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Sexually transmitted infections (STIs) can impair sexual health. Surveillance and study data were used to provide an overview over STIs in Germany. We estimated 3900 new HIV diagnoses in 2015. Of newly diagnosed infections, 57% were attributed to men who have sex with men (MSM). It was further estimated that there were 3200 new HIV infections and 84,700 people living with HIV in 2015. A total of 6834 syphilis infections were recorded in 2015, which corresponds to an increase of 149% since 2009. The incidence in men was 16-times higher than in women. Of syphilis infections, 85% could be attributed to MSM. Antimicrobial resistance of gonococci against the broad-spectrum antibiotic cefixime decreased between 2014 and 2016 after a change of therapy guidelines and remained stable on a low level regarding the antibiotic ceftriaxone. After an increase of resistance against the antibiotic azithromycin to 11.3% in 2015, we observed a decreasing trend in 2016. Between 2013 and 2015, 2,355,336 chlamydia tests were reported through the chlamydia sentinel network. Of these, 92.5% of samples were from women. Uptake for screening for women

Weltweit sind zunehmende Antibiotikaresistenzen (AMR) bei Infektionen mit Neisseria gonorrhoeae (NG) zu beobachten. Aufgrund der fehlenden Meldepflicht in Deutschland stehen kaum epidemiologische und bevolkerungsbezogene Daten zur Verbreitung von NG-Infektionen und deren AMR zur Verfugung. Ziel der hier vorgestellten Erhebung war die Erfassung der NG-Diagnostikmethoden und AMR-Testungen von Laboren in Deutschland. Zwischen Juni und August 2013 wurde eine Querschnittserhebung in Deutschland uber einen Online-Fragebogen durchgefuhrt. Labore mit NG-Diagnostik wurden identifiziert, um sie hinsichtlich der Diagnostikmethoden, des Probenumfangs, der getesteten Antibiotika, der beobachteten AMR sowie mit Blick auf allgemeine Laborangaben zu charakterisieren. Insgesamt fuhrten 188 von 521 teilnehmenden Laboren eine NG-Diagnostik durch. Ihre Angaben waren somit Grundlage fur die weiteren statistischen Auswertungen. 92,6 % der Labore fuhrten einen Kulturnachweis durch. Im Median wurden 60 Proben pro Quartal (PpQ) (IQR 15–270) getestet. Der Positivenanteil unter Mannern lag bei 4,1 % sowie 6,9 %. Die Mehrzahl (82,1 %) der 151 Labore mit Kulturnachweis fuhrte eine AMR-Testung durch. Die hier am haufigsten getesteten Antibiotika waren Ciprofloxacin (94,8 %), Penicillin (93,1 %), Doxycyclin (70,0 %) und Ceftriaxon (67,2 %). Die Antibiotika gegen die am haufigsten jemals Resistenzen beobachtet wurden waren Ciprofloxacin (87,1 %), Penicillin (78,3 %), Doxycyclin (56,6 %) und Azithromycin (35,1 %; alle Angaben als Protzentsatz der Labore). Es wurden unterschiedliche AMR-Ablesestandards verwendet. Die weltweite Resistenzentwicklung weist darauf hin, dass eine regelmasige Uberwachung von AMR bei NG-Infektionen erforderlich ist. Die im Rahmen der Studie erhobenen Daten zur deutschen Laborlandschaft bei der NG-Diagnostik bieten hierfur eine wichtige Voraussetzung.

Objectives To determine the prevalence of pharyngeal and rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among men who have sex with men (MSM) in Germany and describe associations between these infections, sexual practices and other factors to provide an evidence base for screening recommendations. Methods We conducted a cross-sectional study in 22 sentinel sites of sexually transmitted infections across Germany. Pharyngeal and rectal swabs were collected and tested for CT and NG with a nucleic acid amplification test (NAAT). Information on HIV status, number of sex partners and sexual practices was collected and linked to NAAT results. Results Overall, 2247 MSM were screened for pharyngeal or rectal CT and NG infections; median age was 34 years (range 16–83). Prevalence of CT was 1.5% in pharyngeal and 8.0% in rectal specimens. Prevalence of NG was 5.5% in pharyngeal and 4.6% in rectal specimens. Local symptoms were reported in 5.1% of pharyngeal and 11.9% of rectal infections. Altogether 90.8% of rectal or pharyngeal infections would remain undetected if only symptomatic cases were tested. Rectal infection was significantly more likely in men reporting multiple partners (2–5 partners, OR=1.85; 6–10 partners, OR=2.10; >11 partners, OR=2.95), men diagnosed with HIV (OR=1.60) and men practising receptive anal intercourse without a condom (OR=1.54). Pharyngeal infection was more likely in men reporting multiple partners (6–10 partners, OR=2.88; >11 partners, OR=4.96), and men diagnosed with HIV (OR=1.78). Conclusions Pharyngeal and rectal infections in sexually active MSM can remain undetected and thus transmissible if swabbing is not offered routinely. Screening should be offered particularly to MSM diagnosed with HIV and MSM reporting multiple partners.

Chlamydia trachomatis (CT) infections are not reportable in Germany and limited data on prevalence are available. CT screening has been offered free of charge to pregnant women since 1995 and to all women under 25 years since 2008. For symptomatic women and men, diagnostic testing is covered by statutory health insurance. We describe the establishment of a nationwide, laboratory-based, voluntary sentinel that electronically collects information on all performed CT tests with test results, test reason and patient information. The sentinel represents one third of all performed CT tests in Germany. In the period from 2008 to 2014, 3,877,588 CT tests were reported, 93% in women. Women aged 20–24 years and men aged 25–29 years were the most frequently tested age groups. The overall proportion of positive tests (PPT) among women was 3.9% and among men 11.0%. The highest PPT among women was in the age groups 15–19 (6.8%) and 20–24 years (5.9%), and among men in the age groups 20–24 (19.2%), 15–19 (15.4%) and 25–29 years (14.8%). The PPT for CT was high among women and men younger than 25 years. Prevention is urgently needed. Monitoring of CT infection in Germany should be continued.

In Germany, routine RV-vaccination is not adopted into the national immunization schedule as of 2012. Because RV-vaccines were already on the market since 2006, in 2010 a moderate (58%) and low (22%) vaccine uptake was observed in the 5 eastern federal states (EFS) and the 11 western federal states (WFS), respectively. To assess the impact of RV-vaccination, we compared the incidence rates (IR) of RV-related hospitalizations before (2004‒2006) and in seasons after (2008/09–2010/11) RV-vaccine introduction in Germany by utilizing data from the national mandatory disease reporting system. In the EFS, the IR was significantly reduced in age-groups < 18 mo in 2008/09 and in age-groups < 24 mo in 2009/10–2010/11. In the WFS an IR-reduction was observed only in age-groups < 12 mo in 2008/09 and in age-groups < 18 mo in 2009/10–2010/11. Overall IR-reduction in age-groups < 24 mo comparing 2008–11 with 2004–06 was 36% and 25% in EFS and WFS, respectively. In addition, we computed IR-ratios (IRR) in the seasons after mid-2006 with negative binomial regression. The effect of vaccination was independent from the geographic region. Vaccination was associated with a significant reduction in RV-related hospitalizations in the age-groups 6–23 mo. Most prominently, vaccination of 50% of infants led to an estimated decrease in age group 6–11 mo by 42%. No significant reduction was observed in age-groups ≥ 24 mo. In conclusion, in the German setting with low to moderate vaccine uptake, RV-related hospitalization incidence decreased substantially depending on the achieved vaccination coverage, but only in the first two years of life.

To determine prevalence of lymphogranuloma venereum among men who have sex with men in Germany, we conducted a multicenter study during 2009–2010 and found high rates of rectal and pharyngeal infection in men positive for the causative agent, Chlamydia trachomatis. Many infections were asymptomatic. An adjusted C. trachomatis screening policy is justified in Germany.

Background Chlamydia trachomatis (CT) infections are not reportable in Germany and limited data on CT-prevalence among women is available. In 2008 an opportunistic CT-screening programme for women Methods In September 2010 voluntary laboratory-based sentinel surveillance system was implemented and is collecting retrospective (from 2008) and prospective data on CT-tests together with information on age and test reason (TR). We calculated positivity rates (PR) by age-group and TR over years. We used Chi2 and two-sample t-test, accordingly. We estimated coverage of OCS by extrapolating the proportion of CT-tests attributable to OCS to the respective German population. Results As of 10.04.2015 data from 24 laboratories were available for analysis. Overall 93% (3,440,131) of all tests (3,701,288) were among women. Among those 24% were attributable to OCS, 36% to screening in pregnancy, 25% to diagnostic testing, and in 15% the TR was unknown. The coverage of OCS increased over time from 8% in 2008 to 11% in 2009, and 12% in 2014. PR was highest in age-groups 15–19 (6.75%) and 20–24 (5.93%) years compared to age-groups Conclusion The proportion of young women testing positive for CT is high despite gradual but slight decrease in PR among 15–24 years old women. OCS coverage in Germany is low and did not increase substantially in the last years. OCS should be promoted among the target population and physicians. Awareness campaigns for young women should be implemented. Respective regulations should be expanded and remuneration for counselling to physicians for OCS offered. Disclosure of interest statement Chlamydia trachomatis laboratory sentinel is funded by German Federal ministry of health. No conflicts of interest.

Introduction Neisseria gonorrhoeae (NG)-infections are not reportable in Germany and only limited data on NG-epidemiology and antimicrobial resistance (AMR) are available. With GORENET we monitor the NG-AMR and patterns of resistance testing in Germany in order to guide treatment algorithms and targeted prevention strategies. Methods We recruited laboratories based on geographic distribution and number of NG-isolates. From April 2014 prospective data on all performed NG-AMR-tests together with patient-related information were collected. Laboratories send a part of the isolates to the national reference laboratory (NRL) for culturing and AMR-testing towards ceftriaxone, cefixime, azithromycin, ciprofloxacin, and penicillin by using E-Test, as well as beta-lactamase. Results are interpreted according to European Committee on Antimicrobial Susceptibility Testing 4.0. We described the reported samples by sex and age and characterised isolates tested in NRL by resistance patterns. We calculated proportions and medians, together with interquartile range (IQR), where appropriate. Results Between April and December 2014 we received information on 651 isolates tested in 19 laboratories. Altogether, 90.3% isolates were from men and 8.5% from women. Median age of tested men was 36 (IQR 29–49) and women 28 (IQR 22–41) years. NRL received 502 isolates, 342 were vital and 253 were tested for AMR. From those 0 were resistant towards ceftriaxone, 1.6% towards cefixime, 11.1% towards azithromycin, 73.1% towards ciprofloxacin, and 30.4% towards penicillin. Further 37.9% and 50.6% isolates were intermediate susceptible to Azithromycin and to Penicillin. From 205 isolates tested for beta-lactamase, 25.9% were positive. Conclusion In Germany isolates tested for NG-AMR were mostly from men. We assume that a substantial proportion of these isolates could be from men having sex with men. NG-AMR to ceftriaxone and cefixime remains low, while resistance and intermediate susceptibility to azithromycin, ciprofloxacin and penicillin is substantial. Monitoring of NG-AMR should be highly prioritised. Disclosure of interest statement The GORENET Project is funded by German Federal Ministry of Health. No conflicts of interest.

Background Chlamydia trachomatis (CT) infections are not reportable in Germany and limited data on CT-prevalence among women is available. In 2008 an opportunistic CT screening programme for women Methods In September 2010 voluntary laboratory-based sentinel surveillance system was implemented and is collecting retrospective (from 2008) and prospective data on performed CT-tests together with results and information on age and test reason (TR). We calculated positivity rates (PR) by age and TR and compared them with Chi 2 test. We described data by time and estimated the proportion of the target population reached by OCS. Results As of 27.11.2012 data from 14 laboratories were available for analysis. These data cover approximately 25% of all CT-tests performed in Germany. Overall 90.6% (643,332) of all tests (710,021) were among women. Among those 19.1% (122,650) were attributable to OCS, 31.3% (201,322) to screening in pregnancy (CSP), 30.6% (197,013) to diagnostic test (DT), and in 19.0% (122,347) the TR was not known. The number of OCS-tests increased by 114% in 2009, 15% in 2010, and 7% in 2011 compared to the previous year. Extrapolating, OCS covered 10% of the target population. OCS PR was 5.3%, higher than for other TR (2.6% among CSP, and 3.9% among DT, p-value Conclusion The proportion of young women testing positive for CT was high. OCS coverage in Germany is insufficient and did not increase substantially in the last years. OCS should be promoted among the target population and physicians. Awareness campaigns for young women should be implemented. Respective regulations should be expanded and remuneration to physicians for OCS offered.