Management in Health, Vol 17, No 3 (2013)

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THE EVALUATION OF THE AMPLITUDES AND TENDENCIES OF THE EVOLUTION OF SEXUALLY TRANSMISSIBLE DISEASES IN MURES AREA

THE EVALUATION OF THE AMPLITUDES AND TENDENCIES OF THE EVOLUTION OF SEXUALLY TRANSMISSIBLE DISEASES IN MURES AREA

 

 

Claudia Andreea NISTOR1 , Cecilia LAZAR2 , Septimiu Toader VOIDĂZAN3

 

1Supervision and Control Service of infectious Nosocomial Diseases, Mures County Hospital.

2Department of Epidemiology, Health Administration, Harghita.

3Department of Epidemiology, University of Medicine and Pharmacy of Tg. Mureş.

 

 

ABSTRACT: INTRODUCTION: Sexually transmissible diseases represent an important public health problem, even for the adolescents and young people, because of an increased morbidity, its complications, premature deaths and even its economic-social implications.

The study suggests monitoring of sexually transmissible diseases (syphilis and infective gonococcus) by determining their morbidity in Mures and Harghita County, during the period 2005-2012, together with the associated risk factors and life style.

MATERIAL AND METHOD: I carried out a descriptive epidemiological study by analyzing cases of sexual transmissible diseases (syphilis, gonorrhoea) reported by the Public Health Ministry for the period 2005-2012 in Mures and Harghita County. I followed the trend of infection and incidence of transmissible diseases in function of age, sex, provenance and seasonality.

RESULT: The incidence of syphilis in Mures County varied between 20.1%ooo in 2005 and 10.2%ooo in 2012, but in Harghita County it varied between 36.4%ooo in 2005 and 13.4%ooo in 2012. For infective gonococcus, the incidence in Mures County varied between 1.2%ooo in 2005 and 1.0%ooo in 2012, while in Harghita County it varied between 9.5%ooo in 2005 and 6.8%ooo in 2012.

CONCLUSION: I concluded that the evolution of cases of syphilis in the two counties is comparable. Infective gonococcus appears most often at male patients who live in cities. The cases of syphilis and gonorrhoea were more common at young patients (second to third decade) who are sexually active.

 

Keywords: Syphilis, gonorrhoea, Mures, Harghita.

 

 

INTRODUCTION

Sexually transmissible diseases (STD) represent a global public health problem with increasing incidence. In the beginning of the 21st century STD-s increased in many of the European countries, most probable caused by multiple factors, such as increased screening, usage of more sensitive diagnostic tests, supervision systems and the report of infected persons, and not at least, the decreased use of sexual protection and less safe sex in subpopulations [1]. In Europe, up to 30.000 cases of gonorrhoea, 18.000 cases of syphilis and up to 350.000 cases of Chlamydia were reported in 2010 [2].Some subpopulations appeared to be more affected than others: homosexuals are disproportional affected by gonorrhoea and syphilis while people between the age 15 to 24 are more affected by Chlamydia and gonococcus.

Based on the global evolution, it seems that Romania, at the current moment, is in the same situation as the global evolution of STD-s. So, the incidence of syphilis reported in 2003 was of 44.6%ooo, which means 2.5 times greater than it was in 1989, with the highest increase in the urban areas (49.76%ooo in 2003) compared to the rural areas (38.84%ooo), and also at the male sex (55.46%ooo), with the highest numbers at the young ages, under 25 years. The evolution of gonorrhoea was inverse, it decreased to 11.62%ooo in 2003 compared to 35.7%ooo in 1989 (and even compared to 2002 with the incidence of 17.5%ooo) [3].

 

Objective of the study: Monitoring of sexually transmissible diseases (syphilis and infective gonococcus) by determining the dynamics of the morbidity in Mures and Harghita County, during the period 2005-2012, in the context of the associated risk factors and life style.

 

MATERIAL AND METHOD

To reach my objective I used a descriptive epidemiological study, by analyzing cases of STD-s (syphilis, gonorrhoea) reported to the ministry of public health in the period 2005-2012 in Mures and Harghita County. I followed the infection trend, incidence of STD by looking at the following functions: age, sex, and area of origin and the period of the year when the cases appeared.

Data sources concerning the population: Statistical county ministry, national institute of statistics and Romania Statistic Annual for 2011 and declaration papers for the STD with syphilis and gonorrhoea from Public Health Department of Mures County and of Miercurea Ciuc, Romania Statistic Annual for 2011 and the ministry of public health in Bucharest [3].

The numbers were organized with Excel and the statistical analysis was done by using the program MedCalc (bvba Version 12.3.0, Mariakerke, Belgium). The chi-square test (χ2) was used for the category variables, expressed as percents. All the tests were interpreted according to the significance threshold p=0.05 and statistical significant was considered for the p-values under the threshold.

 

RESULTS

The incidence of syphilis in Mures County varied between 20.1%ooo in 2005 and 10.2%ooo in 2012, with the peak incidence in 2007 (22.3%ooo), and in Harghita County it varied between 36.4%ooo in 2005 and 13.4%ooo in 2012, with the peak incidence in 2005. On a national level the incidence varied between 31.7%ooo in 2005 and 7.2%ooo in 2012 (figure 1).

 

Figure 1 - Incidence of syphilis cases in Mures and Harghita County compared to Romania, during the period 2005-2012

 

For infective gonococcus, the incidence in Mures County varied between 1.2%ooo in 2005 and 1.0%ooo in 2012, with the peak incidence in 2006 (2.6%ooo), and in Harghita County the incidence varied between 9.5%ooo in 2005 and 6.8%ooo in 2012, with the peak incidence in 2009 (10.7%ooo). On a national level the incidence varied between 7.8%ooo in 2005 and 1.8%ooo in 2012 (figure 2).

 

 

 

 

 

 

 

 

 

Figure 2 - Incidence of infective gonococcus cases in Mures and Harghita County compared to Romania during the period 2005-2012

The distribution of syphilis cases, according to the residence, in Mures County, showed that up to half of the cases (54.6%) came from the urban areas, within a similar structure of the population. The distribution according to sex showed that 51.6% of the cases were women compared to 48.4% men, and the reason for this higher number of women was explained by the difference in the population structure, where the female population was predominant (50.8%).

For the Harghita County I saw a predominance of syphilis cases in the urban areas, approximately 60.0%, the predominant part of the population coming from the rural areas (53.8%). Distribution according to the sex indicates a small predominance of the male sex (55.5% versus 44.5%) (table I).

 

Table I - Medium distribution of provenance and sex in the two counties and the syphilis cases during the period 2005-2012

 


 

Mureş

Harghita

Population

(%)

Number of

Syphilis cases

(%)

Population

(%)

Number of

Syphilis cases

(%)

Area

Urban

51.8

54.6

46.2

59.6

Rural

48.2

45.4

53.8

40.4

Sex

Female

50.8

51.6

50.3

44.5

Male

49.2

48.4

49.7

55.5

 

The distribution of cases of infective gonococcus according to the regional origin in Mures County showed that almost two thirds of the cases (71.9%) came from the urban areas, and the distribution according to the sex showed that the majority of the reported cases was male representatives (91.2%).

For the Harghita County I found the same urban predominance of infective gonococcus (approximate 2/3 from the cases). Distribution according to the sex indicates a much larger number of male cases (77.1% versus 22.9%) (table 2).

Table 2 - Medium distribution of provenance and sex in the two counties and the infective gonococcus cases during the period 2005-2012

 


 

Mureş

Harghita

Population

(%)

Number of

Syphilis cases

(%)

Population

(%)

Number of

Syphilis cases

(%)

Area

Urban

51.8

71.9

46.2

64.8

Rural

48.2

28.1

53.8

35.2

Sex

Female

50.8

8.7

50.3

22.9

Male

49.2

91.2

49.7

77.1

 

An analysis of syphilis cases according to the age group between the two counties showed us the greatest difference in the age group 25-34 years, with the most cases reported in Mures County (p=0.01). In contrast, up to the age of 50 years, the most cases were reported in Harghita County with a higher statistically significant difference compared to the percents in Mures County (table 3).

 

Table 3 - Age group distribution of the syphilis cases from Mures and Harghita County during the period 2005-2012

 


Age group

Mureș

Harghita

P value

5-9

0.8%

0.0%

-

10-14

1.3%

1.3%

-

15-19

10.7%

8.8%

0.48

20-24

16.1%

14.3%

0.58

25-34

36.9%

27.7%

0.01

35-44

22.0%

19.7%

0.52

45-54

8.4%

12.2%

0.11

55-64

3.1%

10.5%

0.0001

65-74

0.7%

3.4%

0.008

75-84

0.2%

2.1%

0.01

Total

100.0%

100.0%

-

 

As for the gonococci infection, the statistical significant difference between the two counties was shown for the age group of 15-19 years (% higher in Mures County), of 20-24 years (% higher in Harghita County) and the age group of 45-54years (% higher in Mures County) (table 4).

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 4 - Age group distribution of the infective gonococcus from Mures and Harghita County during the period 2005-2012

 


Age group

Mureș

Harghita

P value

5-9

0.0%

0.0%

-

10-14

3.5%

1.4%

0.16

15-19

22.8%

12.2%

0.0007

20-24

19.3%

35.1%

0.0001

25-34

29.8%

33.8%

0.29

35-44

8.8%

10.8%

0.44

45-54

10.5%

5.4%

0.02

55-64

1.8%

1.4%

-

65-74

1.8%

0.0%

-

75-84

1.8%

0.0%

-

Total

100.0%

100.0%

-

 

DISCUSSION

The study followed the trend of two sexually transmissible diseases in Mures County compared to the neighbouring county (Harghita) and the national level during a period of 8 years (2005-2012).

For the syphilis cases, the number of newly diagnosed cases registered in the last years of our study lowered compared to the first years of the study. This trend was apparent both in Mures and Harghita Counties and on a national level.

For the cases of infective gonococcus, the reports from the two counties, as from the national level are different. The incidence in the country shows a continuing decrease from 2005 to 2012. The incidence in Mures County was much smaller compared to Harghita County or the national level and it maintained during the whole period of the study. In contrast, in Harghita County the cases of gonorrhoea were up to the national level, with an oscillatory evolution, showing two peaks in the incidence, one at the start of our study (year 2005 and 2006) and the other one in the middle of the study (years 2009 and 2010).

Interesting is, that some of the countries in Europe, for example England, Germany or Sweden described an increase of the incidence of STD, especially at the homosexuals [2, 4, 5]. In France, an increase of infective gonococcus from 52 % was described between 2008 and 2009, but not in the following years [6]. In England, the increase in incidence of infective gonococcus was 25 % for the general population, up to 61 % for the homosexual population and 42 % for the population between 25 and 34 years old [4].The number of syphilis cases in France decreased to the national level in 2008 and 2009, after an increase in 2007 [7]. In England, an increase with 10 % of syphilis was observed in 2011, higher at the young population and the homosexuals [4].

In our study, the distribution of the syphilis cases based on the provenance was similar for the two counties, with a slightly higher value in the urban areas (50-55%). Based on sex, there were more females affected in Mures County and more males in Harghita County.

The situation was much different when I analyzed the cases of infective gonococcus, where the most part of the affected persons were from the urban areas (up to 2/3) and of the male sex (91.2% in Mures County and 77.1% in Harghita County).

Gonorrhoea is easily spread and can lead to infertility both for men and women, if it is not treated correctly with antibiotics. An effective control of gonorrhea is based on the success of the antimicrobial treatment. Untreated infection can lead to severe relapses, inclusive pelvic inflammatory disease, abortions in the first trimester, entopic pregnancy and infertility, and can contribute to the spread of HIV. The current treatment in Europe recommends the use of a singular injectable dose (ceftriaxone), or oral third generation cephalosporin (cefixim) and the same treatment for the partner at the same time [8].

Every sexually active person is at risk of STD, indifferent of sex, race, social class or sexual orientation. Teens and young adults get infected with sexual transmissible diseases much easier than older people. Up to the age of 25 years, half of the sexually active adults can become sick. With more sexual partners the same risk increases. CDC Atlanta has declared that the STD-s inclusive syphilis or gonorrhoeas are increasing for the homosexuals [2, 9].

We have observed that the syphilis appears in higher percents at persons between the ages of 25-34 years, and of 35-44 years. Up to these ages the cases are reported to decrease, but I observed a higher share in Harghita County with significant difference compared to Mures County. Infective gonococci appear more often at younger persons, aged of 20-34 years.

The best ways to avoid STD are: to communicate with your partner if you have an STD; tests before the start of sexual activity; relationships with a long term non-infected partner. It is important for the pregnant females to be tested for STD. They can cause a premature labor and birth complications. Many of the STD can be transferred from mother to baby during the pregnancy, delivery or after the child has been born. The effects of STD for the children can be stillborn, small birth weight, neurological problems, blindness, liver problems and serious infections. The treatment during pregnancy can cure an STD and reduce the risk of transmitting it to the baby [8].

The incidence of infective gonococcus and syphilis has to be carefully monitored and the interventions of public health directed to the affected groups. This intervention program has to be based on evidence and the monitoring in a rigorous and systematically manner in order to assure its quality. The appearance of a multi resistant branch of N. gonorrhoea is a serious threat for the public safety which can lead to the loss of the last options for an efficient treatment in the close future. Experts in the public health sector and the medical specialists have to be informed about the actual situation and be attentive to failure of the treatment.

 

CONCLUSION

From the analysis of the evolution (2005-2012) of infective gonococcus and syphilis in these two counties, the following can be concluded:

         The evolution of the syphilis cases are comparable between the two counties;

         The evolution is constant and under national level of the gonorrhoea cases in Mures County;

         Oscillatory evolution and up to the national level of gonorrhoea cases in Harghita County;

         Infective gonococcus appear more often at males and in urban areas;

         Cases of syphilis and gonorrhoea are more common at young patients (second to third decade of life) and sexually active.

 

It is useful and necessary to start a national prophylaxis and information program, continued institutionalized education for preventing of sexually transmitted diseases and sexual life for groups of all age. The state health institutions have to try to coordinate this program at minimum three levels: the teaching institutions, the family centres and the centres for family planning.

 

References

1.       VAN de LAAR, M., SPITERI, G.,-Increasing trends of gonorrhoea and syphilis and the threat of drug-resistant gonorrhoea in Europe. Euro Surveill.;17(29), 2012;

2.       European Centre for Disease Prevention and Control (ECDC)., -Sexually transmitted infections in Europe 1990-2010. Stockholm: ECDC; 2012;

3.       Anuarul de statistica sanitara 2011; Ministerul Sanatatii, Centrul de Statistica Sanitara si Documentare Medicala; Bucuresti, 2012;

4.       SAVAGE, E.J., MARSH, K., DUFFELL, S., ISON, C.A., ZAMA, A., HUGHES, G., -Rapid increase in gonorrhoea and syphilis diagnoses in England in 2011. Euro Surveill. 17(29), 2012;

5.       BREMER, V., MARCUS, U., HAMOUDA, O., -Syphilis on the rise again in Germany-results from surveillance data for 2011. Euro. Surveill. 17(29), 2012;

6.       NGUYEN, E., BOUYSSOU, A., LASSAU, F., BASSELIER, B., SEDNAOUI, P., GALLAY, A., et al., -Significant increase of Neisseria gonorrhoeae infections in France: data from the RENAGO and RESIST networks as of 31 December 2009. Bull Epidemiol Hebdom.:26-8., 2011;

7.       BOUYSSOU, A., JANIER, M., DUPIN, N., ALCARAZ, I., VERNAY-VAISSE, C., BASSELIER, B., et al., -Syphilis in France: Analysis of ten years surveillance data, 2000-2009. Bull Epidemiol Hebd 26-8., 2011;

8.       BIGNELL, C., IUSTI/WHO.-2009, -European (IUSTI/WHO) guideline on the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS. 20(7):453-7., 2009;

9.       ENKI, D.G., NOUFAILY, A., GARTHWAITE, P.H., ANDREWS, N.J., CHARLETT, A., LANE, C., et al., -Automated biosurveillance data from England and Wales, 1991-2011. Emerg Infect Dis. 19(1):35-42.,2013.

 

 



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