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Surveillance systems for STIs in the European Union: facing a changing epidemiology
  1. C M Lowndes1,
  2. K A Fenton1,2,
  3. the ESSTI (European Surveillance of STIs) Network*
  1. 1Department of HIV and Sexually Transmitted Infections, Health Protection Agency Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK
  2. 2Centre 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
  1. 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;


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.

  • 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
  • European Union
  • STIs
  • surveillance
  • prevention

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  • * ESSTI Network: members of ESSTI collaborative and steering groups

    Austria: Reinhild Strauss, BM for Social Security and Generations, Vienna, Austria; Angelika Stary, Outpatient Center for Diagnosis of Infectious Venerodermatological Diseases, Vienna. Belgium: Andre Sasse, Epidemiology Section, Scientific Institute of Public Health, Brussels; Marjan Van Esbroeck, Inst. voor Tropishe Geneeskunde, Antwerp. Denmark: Else Smith, Department of Epidemiology, Statens Serum Institut, Copenhagen; Steen Hoffmann*, Department of Epidemiology, Statens Serum Institut, Copenhagen. Finland: Matti Lehtinen, National Public Health Institute, Helsinki; Pentti Huovinen, Antimicrobial Research Laboratory, National Public Health Institute, Turku. France: Veronique Goulet; Francoise Hamers*, Institut de Veille Sanitaire; Dépt des maladies infectieuses, St Maurice; Patrice Sednaoui, Laboratoire de Bactériologie, Institut Fournier, Paris. Germany: Osamah Hamouda, Infektionsepidemiologie/AIDS-Zentrum, Robert Koch Institut, Berlin; Peter Kohl, Department of Dermatology and Venereology, Neukolln Academic Hospital, Free University of Berlin. Greece: Mina Psichogiou, Hellenic Center for Infectious Diseases Control, Department for Surveillance and Intervention, Athens; Eva Tzelepi, National Reference Center for N gonorrhoeae, Hellenic Pasteur Institute, Athens. Ireland: Mary Cronin, National Disease Surveillance Centre, Dublin. Italy: Barbara Suligoi*, Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome; Paola Stefanelli, Department of Infectious, Parasitic and Immuno-mediated Diseases, Istituto Superiore di Sanità, Rome. Netherlands: Marita van de Laar*, National Institute of Public Health and the Environment (RIVM), Department of Infectious Disease Epidemiology, Bilthoven; Joke Spaargaren, GG and GD Amsterdam, Public Health Laboratory, Amsterdam. Norway: Hans Blystad, Norwegian Institute of Public Health, Oslo; Jorgen Lassen, Norwegian Institute of Public Health, Oslo. Portugal: Jacinta Azevedo, Consulta de DST do Centro de Saude da Lapa, Lisbon; Maria Jose Borrego, Centro de Bacteriologia, Instituto Nacional de Saude Dr Ricardo Jorge, Lisbon. Spain: Jesús Castilla, Centro Nacional de Epidemiología, Instituto de Salud Carlos lll, Madrid; Julio Vazquez, Centro Nacional de Microbiologia, Madrid. Sweden: Torsten Berglund*, Swedish Institute for Infectious Disease Control, Solna; Johan Giesecke*, Swedish Institute for Infectious Disease Control, Solna; Hans Fredlund, Swedish Reference Laboratory for Pathogenic Neisseria, University Hospital, Örebro. UK: Mike Catchpole*, Health Protection Agency Communicable Disease Surveillance Centre, London; Hugh Young*, Scottish Neisseria gonorrhoeae Reference Laboratory (SNGRL), Laboratory Medicine (Microbiology), Edinburgh Royal Infirmary, Edinburgh; Chris Bartlett*, UCL Centre for Infectious Disease Epidemiology, Department of Primary Care and Population Sciences, London; Cathy Ison*, Department of Infectious Diseases and Microbiology, Imperial College School of Medicine, London; Jodi Cooper, Health Protection Agency Communicable Disease Surveillance Centre, London; Anne Scoular, Scottish Centre for infection and Environmental Health, Glasgow.

    Member of ESSTI Steering Group.