Recent Trends from Laboratory Reporting
Since 1995, laboratories across England and Wales have voluntarily reported positive diagnoses of gonorrhoea (LabBase II). This provides an insight into the epidemiology of gonorrhoea in all sites where it is diagnosed, including non-GUM settings. During 2005, 14,740 diagnoses of gonorrhoea were reported in LabBase II compared to 14,536 in 2004, an increase of 1%. A substantial decrease of 15% in the number of diagnoses was previously noted between 2003 and 2004.
Although there was an annual increase of four percent (from 8,882 to 9,238) of gonorrhoea diagnoses among men, there was an annual decrease of two percent (from 5,370 to 5,280) among women in 2005. The highest number of reports in 2005 was seen in the 25 to 34 years group for men and the 16 to 19 year group for women. An increase in the number of diagnoses was observed in all male age groups except in the 16 to 19 years group, which showed a decrease of 13% (from 1,202 to 1,051) in 2005. The number of diagnoses decreased in all female age groups bar the 35 to 44 age group which showed an increase by 17% (from 274 to 321) in the same year.
In accordance with the KC60 data, the LabBase II figures shows that London is the region with the highest number of diagnoses reported (3,876 in 2005), accounting for 26% of the total diagnoses made. Yorkshire and the Humberside, East Midlands, North East, North West, and London regions have all shown an increase in the number of gonorrhoea diagnoses between 2004 and 2005. As LabBase II is a voluntary reporting system the proportion of diagnoses reported may reflect laboratory participation rather than disease burden.
Recent trends in population sub-groups
Rates of gonococcal infection tend to be higher in urban and deprived areas and among certain population subgroups: MSM, young women, and some black ethnic populations. The high rates of gonorrhoea observed in urban areas partly reflect the distribution of these risk groups, access to care and assertive patterns of sexual mixing.
In 2005, 4,039 diagnoses of gonorrhoea reported from GUM clinics in England, Wales and Northern Ireland were homosexually acquired, an increase of nine percent since 2004. This accounts for 30% of all male diagnoses in the same period. Since 1995, the annual diagnoses of gonorrhoea among MSM showed gradual increases in the all age groups, with the highest number of infections observed in the 16 to 24 age group throughout. The increasingly high rates of gonorrhoea in MSM probably reflect increases in high risk sexual behaviour, with many MSM reporting more sexual partners and unsafe sex than previously [6]. Moreover, rectal diagnoses of gonorrhoea among men reported to LabBase II increased by 23% (from 459 to 566 positive isolates) in 2005 compared to 2004.
Young people are disproportionately affected by gonorrhoea. In 2005, young men aged 16 to 24 years accounted for 40% (5,299/13,406) of all diagnoses in men, and young women aged 16 to 24 years accounted for 70% (3,690/5,259) of all diagnoses in women. These figures are likely to underestimate the population prevalence as gonorrhoea is frequently asymptomatic in women, who may therefore not attend a clinic for testing.
Ethnicity data are not routinely collected as part of the KC60 dataset but it is available from the Gonoccoccal Resistance to Antimicrobials Surveillance Programme (GRASP). Data from GRASP highlights the disproportionate burden of gonorrhoea found among black and other ethnic minorities. High rates of gonorrhoea in these groups are likely to result from a number of factors. Sexual attitudes and behaviours vary considerably across ethnic groups and in social economic status, and access to, and use of healthcare services.
A gradual decrease in the number of diagnosis of gonorrhoea over the last few years has been observed. Diagnosis of gonorrhoea is increasing among MSM and the highest burden of infection continues to centre on young people and certain ethnic minority groups. The ongoing development of enhanced surveillance is therefore essential to permit the collection of behavioural, demographic and microbiological data in multiple settings, necessary to provide a more accurate assessment of the changing epidemiology of gonococcal infection, and enable effective allocation of future preventive efforts.