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Gonorrhoea, a condition on the rise, is associated with high morbidity, and the possibility of reproductive sequelae has become a public health problem in Denmark. It is important to perform swabs for gonorrhoea from all relevant anatomical locations, whether or not there are symptoms. Through complete microbiological diagnostics, treatment with recommended antibiotics and partner detection, infection chains can be broken. Whole-genome sequencing in real time will identify outbreaks in high-risk populations.

Introduction: The aim of the study was to assess the incidence of sexually transmitted infections (STIs) in immigrants in Denmark., Material and Methods: Analysis of surveillance data from 1.8.1990-31.5.2000 for HIV infection and from 1.1.1994-31.5.2000 for gonorrhoea and syphilis. National data on the population mainly per 1.1.1998 were used., Results: Overall, 28% of the notified, newly diagnosed HIV-infected persons were foreigners, a proportion which was 18% for both cases with gonorrhoea and syphilis; 488 (64%) were from Africa, whereas 110 (14%) were from Europe. The estimated annual incidence of first-time diagnosed HIV infection was five times higher in immigrants than in native Danes (22.3 vs 4.1 per 10(5)), namely 161.8 per 10(5) in Africans and 5.6 per 10(5) in Europeans. Similar differences were found for gonorrhoea (6.87 vs 2.14 per 10(5)) and syphilis (1.66 vs 0.16 per 10(5)). In addition, the annual incidence of newly diagnosed HIV was three times higher in male and 16 times higher in female immigrants than in Danes. The incidence of both gonorrhoea and syphilis in Danes was five times higher in men than in women, which was also found for gonorrhoea in immigrants. In immigrants, no real difference in the incidence of HIV and syphilis was found between the two genders., Conclusion: The incidence of diagnosed HIV infection, gonorrhoea, and syphilis in Denmark is generally low, but fairly high in certain groups of immigrants. Information, early diagnosis and treatment are central elements in the prevention of STIs and should be adapted for new sub-populations.

During this century the incidence of gonorrhoea in Greenland has increased continuously and since the late 1960's syphilis has been reported with two epidemic peaks in 1976 and 1987. In 1986 a systematic intervention strategy was initiated consisting of 1) information and education, 2) enhancement of the attention of the medical profession to STD 3) critical evaluation of methods of examination and treatment 4) carefully performed partner notification and the use of epi-treatment of contacts in selected cases and finally 5) continued public information about the result of these efforts and the prevention of spread of HIV-infection. Education was established in schools. Instructions for examination and treatment were renewed, special training was offered to health care personnel, and in 1988 a venereologist was employed by the Health Service. An almost constant decline in the incidences of both gonorrhoea and syphilis has now been demonstrated, which may easily be attributed to the above measures. However, it is uncertain whether the reduction is due to the improved treatment or a real change in sexual behaviour. Studies of knowledge and behaviour indicate that it is still necessary to influence attitudes to sexual behaviour, and to teach "safer sex" in order to further reduce the incidence of STD and to impede the spread of HIV.

A total of 803 patients participated in a consecutive review of the disease pattern concerning venereal diseases. The investigation took place in the Clinic for Venereal Diseases in Nuuk/Godthåb during a period of three months. Less than half of the contacts were on account of symptoms of genital infection. One fifth of the patients had been summoned for partner control. A corresponding proportion felt well and had not been exposed to any known risk of infection. Chlamydia trachomatis was demonstrated in 19% and gonorrhoea in 10%. Among the asymptomatic persons, 16% were found to be Chlamydia positive and 0.6% gonococcal positive. Syphilis was demonstrated in one man and one woman. One man was known to be HIV-positive and two contacts of this patient were found to be negative but seroconversion occurred subsequently in both cases. Vaginitis and bacterial vaginosis were found in 38% of the women. In over one third (39%), no clinical or microbiological evidence of genital infection was found. Early diagnosis, treatment, information and tracing of contacts are still the cardinal principles in the combat of venereal diseases in Greenland.

The prescript requiring application of silver nitrate eye drops (0.66% AgNO3) to the conjunctivae of the newborn within two hours after delivery was revoked in March 1985. The present study comprises a prospective investigation of the occurrence of microorganisms in specimens of eye secretion from neonates received during the period February-April 1986, and a review of findings of Neisseria species and B. catarrhalis in 3,485 specimens of ocular secretions and of C. trachomatis in 1,240 conjunctival scrapes received at the Neisseria Department 1986-1988. The numbers of cases of conjunctivitis neonatalis caused by the following microorganisms were: N. gonorrhoeae 8, N. cinerea 6, other Neisseria species 8, B. catarrhalis 49 and C. trachomatis 92. During the period 1984-1988, the total number of neonates with gonococcal conjunctivitis neonatalis was 18. The gonococcal infection was diagnosed within the first week of life in 50% of the cases but could occur as late as in the fourth week of life. Similarly, infection with B. catarrhalis was most common in neonates less than one week old (49%), whereas chlamydial infection was most common in the second week of life (39%). It is concluded that the eyes of neonates should be carefully observed for at least four weeks and that microbiological examinations for gonococci and chlamydia are indicated if signs of infection appear.

The first case of HIV infection in Greenland was demonstrated towards the end of 1985 and, since then, a general informative campaign was instituted and teaching material about AIDS and HIV infection were prepared for use in schools. This activity was particularly great in 1987 and 1988. The main messages were 1) use of condoms and 2) reduction in the number of sexual partners. The incidence of gonorrhoea has been very high for many years in Greenland and the incidence of gonorrhoea was employed as indicator for the effect of the prophylactic campaign. Investigation revealed a decrease of 67% during the period 1985-1988. The decrease was particularly great in 1988 (58%). There appears to be a direct connection between this observation and the two main messages of the campaign as the employment of condoms increased tenfold during the period 1986-1988 end contact investigations revealed a decrease in the number of unknown sexual partners. On the other hand, no definite decrease in the total number of sexual partners was reported by patients attending the clinic for Venereal Diseases in Godthåb. It is emphasized that the incidence of gonorrhoea has decreased markedly but it is still considerably higher than the incidence in Denmark. Continued and active prophylactic efforts are still required.

All 335 pregnant women referred for termination of pregnancy in the first trimester were examined preoperatively for infection with Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) and were questioned about symptoms of gynaecological infection. Only 0.6% had positive cultures for gonorrhoeae while CT infection was demonstrated in 7.8%. Half of the women with infection had one of the following symptoms: discharge, pain or dysuria. These same symptoms were, however, also found in half of the women without infection. All gynaecological special departments in Denmark and a few of the surgical departments which carry out termination of pregnancy replied to a questionnaire about routine examinations for NG and CT in cases of termination of pregnancy. Only 29.2% of the departments made routine preoperative examinations for CT, NG or both. It is concluded that there are no indications for routine examination for gonococcal infection whereas screening for CT infection appears to be indicated.