Search

Background Diagnoses of bacterial sexually transmitted infections (STIs) have increased in France since the 2000s. The main strategy to control STI transmission is recommending/facilitating access to condom use, testing, and antibiotic treatments. Aim This study analyses the evolution of STI testing in the private sector in France from 2006 to 2020. Methods National health insurance reimbursement data were used to determine numbers and rates of individuals aged ≥ 15 years tested for diagnoses of chlamydia, gonorrhoea and syphilis in the private sector in France and to describe their evolution from 2006 to 2020. Results Upward tendencies in testing were observed from 2006 to 2019 for all three STIs. The highest testing rates were identified in people aged 25‒29-years old. The observed testing-increase from 2017 to 2019 was twice as high in young people ( Conclusion Improvements found in STI testing rates may have resulted from better awareness, especially among young people and health professionals, of the importance of testing, following prevention campaigns. Nevertheless, testing levels remain insufficient considering increasing diagnoses. In 2020, the COVID-19 pandemic had a considerable impact on STI testing. Partner notification and offering diverse testing opportunities including self-sampling are essential to control STI epidemics particularly in exposed populations.

International audience; Objective: To characterize the current profile of gonococcal infections in France, and to describe their management. Patients and method: A population-based retrospective study of all gonococcal infections documented by PCR in two French departments (Île-et-Vilaine, Morbihan), in 2014–2016. Cases were identified through hospital databases and the Rénago sentinel network. Results: We enrolled 245 patients (96 females, 149 males), with a median age of 25 years [interquartile range, 21–33]. The incidence rate was estimated at 4.54 per 100,000 inhabitants-year. Cases were diagnosed mostly by a general practitioner (n = 122, 49.8%) or a gynecologist (n = 45, 18.4%). The main clinical presentations included urethritis (n = 59), pelvic inflammatory disease (n = 40), cervicitis (n = 12), and anorectitis (n = 11). The main coinfections were Chlamydia trachomatis (n = 40) and HIV (n = 8). Ceftriaxone MIC was ≤ 0.12 mg/L in 146/147 patients with positive culture. Treatment was appropriate in 52/74 (70.2%) patients with available data. Conclusions: In France, general practitioners are at the front line in management of gonococcal infections. © 2020 Elsevier Masson SAS

BACKGROUND Viral and bacterial sexually transmitted infections (STI) are public health concerns worldwide but surveillance systems are not comprehensive enough to design and monitor accurately STI control strategies in most countries. In 2016, 320 STI clinics (CeGIDD in French) with expanded sexual health missions were implemented in France, primarily targeting most exposed populations, although access is free of charge for anybody. OBJECTIVE This article describes the mandatory surveillance system (SurCeGIDD) based on CeGIDDs’ individual data aiming to better guide STI prevention. METHODS A decree ensured the use of software to manage consultations in CeGIDDs and to transfer surveillance data. A webservice was implemented to secure data transfer from CeGIDDs’ softwares to a centralized database. CeGIDDs can also transfer data in CSV format via a secured data-sharing platform. Then, data are automatically checked before integration. Socio-demographic variables, sexual exposure, blood exposure, symptoms, STI tests, STI diagnoses and sexual health services delivery were collected for the previous year (n-1). Preliminary and descriptive analyses of 2017-2018 data, respectively transmitted in 2018 and 2019, were performed using numbers and proportions for qualitative variables. RESULTS In 2017, 54 (out of 320 , i.e. 17%) of CeGIDD transmitted their data. In 2018, this number of participants increased to 143 (45%) CeGIDDs. Corresponding volume of records increased from 2,414 in 2017 to 382,890 in 2018. In 2018, majority of attendances were hospital based (69%, n= 263,480). Considering the growing volume of information, an advisory committee was set up to guide the construction of algorithms enabling accurate data management and analyses. CONCLUSIONS The automated surveillance SurCeGID is functional despites challenges hampering its expansion. The effectiveness of surveillances using routinely collected records, demonstrated through the monitoring of Covid-19 pandemic, might help to better guide and evaluate STI prevention and services delivery.

Background Viral and bacterial sexually transmitted infections (STIs) are public health concerns worldwide, but surveillance systems are not comprehensive enough to design and monitor accurately STI control strategies in most countries. In 2016, 320 STI clinics (CeGIDDs in French) were implemented in France, primarily targeting most exposed populations, although access is free of charge for anybody. Objective This article describes the mandatory surveillance system (SurCeGIDD) based on CeGIDD’s individual data aiming to better guide STI prevention. Methods A decree ensured the use of software to manage consultations in CeGIDDs and to transfer surveillance data. A web service was implemented to secure data transfer from CeGIDDs’ software to a centralized database. CeGIDDs can also transfer data in CSV format via a secured data-sharing platform. Then, data are automatically checked before integration. Data on sociodemographic variables, sexual exposure, blood exposure, symptoms, STI tests, STI diagnoses, and sexual health services delivery were collected for the previous year (n–1). Preliminary and descriptive analyses of 2017-2018 data transmitted in 2018 and 2019, respectively, were performed using numbers and proportions for qualitative variables. Results In 2017, 54/320 (16.9%) CeGIDDs transmitted their data. In 2018, this number of participants increased to 143/320 (44.7%) CeGIDDs. The corresponding volume of records increased from 2414 in 2017 to 382,890 in 2018. In 2018, most attendances were hospital based (263,480/382,890, 68.81%). In 2018, attendees were mostly men 227,326/379,921 (59.84%), while 151,963/379,921 (40%) were women 632/379,921 (0.17%) transgenders. The median age was 27 years for men, 23 years for women, and 30 years for transgender. Half of the attendees (81,964/174,932, 46.85%) were heterosexual men, 69,016/174,932 (39.45%) heterosexual women, 20,764/174,932 (11.87%) men who have sex with men, and 3188/174,932 (1.82%) women who have sex with women. A majority of them were born in France (227,698/286,289, 79.53%) and unemployed 115,913/211,707 (54.75%). The positivity rates were 0.37% for 205,348 HIV serologies, 1.31% for 131,551 hepatitis B virus serologies, 7.16% for 161,241 Chlamydia trachomatis PCR, 2.83% for 146,649 gonorrhea PCR, 1.04% for the syphilis combination of treponema and nontreponema serologies, and 5.96% for 13,313 Mycoplasma genitalium PCR. Conclusions Despite challenges, the effectiveness of the SurCeGIDD surveillance based on routine patients’ records was demonstrated. The wide range of information, including socioeconomic determinants, might help to better guide and evaluate the prevention policies and services delivery. However, the growing volumes of information will require adapted tools and algorithms for the data management and analyses.

Background In 2016–2017, a European-wide circulation of genotype IA hepatitis A virus was responsible for hepatitis A outbreaks in men who have sex with men (MSM). This study aimed to describe the outbreak investigation in Seine-Maritime department (France) and the control measures implemented accordingly. Methods Outbreak description used data from mandatory reporting and enhanced surveillance of male cases. Confirmed case was genotype IA isolated, possible cases had no reported genotype information. Targeted control measures included communication on sexual practices at risk of hepatitis A transmission and two vaccination campaigns in April 2017 and January 2018. Characteristics of cases and vaccinees were described. We reported the best communication channel for relaying outbreak information and control measures based on the monitoring of social network activities and feedback from vaccinees. Results During the outbreak period (December 2016 to December 2017), a total of 48 confirmed outbreak cases and 30 possible outbreak cases were notified. Among them, 69 were male (88%). Two epidemic waves were observed. Cases encountered their partners through gay-dating apps (54%) and in one specific sauna (62%). In response to the outbreak, two vaccination campaigns were deployed. A total of 156 MSM were vaccinated, of whom 56 in a truck parked beside the sauna. Most of the vaccinees had been informed about the campaign through dating apps (44%). Community-based organizations involved in sexual health promotion and other gay social media were very proactive in sharing information about the outbreak and promoting the vaccination campaign through their social media account and also on site (gay venues). Vaccinees reported the same sexual practices at risk of hepatitis A transmission as cases. Conclusions In response to this massive hepatitis A outbreak that affected mostly MSM in Seine-Maritime department, vaccination campaign remained the cornerstone of prevention. Prevention officers from the community-based organization played a key role in vaccination promotion. Gay-dating apps and outdoor sessions of vaccination allowed to effectively reach MSM. Cost-effectiveness studies might analyze the interest of a continuous sexual health promotion including vaccination against hepatitis A in MSM through dating apps and social networks.

Diagnoses of bacterial sexually transmitted infections (STI) have been increasing in France since their resurgence in the late 1990s. This article presents recent epidemiological trends until 2016 and the patients’ characteristics. STI surveillance relies on sentinel networks: a clinician-based network RésIST (clinical, biological and behavioural data for early syphilis and gonorrhoea), the lymphogranuloma venereum (LGV) network (clinical, biological and behavioural data for rectal LGV, and the laboratory networks Rénachla and Rénago (demographic and biological data for chlamydial infections and gonorrhoea, respectively). Here we describe trends between 2014 and 2016, using data from diagnostic centres which participated regularly during the study period. The number of early syphilis, gonorrhoea and LGV diagnoses increased between 2014 and 2016, particularly in men who have sex with men. An increase in syphilis and gonorrhoea cases was also observed in heterosexuals. Nevertheless, we observed a drop in 2016 for syphilis and chlamydial infections after two decades of increases. Under-reporting and shortage of benzathine penicillin in 2016 may explain this latest evolution. Regular screening of patients and partners, followed by prompt treatment, remains essential to interrupt STI transmission in a context where human immunodeficiency virus (HIV) prevention has expanded towards biomedical prophylaxis.

International audience; BACKGROUND:In a context of increasing use of Nucleic Acid Amplification Test, diagnoses of Neisseria gonorrhoeae and Chlamydia trachomatis infections among men increased in Europe and USA since 2007. We aimed to describe trends in the incidence of male urethritis in France between 2007 and 2017.METHODS:We analysed male urethritis clinical cases reported by the French GPs' Sentinelles network.RESULTS:GPs reported 1944 cases of male urethritis during the study period. The estimated annual incidence rates in men aged 15 years and older remained stable between 226 cases per 100,000 seen in 2007 and 196 in 2017 (P value = 0.9). A third-generation cephalosporin with macrolide or tetracycline was prescribed in 17.5% of cases in 2009 (27/154) and 32.4% in 2017 (47/145) (P value = 0.0327).CONCLUSIONS:The incidence rates for adult male urethritis diagnosed in primary care have remained stable since 2007 in France in contrast with the increasing trend of Neisseria gonorrhoeae and Chlamydia trachomatis infections based on microbiological surveillance. Using stable clinical definition for male urethritis seems essential to follow correctly epidemiological dynamic.

We report a multidrug-resistant Neisseria gonorrhoeae urogenital and pharyngeal infection with ceftriaxone resistance and intermediate resistance to azithromycin in a heterosexual woman in her 20s in France. Treatment with ceftriaxone plus doxycycline failed for the pharyngeal localisation. Whole-genome sequencing of isolate F90 identified MLST1903, NG-MAST ST3435, NG-STAR233, and relevant resistance determinants. F90 showed phenotypic and genotypic similarities to an internationally spreading multidrug-resistant and ceftriaxone-resistant clone detected in Japan and subsequently in Australia, Canada and Denmark.

We report a multidrug-resistant Neisseria gonorrhoeae urogenital and pharyngeal infection with ceftriaxone resistance and intermediate resistance to azithromycin in a heterosexual woman in her 20s in France. Treatment with ceftriaxone plus doxycycline failed for the pharyngeal localisation. Whole-genome sequencing of isolate F90 identified MLST1903, NG-MAST ST3435, NG-STAR233, and relevant resistance determinants. F90 showed phenotypic and genotypic similarities to an internationally spreading multidrug-resistant and ceftriaxone-resistant clone detected in Japan and subsequently in Australia, Canada and Denmark.

ObjectiveIn France, surveillance of early syphilis (primary, secondary and early latent) relies on the clinician-based ResIST sentinel network. Although ResIST enables the monitoring of trends, a complete picture of the syphilis epidemic is not possible. More specifically, cases reported by this network are mostly diagnosed in free sexually transmitted infection clinics and hospitals (75% and 24%, respectively). This study aims to estimate the number and rate of diagnoses made outside these health facilities by exploring health insurance data.MethodsAn algorithm combining healthcare reimbursements for specific diagnostic tests and recommended treatment was fitted to identify syphilis cases. Sensitivity analyses were used to validate the algorithm. Age-standardised and gender-standardised diagnosis rates were estimated using census data.ResultsBetween 2011 and 2013, 12 644 (7.5 cases per 100 000 inhabitants) reimbursements were made for syphilis-related diagnoses. The annual number of cases increased by 22% from 2011 (n=3771, rate=6.7/100 000) to 2013 (n=4589, rate=8.2/100 000). The rate of syphilis diagnosis increased in men from 12.9/100 000 to 16.0/100 000, while it remained steady in women at approximately 1.8/100 000. The disease burden was greatest in French overseas territories (18.1/100 000) and in the Paris area (11.7 cases/100 000).ConclusionDespite the lack of data on the number of confirmed diagnoses and information on sexual behaviour, these findings demonstrate the relevance of analysing insurance data to help monitor the syphilis epidemic in patients who visit general practitioners and non-hospital-based specialists. Thus, reimbursement database might be a relevant alternative source of continuous information on syphilis in countries with similar insurance-based healthcare systems.

TB is a major public health concern throughout the world. In the developing world, informal care is one of the factors that contribute to the spread of the epidemic through delayed treatment initiation. The objective of this study was to examine the care-seeking behavior of TB patients from the onset of symptoms to the start of treatment and to assess the risk factors associated with the informal treatment of symptoms of tuberculosis in N'djamena and Moundou (Chad). A questionnaire survey was conducted among 286?newly diagnosed pulmonary tuberculosis patients (? 15 years old). A logistic regression model was used to assess the factors associated with informal care use. The study found that 40% of the patients had used informal care before undergoing treatment. Informal care use was found to be associated with the treatment site, belonging to a lower social class, the belief in the effectiveness of traditional treatment methods, a chronic disease and the belief that other people hide their disease. Although the diagnosis and treatment of tuberculosis are both free in Chad, delayed treatment initiation is common among many patients, who often resort to informal care. Health education, interventions aimed at reducing the financial impact of the disease and the active involvement of traditional healers in the detection of tuberculosis can contribute to promoting early access to public health services for the treatment of TB symptoms.

Background Tuberculosis remains one of the leading causes of morbidity and mortality in low-resource countries. One contagious patient can infect 10 to 20 contacts in these settings. Delays in diagnosing TB therefore contribute to the spread of the disease and sustain the epidemic. Objectives The aim of this study was to assess delays in diagnosing tuberculosis and the factors associated with these delays in the public hospitals in Moundou and Ndjamena, Chad. Methods A structured questionnaire was administered to 286 new tuberculosis patients to evaluate patient delay (time from the onset of symptoms to the first formal or informal care), health-care system delay (time from the first health care to tuberculosis treatment) and total delay (sum of the patient and system delays). Logistic regression was used to identify risk factors associated with long diagnostic delays (defined as greater than the median). Results and discussion The median [interquartile range] patient delay, system delay and total delay were 15 [7–30], 36 [19–65] and 57.5 [33–95] days, respectively. Low economic status (aOR [adjusted odds ratio] =2.38 [1.08-5.25]), not being referred to a health service (aOR = 1.75 [1.02- 3.02]) and a secondary level education (aOR = 0.33 [0.12-0.92]) were associated with a long patient delay. Risk factors for a long system delay were a low level of education (aOR = 4.71 [1.34-16.51]) and the belief that traditional medicine and informal care can cure TB (aOR = 5.46 [2.37-12.60]). Conclusion Targeted strengthening of the health-care system, including improving patient access, addressing deficiencies in health-related human resources, and improving laboratory networks and linkages as well as community mobilization will make for better outcomes in tuberculosis diagnosis.