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The epidemiology of gonorrhoea in Norway, 1993-2007: past victories, future challenges.

Jakopanec I, Borgen K, Aavitsland P - BMC Infect. Dis. (2009)

Bottom Line: Only one woman (0.5%) was positive from the rectum.The proportion resistant to quinolone has risen from 3% in 1995 to 47% in 2007, with 81% of the latter isolated from patients infected in Asia.We advocate antimicrobial susceptibility testing for all cases and recommend taking samples for culture from all exposed anatomical sites.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, PO Box 4404 Nydalen, N-0403 Oslo, Norway. irena.jakopanec@fhi.no

ABSTRACT

Background: Gonorrhoea, a bacterial infection caused by Neisseria gonorrhoeae, has been increasing in several European countries, particularly among men who have sex with men (MSM) and teenagers. We describe the epidemiology of gonorrhoea in Norway in the recent 15 years in order to guide recommendations on the diagnosis, treatment and prevention of gonorrhoea. An evaluation of the Norwegian Surveillance System for Communicable Diseases (MSIS) in 1994, involving GPs and microbiological laboratories, suggested that the system has a high coverage, capturing over 90% of patients diagnosed with gonorrhoea.

Methods: Using MSIS data on gonorrhoea cases we analysed specific trends by route of transmission, age, gender, anatomical sampling site, antimicrobial resistance and travel history from 1993-2007 and, to focus on more recent trends, from 2003-2007. MSM and heterosexual cases were defined by route of transmission.

Results: From 1993 to 2007, 3601 gonorrhoea cases were reported. MSM cases increased from 10 in 1994 to 109 cases in 2004. From 2003-2007, the incidence of gonorrhoea was 5.4/100,000 person-years (95%CI: 4.9-6.0). Over these five years, MSM accounted for an average of 80 cases per year, of which 69% were infected by casual partners. In the same period, 98% of heterosexually infected had a positive swab from urethra only and only two (0.3%) from the pharynx. Only one woman (0.5%) was positive from the rectum. From 1993 - 2007, antimicrobial resistance results were reported for 3325 N. gonorrhoeae isolates (98% of cultured samples). The proportion resistant to quinolone has risen from 3% in 1995 to 47% in 2007, with 81% of the latter isolated from patients infected in Asia.

Conclusion: The overall incidence of gonorrhoea in Norway remains low, but the increasing number of MSM cases calls for new, more effective approaches to prevention. Infections originating from abroad represent a constant risk of importing antimicrobial resistant N. gonorrhoeae. Due to the prevalence of quinolone resistant N. gonorrhoeae in Norway, third-generation cephalosporins should replace quinolones as the first choice in treatment guidelines. We advocate antimicrobial susceptibility testing for all cases and recommend taking samples for culture from all exposed anatomical sites.

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Proportion of PPNG and quinolone resistance of 3399 cultured isolates of N. gonorrhoeae Norway, 1993–2007. PPNG surveillance started in 1993 and quinolone surveillance in 1995.
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Figure 4: Proportion of PPNG and quinolone resistance of 3399 cultured isolates of N. gonorrhoeae Norway, 1993–2007. PPNG surveillance started in 1993 and quinolone surveillance in 1995.

Mentions: From 1993 to 2007, 3399 cases (94%) were diagnosed by culture. In 2001, culturing was used in 89% of the cases, the lowest proportion in the entire period. Antimicrobial resistance was reported for 3325 (98%) of all cultured N. gonorrhoeae isolates. From 2003 to 2007, there has been a marked increase in the number of isolates reported to be quinolone resistant only, or both PPNG and quinolone resistant (Figure 4). Quinolone resistance is mainly found in isolates from patients infected in Asia. Among these patients, the proportion of quinolone resistance rose from 8% in 1998 to 81% in 2007.


The epidemiology of gonorrhoea in Norway, 1993-2007: past victories, future challenges.

Jakopanec I, Borgen K, Aavitsland P - BMC Infect. Dis. (2009)

Proportion of PPNG and quinolone resistance of 3399 cultured isolates of N. gonorrhoeae Norway, 1993–2007. PPNG surveillance started in 1993 and quinolone surveillance in 1995.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2666741&req=5

Figure 4: Proportion of PPNG and quinolone resistance of 3399 cultured isolates of N. gonorrhoeae Norway, 1993–2007. PPNG surveillance started in 1993 and quinolone surveillance in 1995.
Mentions: From 1993 to 2007, 3399 cases (94%) were diagnosed by culture. In 2001, culturing was used in 89% of the cases, the lowest proportion in the entire period. Antimicrobial resistance was reported for 3325 (98%) of all cultured N. gonorrhoeae isolates. From 2003 to 2007, there has been a marked increase in the number of isolates reported to be quinolone resistant only, or both PPNG and quinolone resistant (Figure 4). Quinolone resistance is mainly found in isolates from patients infected in Asia. Among these patients, the proportion of quinolone resistance rose from 8% in 1998 to 81% in 2007.

Bottom Line: Only one woman (0.5%) was positive from the rectum.The proportion resistant to quinolone has risen from 3% in 1995 to 47% in 2007, with 81% of the latter isolated from patients infected in Asia.We advocate antimicrobial susceptibility testing for all cases and recommend taking samples for culture from all exposed anatomical sites.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, PO Box 4404 Nydalen, N-0403 Oslo, Norway. irena.jakopanec@fhi.no

ABSTRACT

Background: Gonorrhoea, a bacterial infection caused by Neisseria gonorrhoeae, has been increasing in several European countries, particularly among men who have sex with men (MSM) and teenagers. We describe the epidemiology of gonorrhoea in Norway in the recent 15 years in order to guide recommendations on the diagnosis, treatment and prevention of gonorrhoea. An evaluation of the Norwegian Surveillance System for Communicable Diseases (MSIS) in 1994, involving GPs and microbiological laboratories, suggested that the system has a high coverage, capturing over 90% of patients diagnosed with gonorrhoea.

Methods: Using MSIS data on gonorrhoea cases we analysed specific trends by route of transmission, age, gender, anatomical sampling site, antimicrobial resistance and travel history from 1993-2007 and, to focus on more recent trends, from 2003-2007. MSM and heterosexual cases were defined by route of transmission.

Results: From 1993 to 2007, 3601 gonorrhoea cases were reported. MSM cases increased from 10 in 1994 to 109 cases in 2004. From 2003-2007, the incidence of gonorrhoea was 5.4/100,000 person-years (95%CI: 4.9-6.0). Over these five years, MSM accounted for an average of 80 cases per year, of which 69% were infected by casual partners. In the same period, 98% of heterosexually infected had a positive swab from urethra only and only two (0.3%) from the pharynx. Only one woman (0.5%) was positive from the rectum. From 1993 - 2007, antimicrobial resistance results were reported for 3325 N. gonorrhoeae isolates (98% of cultured samples). The proportion resistant to quinolone has risen from 3% in 1995 to 47% in 2007, with 81% of the latter isolated from patients infected in Asia.

Conclusion: The overall incidence of gonorrhoea in Norway remains low, but the increasing number of MSM cases calls for new, more effective approaches to prevention. Infections originating from abroad represent a constant risk of importing antimicrobial resistant N. gonorrhoeae. Due to the prevalence of quinolone resistant N. gonorrhoeae in Norway, third-generation cephalosporins should replace quinolones as the first choice in treatment guidelines. We advocate antimicrobial susceptibility testing for all cases and recommend taking samples for culture from all exposed anatomical sites.

Show MeSH
Related in: MedlinePlus