Notifiable Sexually Transmitted Infections 2009 Annual Report

Transcription

1 Notifiable Sexually Transmitted Infections 29 Annual Report

2 21 Government of Alberta Alberta Health and Wellness, Surveillance and Assessment Send inquiries to:

3 Notifiable Sexually Transmitted Infections 29 Annual Report December 21 Executive Summary There are just under 1 communicable diseases in Alberta which are notifiable to public health officials. While only seven of the notifiable diseases are sexually transmitted infections (STI), they are by far the most commonly reported notifiable diseases in Alberta. In 29, STIs made up 72% of all notifiable disease cases reported (see chart). Proportion of Notifiable STI* and Other NDs** in Alberta The seven reportable STIs are: chlamydia, chancroid, gonorrhea, 1% non-gonococcal urethritis (NGU), 42% 39% 37% 32% 32% 32% 28% 8% lymphogranuloma venereum (LGV), mucopurulent cervicitis 6% (MPC) and syphilis. In 29, 4% there were no cases reported of 58% 61% 63% 68% 68% 68% 72% chancroid or LGV. Chlamydia 2% and gonorrhea were the two most commonly reported STIs. % Although the greatest number of cases of STIs occurred in the former Calgary and Edmonton 23 (n=19,914) 24 (n=18,239) 25 (n=18,825) 26 (n=2,867) regions, the Northern Lights region had the highest rates of chlamydia, gonorrhea, infectious syphilis and mucopurulent cervicitis. The East Central region had the lowest rates of infection; and is the only region with no newly diagnosed infectious syphilis cases in 29. Chlamydia Chlamydia is the most commonly reported notifiable disease in Alberta and the number of reported cases continues to increase in Alberta. In 29, over 13, cases were reported to the province with the majority of cases being young Caucasian females. Gonorrhea There was a noticeable decline in gonorrhea cases in 29. The largest drop in cases has been among males, although rates for both males and females decreased in 29 for all regions. Syphilis In March 27 a syphilis outbreak was declared in Alberta by the acting Chief Medical Officer of Health. The infectious syphilis rate was slightly higher in 29 than in 27 or 28. of congenital syphilis continue to be identified in the province despite changes to the provincial prenatal screening program. Seven cases were identified in 29 bringing the total number of congenital syphilis cases to 26 cases since 2. Non-Gonococcal Urethritis (NGU) and Mucopurulent Cervicitis (MPC) 27 (n=22,365) STI % Non-STI % 28 (n=23,354) 29 (n=23,858) Rates for NGU have been steady for the last six years, fluctuating between 34 and 4 cases per 1, males. During this same period, MPC cases and rates have been steadily increasing with a slight plateau in the last two years. Data Note Data for this report was collated April 1, 21. Information received after April 1 is not reflected in this report Government of Alberta

4 Notifiable Sexually Transmitted Infections 29 Annual Report December 21 Chlamydia Chlamydia is the most commonly reported notifiable disease in Alberta. It is a bacterial infection, transmitted through sexual contact or from mother to child during delivery. Chlamydia is easily treatable with antibiotics, but because it is often asymptomatic it may be left untreated allowing complications to become severe. The risk of pelvic inflammatory disease, ectopic pregnancy, infertility, pelvic pain and reactive arthritis are the associated complications for females. For males, risk of infertility, reactive arthritis and infection of the epididymis and testes may occur if chlamydia is untreated. Number and Crude Rate (per 1,) of Chlamydia in Alberta (n=95,785) (January 1st, December 31st, 29) 16, 14, 12, 1, 8, 6, 4, 2, Rates (per 1,) and rates of chlamydia have steadily increased in Alberta over the last 1 years, with rates in 29 (371.2 cases per 1, perons) more than double what was seen in 1999 (179.7 cases per 1,) ,333 5,822 6,29 7,166 7,79 8,185 8,738 1,275 11,13 11,824 13,43 Rate Number and Crude Rate (per 1,) of Chlamydia in Alberta by Sex (January 1st, December 31st, 29) 1, 8, 6, 4, 2, Rates (per 1,) Females have historically had higher reported rates of chlamydia than males. In 29, female rates were twice as high as male rates (498 vs 246 cases per 1, persons) Female 3,886 4,218 4,41 5,14 5,39 5,56 5,818 6,78 7,23 7,789 8,976 Male 1,447 1,64 1,88 2,152 2,4 2,679 2,92 3,495 3,783 4,35 4,454 Female Rates Male Rates Government of Alberta

5 Notifiable Sexually Transmitted Infections 29 Annual Report December 21 5, 4, 3, 2, 1, Number and Crude Rate (per 1,) Chlamydia by Former Health Region (n=13,43) (January 1st - December 31st, 29) Chinook Palliser Calgary DTHR East Central Capital Aspen PCH NLHR ,476 1, , Rate Rates (per 1,) Chlamydia rates also differ within the province by former health region. Although Calgary and Capital had the majority of cases, disease rates were higher in three other regions: David Thompson, Aspen and Northern Lights. Northern Lights had the highest rate in the province at 72 cases per 1, persons. The lowest rates occurred in East Central at 16 cases per 1,. 4, 3, 2, 1, Number and Crude Rate (per 1,) Chlamydia by Former Health Region and Sex (n=13,43) (January 1st - December 31st, 29) Chinook Palliser Calgary DTHR East Central Capital Aspen PCH NLHR Female ,57 1, , Male , , Female Rates Male Rates , Rates (per 1,) As mentioned, females make up the majority of chlamydia cases, as seen consistently across former health regions. As can be seen on the graph to the left, the smallest discrepancy between males and females is in East Central; the largest in Aspen Age-Specific Rate (per 1,) and Counts of Chlamydia in Alberta (n=13,43) (January 1st - December 31st, 29) 2, 1,75 1,5 1,25 1, Rates (per 1,) The highest rates occurred among older teens/young adults; the rates for the 2 to 24 year age group was 1,88 cases per 1, persons. In Alberta, 63% of all cases were in people between the ages of 15 and 24 years old ,447 5,28 2, Rate , , Government of Alberta

6 Notifiable Sexually Transmitted Infections 29 Annual Report December 21 1% 8% 6% 4% 2% % Proportion of Chlamydia in Alberta by Ethnicity (n=76,144 excludes Unknown) (January 1st, December 31st, 29) Other Asian Aboriginal Black Caucasian Over the past 1 years, the proportion of chlamydia cases by known ethnicity has remained consistent. Between 6% and 7% of cases have been in Caucasians, followed by Aboriginals. The majority of cases with known sexual preference since 26 were heterosexual Government of Alberta

7 Notifiable Sexually Transmitted Infections 29 Annual Report December 21 Gonorrhea Gonorrhea is the second most commonly reportable sexually transmitted infection in Alberta, caused by the bacterium Neisseria gonorrhoeae. Many gonorrheal infections are asymptomatic, particularly in women. Common symptoms in males are painful urination and urethral discharge; in women they are mucopurulent cervicitis and sometimes urethritis. Untreated gonorrhea can spread through the body affecting joints and even heart valves. Resistance to antibiotics traditionally used to treat gonorrheal infections is increasing, thus prevention is key. and rates of gonorrhea have steadily increased up until 26 when they plateaued. Both rates and cases then dropped significantly in 29. The contributing factors for this decrease are being investigated as it is outside expected estimates. Number and Crude Rate (per 1,) of Gonorrhea in Alberta (n=14,515) (January 1st, December 31st, 29) 2,5 2, 1,5 1, Rates (per 1,) ,16 1,358 1,56 2,17 2,154 2,63 1,537 Rate As can be seen in the graph to the right, there was a marked decrease in cases and rates of gonorrhea among males in 29. Males have had predominately higher rates of gonorrhea than females since 2, however in 28 rates for males did decline and further declined in 29. The rates of disease for males and females in 29 have almost converged, something that has not occurred since Number and Crude Rate (per 1,) of Gonorrhea in Alberta by Sex (January 1st, December 31st, 29) 1,4 1,2 1, Female Male ,271 1,3 1, Female Rates Male Rates Rates (per 1,) 5 21 Government of Alberta

8 Notifiable Sexually Transmitted Infections 29 Annual Report December 21 The breakdown of gonorrhea cases by sex and select age groups showed that females have higher rates of disease than males for those under 25 years of age. The highest reported rates were for 15 to 19 year old females (21 cases per 1, persons) while males peaked in the 2 to 24 year age group (167 cases per 1,). Males have higher rates than females for age groups 25 years and over. Age-Specific Rate (per 1,) and Counts of Gonorrhea by Sex in Alberta (January 1st - December 31st, 29) < Female Male Female Rates Male Rates Rates (per 1,) For former health regions in 29, the rates of gonorrhea are generally higher in northern Alberta than the south. Total rates of disease (for both females and males) decreased in 29 for all regions except Palliser, which increased slightly from 8.4 cases per 1, persons in 28 to 1. cases per 1, in 29. Number and Crude Rate (per 1,) Gonorrhea by Former Health Region and Sex (n=1,537) (January 1st - December 31st, 29) Chinook Palliser Calgary DTHR East Central Capital Aspen PCH NLHR Rates (per 1,) Female Male Female Rates Male Rates Government of Alberta

9 Notifiable Sexually Transmitted Infections 29 Annual Report December 21 The ethnicity of gonorrhea cases has also changed over the years. Aboriginals have been overrepresented throughout the years as cases, and have the largest proportion as an ethnic group in both 28 and 29. The proportion of Caucasian gonorrhea cases has been trending down since % 8% 6% 4% 2% % Proportion of Gonorrhea in Alberta by Known Ethnicity (January 1, December 31, 29) (n=11,693 excludes Unknown) Other Asian Aboriginal Black Caucasian There are a higher number of male gonorrhea cases than female for all ethnic groups except Aboriginal. Fifty percent of the total number of gonorrhea cases in females are Aboriginal Gonorrhea in Alberta by Ethnicity and Sex (n=1,537: F=755, M=782) (January 1st - December 31st, 29) 1 Aboriginal Black Asian Caucasian Other Unknown Female Male Government of Alberta

10 Notifiable Sexually Transmitted Infections 29 Annual Report December 21 Syphilis One of the oldest sexually transmitted diseases recorded is syphilis. Syphilis is caused by the bacterium Treponema pallidum. Undiagnosed or untreated syphilis progresses through several stages: primary, secondary, latent and tertiary. Untreated syphilis can lead to destruction of soft tissue, bone, blindness and heart failure. More importantly, a mother with untreated syphilis may transmit the disease to her unborn child, which can lead to death or lifelong deformity of the child. This section discusses infectious syphilis which covers the primary and secondary stages, as well as early latent. The breakdown of infectious syphilis cases by stage of infection for 29 is below: Stage of Infectious Syphilis Early Latent 17 Primary 18 Secondary 48 Symptomatic CNS (Central Nervous System) 2 Asymptomatic CNS 1 Unknown 1 Number and Crude Rate (per 1,) of Infectious Syphilis in Alberta (n=1,294) (January 1st, December 31st, 29) Rate Syphilis has regained notoriety in Alberta as cases continue to rise and a province-wide outbreak was declared in March 27. The last outbreak occurred in the mid-198 s, with a peak of 574 cases in Since this last outbreak, reports of syphilis cases were very low Rates (per 1,) However, starting in 23 there was an exponential increase in the number of syphilis infections reported. Alberta declared an outbreak of syphilis in 27, at which time the number of cases and rate of diagnosed infectious syphilis levelled off. In 29, there were 267 cases reported in the province. Number and Crude Rate (per 1,) of Infectious Syphilis in Alberta by Sex (January 1st, December 31st, 29) Female Male Female Rates Rates (per 1,) Compared to other STI in Alberta, infectious syphilis was reported more often among men (67% of cases are male), older individuals (mean age of diagnosis is 36 years), and homosexuals (2% of cases in 29 were homosexual, the highest proportion of any STI). The chart to the left shows this discrepancy between sexes as cases increased over the years, except for the opposite trend in 28. Male Rates Government of Alberta

11 Notifiable Sexually Transmitted Infections 29 Annual Report December Age-Specific Rate (per 1,) and Counts of Infectious Syphilis in Alberta (n=267) (January 1st - December 31st, 29) Rates (per 1,) While cases of chlamydia and gonorrhea are skewed towards young adults, newly reported infectious syphilis cases are more evenly distributed over age groups until 5 years of age where the number of cases decrease. < Rate Age-Specific Rate (per 1,) and Counts of Infectious Syphilis by Sex in Alberta, Number and Crude Rate (per 1,) Infectious Syphilis by Former Health Region and Sex (January 1st - December 31st, 29) < Female Male Female Rates Male Rates Chinook Palliser Calgary DTHR East Central Capital Aspen PCH NLHR Female Male Female Rates Male Rates Rates (per 1,) Rates (per 1,) The highest rate for females is in the 2 to 24 age group at 18 cases per 1,, which is higher than males for this group. Males have the highest rate in the 22 to 29 age group (22 cases per 1, persons). Not only do case counts and rates of infectious syphilis differ by region, rates by sex also vary greatly depending on the former health region. The majority of cases occurred in the Calgary and Capital regions. Rates for both males and females are highest in Northern Lights (15 and 24 cases per 1, respectively). Rates for females were also greater in the three northern regions and Chinook. There were no cases in East Central Government of Alberta

12 Notifiable Sexually Transmitted Infections 29 Annual Report December 21 1% 8% 6% 4% 2% % Proportion of Infectious Syphilis in Alberta by Known Ethnicity (January 1, December 31, 29) (n=1,249 excludes Unknown) Other Asian Aboriginal Black Caucasian For the last three years, approximately 6% of infectious syphilis cases with known ethnicity have been Caucasian. There are no identifiable trends by ethnicity for this disease. INFECTIOUS SYPHILIS 29 - CASES BY ETHNICITY & SEXUAL PREFERENCE Ethnicity Bisexual Heterosexual Homosexual Unknown/NA Total Aboriginal Black Asian Caucasian Other Unknown Total As mentioned previously, 2% of infectious syphilis cases are homosexual. This is the highest proportion among notifiable STIs. Congenital Syphilis Congenital syphilis is the vertical transmission of syphilis from an infected mother to her infant. Congenital syphilis has also increased in Alberta, with the first case in years reported in Congenital Syphilis Since August 22, Alberta has had a centralized provincial prenatal screening program in place to screen women early in their pregnancy for five infectious diseases infectious syphilis, HIV, hepatitis B, rubella and varicella. In response to the increase in congenital syphilis cases, Alberta also instituted a universal prenatal syphilis re-screening program in May 29 to capture women infected with syphilis during pregnancy (mid-pregnancy and delivery). In 29, three women were identified with infectious syphilis upon re-screening (all three at delivery) Government of Alberta

13 Notifiable Sexually Transmitted Infections 29 Annual Report December 21 Other Syphilis Information Throughout the year, Surveillance and Assessment staff receive ad hoc requests for data from various stakeholders or researchers. Some of these requests cannot be answered with standard or usual statistics as they are not readily available. These ad hoc requests can highlight the wealth of information captured by health practitioners using Alberta Health Wellness forms, as well as identify gaps in either data, treatment or prevention of disease. The following is an example of the findings of a request received in the past few months. Sex Trade Workers Syphilis continues to be an issue within the sex trade. Between 25 and 29, 18 to 46 percent of females diagnosed with infectious syphilis identified themselves as sex trade workers. During this same period, 22 female sex trade workers with infectious syphilis were identified as pregnant. This number is most likely underestimated. Percentage of Infectious Syphilis in Alberta Who Identified Themselves as Sex Workers Female 18% 46% 25% 24% 27% Male 2% 2% 2% 4% % Government of Alberta

14 Notifiable Sexually Transmitted Infections 29 Annual Report December 21 Non-Gonococcal Urethritis (NGU) Non-gonoccocal urethritis is the inflammation of the urethra in males not caused by Neisseria gonorrhoeae. It can be caused by a number of a pathogens including Chlamydia trachomatis, although a specific pathogen is often not identified. Approximately one-quarter of NGU infections are asymptomatic. It can be treated with antibiotics. If NGU is not treated it can cause epididymitis and infertility. NGU is not reportable at the national level. Rates for NGU have been steady for the last six years, fluctuating between 34 and 4 cases per 1, males. Please note that the case definition for NGU was modified in 23 and thus comparisons cannot be made between the time periods before and after 23. 2,5 2, 1,5 1, 5 Number and Crude Rate (per 1,) of NGU in Alberta (n=17,61) (January 1st, December 31st, 29) Rates (per 1,) 2,179 1,66 1,737 1,918 2,75 1,273 1,129 1,37 1,27 1,24 1,39 Rates In 29, the majority of NGU cases were diagnosed in males under the age of 3, with the highest rates occurring between the ages of 2 and 24 years (267 cases per 1,). Age-Specific Rate (per 1,) and Counts of NGU in Alberta (n=1,299 excluded unknown age) (January 1 - December 31, 29) Rates per (1,) < Rate The rate of disease varies across the province, with the highest rate in the former Peace Country region (91 cases per 1,persons ) followed by Capital and Calgary (rates of 84 and 76 cases per 1, respectively) Number and Crude Rate (per 1,) NGU by Former Health Region (n=1,39) (January 1 - December 31, 29) Chinook Palliser Calgary Rate Government of Alberta DTHR East Central Capital Aspen PCH NLHR Rates (per 1,)

15 Notifiable Sexually Transmitted Infections 29 Annual Report December 21 The majority of NGU cases are heterosexual and Caucasian. Approximately 11% of cases are Aboriginal and 1% are Black. NGU 29 - CASES BY ETHNICITY & SEXUAL PREFERENCE Bisexual Heterosexual Homosexual Unknown Total Aboriginal Black Asian Caucasian Other Unknown Total , Government of Alberta

16 Notifiable Sexually Transmitted Infections 29 Annual Report December 21 Mucopurulent Cervicitis (MPC) Mucopurulent cervicitis is the clinical syndrome of inflammation of the cervix in females, most often caused by C. trachomatis or N. gonorrhoeae. It is associated with higher risk of poor pregnancy outcome, upper genital tract disease, and transmission of HIV. MPC can be treated with antibiotics. If left untreated, it can cause pelvic inflammatory disease (PID), chronic pelvic pain, ectopic pregnancy and infertility. As with NGU, MPC is not reportable nationally Number and Crude Rate (per 1,) of MPC in Alberta (n=4,96) (January 1st, December 31st, 29) Rates (per 1,) The case definition for MPC was modified in 23 and thus comparisons cannot be made between the two time periods before and after 23. Since 24, MPC cases and rates have been steadily increasing with a slight plateau in the last two years. Rate Number and Crude Rate (per 1,) MPC by Former Health Region (n=358) (January 1 - December 31, 29) Chinook Palliser Calgary DTHR East Central Capital Aspen PCH NLHR Rate (per 1,) Rates among the former health regions vary between 7.3 cases per 1, females in Palliser to 21.5 cases in Calgary. The highest rates recorded were in Northern Lights with 12 cases per 1, which is ten times higher than the provincial rate of 9.9 cases per 1, for Rate Government of Alberta

17 Notifiable Sexually Transmitted Infections 29 Annual Report December 21 Age-Specific Rate (per 1,) and Counts of MPC in Alberta (n=358) (January 1 - December 31, 29) < Rate Rate (per 1,) More than half of MPC cases in 29 were between 15 and 24 years of age (51%). The rate of disease in 2 to 24 year old females was 88 cases per 1, of MPC in Alberta by Ethnicity (n=358) (January 1 - December 31, 29) 7 15 Aboriginal Black Asian Caucasian Other Unknown The majority of MPC cases in 29 were Caucasian (58%), followed by Aboriginal (24%) Government of Alberta

18 Notifiable Sexually Transmitted Infections 29 Annual Report December 21 Other Studies Sex Education A sexual education program was introduced into the school curriculum in Alberta in Rates of gonorrhea and syphilis in children aged 1 to 19 years old between 1986 to 29 (genital chlamydia was not reportable until 1989) were analyzed to establish what, if any, trends were evident after Three years prior to the start of the sex education program, the rate of both gonorrhea and syphilis in 1 to 19 year olds in Alberta was 347 cases per 1,. By 1989 the rate had decreased to 175 cases per 1,. In 199. the year following the start of the program, the rate further dropped to 98 cases per 1,. The lowest rate of gonorrhea and syphilis in 1 to 19 year olds was in 2 (11 cases per 1,); in 29 it was 72 cases per 1,. Rate of Gonorrhea and Syphilis in 1 to 19 year olds After further statistical analysis comparing rates of gonorrhea among age groups not exposed to sex education versus 1 to 19 year olds, it could not be concluded that sex education alone caused the decline in rates of gonorrhea Government of Alberta