Points • Sex = Awesome • STIs ≠Awesome • STIs – Bacterial or Virus • Risk Factors • Sexual Education • Practice safe sex
  • 38. Questions? Nothing too hard, please!
  • 39. Reference List • Balfe, M. & Brugha, R. (2009) What prompts young adults in Ireland to attend health services for STI testing? BMC Public Health 9 311-319 • Bonita, R, Beaglehole & Kjellstrom, T. (2006) Basic Epidemiology. 2nd edition World Health Organisation. China • European Centre for Disease Prevention and Control. Sexually transmitted infections in Europe 2011. Stockholm: ECDC; 2013. • Lowndes, CM & Fenton, KA. (2004) Surveillance systems for STIs in the European Union: facing a changing epidemiology. Sexually Transmitted Infections 80 264-271 • Mettey, A. Crosby, R, DiClemente , RJ. & Holtgrave, DR. Associations between internet sex seeking and STI associated risk behaviours among men who have sex with men Sexually Transmitted Infection 79 466-468 • Public health benefits of partner notification for sexually transmitted infections and HIV http://www.ecdc.europa.eu/en/publications/Publications/Partner-notification-for-HIV-STI-June-2013.pdf [Accessed on 21.03.2014] • Sex education in Ireland has failed – IFPA http://www.irishhealth.com/article.html?id=5031 • STD symptoms: Common STDs and their symptoms http://www.mayoclinic.org/diseases-conditions/sexually-transmitted-diseases-stds/in-depth/std- symptoms/art-20047081 [Accessed 26.03.2014] • STI Case Studieshttp://www.hawaii.edu/hivandaids/STI%20Case%20Studies%20Lesson%20Plan.pdf [Accessed 26.03.2014] • STI Reports Health Protection Surveillance Centre http://www.hpsc.ie/hpsc/A-Z/HIVSTIs/SexuallyTransmittedInfections/Publications/STIReports/ [Accessed 26.03.2014] • Svare, EL, Kjaer, SK, Worm, AM, Osterlind, A, Meijer, CJLM & Van den Brule, AJC. (2002) Risk factors for genital HPV DNA in men resemble those found in women: a study of male attendees at a Danish STD clinic. Sexually Transmitted Infections 78 215-218 • SYPHILIS IN IRELAND, 2012 http://www.hpsc.ie/hpsc/A- Z/HIVSTIs/SexuallyTransmittedInfections/Syphilis/EpidemiologicalData/AnnualReports/File,14359,en.pdf [Accessed 17.03.2014] • Trends in sexually transmitted infections in Ireland 1995-2012 http://www.hpsc.ie/hpsc/A- Z/HIVSTIs/SexuallyTransmittedInfections/Publications/STIReports/STIAnnualandQuarterlyReports/2012/File,14375,en.pdf [Accessed 17.03.2014]