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How to do it: lessons identified from investigating and trying to control an outbreak of gonorrhoea in young heterosexual adults
  1. K Foster1,
  2. M Cole2,
  3. O Hotonu3,
  4. J Stonebridge1,
  5. G Hughes4,
  6. I Simms4,
  7. C Ison2,
  8. A Waldram5
  1. 1Health Protection Team, Public Health England North East
  2. 2Sexually Transmitted Bacteria Reference Unit, Public Health England Centre for Infectious Disease Surveillance and Control, London, UK
  3. 3Northumberland Sexual Health Service, Northumbria NHS Foundation Trust, Morpeth, UK
  4. 4HIV and STI Department, Public Health England Centre for Infectious Disease Surveillance and Control, London, UK
  5. 5Field Epidemiology Service Newcastle, Public Health England, Newcastle upon Tyne, UK
  1. Correspondence to Dr K Foster, Public Health England North East, Citygate, Gallowgate, Newcastle upon Tyne NE1 4WH, UK; kirsty.foster{at}

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In the early summer of 2011, clinicians at Northumberland Sexual Health clinic noticed a sustained increase in cases of gonorrhoea and, more noticeably, a change in case profile from the usual picture of predominantly men who have sex with men (MSM) to heterosexual young adults, with more young females affected. The lead clinician contacted the local Health Protection Team (HPT) to seek advice about investigation and public health interventions. A multiagency outbreak control team (OCT) was convened to coordinate the investigation and control measures.

Over the following 3-year period, 360 cases of gonorrhoea were detected in a locally discrete population (figure 1) affecting mainly young heterosexual adults. Patterns of transmission were studied and control measures implemented; however, cases continued to occur at rates higher than pre-outbreak levels.

Figure 1

Epidemic curve of outbreak showing all gonorrhoea cases resident in Northumberland, January 2010 to November 2014, including dates when outbreak control actions were initiated. *2010 data were extracted from GUMCAD, 2011 onwards were from enhanced surveillance.

We describe the approaches taken for investigation and implementation of control measures, reflect on lessons learned and offer advice to colleagues facing similar situations. Figure 1 describes the actions taken over the course of the outbreak investigation.

Clinical management of cases and contacts

Cases were managed according to UK national standards.1 Almost all cases were treated on the day of diagnosis. All patients were advised to return for a test of cure; 50% did and all were negative. Eighty-five per cent of cases were treated with ceftriaxone and azithromycin. All cases were offered a full sexually transmitted infection (STI)/HIV screen; 97% accepted. The main reason for declining a full STI screen was not wishing to have a blood sample collected.

Response to a change in case profile

Guidance on the investigation and management of outbreaks of STIs, including the different teams and organisations that should be included, is available2 …

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  • Contributors All authors were members of the outbreak control team; all authors contributed to early discussions about the format of the paper. KF drafted the first version and all authors contributed to further versions and agreed final content. AW undertook the analysis of enhanced surveillance data and compiled the network diagrams and MC completed the molecular analysis.

  • Competing interests None declared.

  • Ethics approval All work reported was carried out as part of an outbreak investigation and therefore ethics approval was not required. PHE has authority to collect patient-level data for public health monitoring and infection control under section 251 of the NHS Act 2006. Prior to 2013 permission was granted to the Health Protection Agency, PHE's predecessor organisation, under section 251 by the Ethics and Confidentiality Committee of the National information Governance Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data held at Public Health England North East; available to appropriate practitioners for internal surveillance purposes only.

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