EPIDEMIOLOGICAL REVIEW

¹ Department of HIV and Sexually Transmitted Infections, Health Protection Agency Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK
² Centre for Sexual Health and HIV Research, Department of Primary Care and Population Sciences and Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, Mortimer Market Centre, off Capper Street, London WC1E 6AU, UK

Correspondence to:
Correspondence to:
Dr Catherine M Lowndes
Department of HIV and Sexually Transmitted Infections, Health Protection Agency, Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK; catherine.lowndes{at}hpa.org.uk

Objectives: To characterise the nature, content, and performance characteristics of existing national STI surveillance systems in the European Union (EU) and Norway, to facilitate collection of comparable surveillance data.

Methods: Cross sectional survey using a structured questionnaire.

Results: Case reporting from clinicians and/or laboratories is the mainstay of EU surveillance systems for bacterial STIs. Coverage of case reporting varies from less than 10% to over 75%, and lack of and/or heterogeneity in case definitions affect the relative specificity and sensitivity of reporting systems. Considerable variations also exist in STI care sites; the populations who use these services; and in partner notification practices, STI screening practices, and STI laboratory diagnostic tests employed, affecting the representativeness of reported data and the sensitivity of surveillance systems for detecting the true number of STI cases.

Conclusions: The heterogeneity of current surveillance systems complicates direct comparison of STI incidence rates across Europe. Introduction of standardised case definitions for reporting, and increased coverage of mandatory reporting systems where necessary, are needed. Definition of standardised minimum datasets and use of sentinel and enhanced surveillance systems to supplement universal case/laboratory notification data, could improve our understanding of the distribution and determinants of STIs across Europe, and aid in the design of effective public health responses. In the context of the changing epidemiology of STIs, systems for detection and monitoring of localised outbreaks of acute bacterial STIs (syphilis and antimicrobial resistant gonorrhoea), as well as prevalence monitoring systems for frequently asymptomatic STIs (chlamydial infection and viral STIs), are also necessary.

Abbreviations: DV, dermatovenereology; ESSTI, European Surveillance of Sexually Transmitted Infections; EU, European Union; GUM, genitourinary medicine; HPV, human papillomavirus; HSV, herpes simplex virus; IDUs, injecting drug users; MSM, men who have sex with men

Keywords: European Union; STIs; surveillance; prevention

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