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Just Google it! Impact of media coverage of an outbreak of high-level azithromycin-resistant Neisseria gonorrhoeae on online searches, and attendances, testing and diagnoses at sexual health clinics in England between 2015 and 2016: an interrupted time series analysis using surveillance data
  1. Christa Smolarchuk1,
  2. Hamish Mohammed1,
  3. Martina Furegato1,
  4. Katy Town1,2,
  5. Helen Fifer3,
  6. Janet Wilson4,
  7. Anthony Nardone5,
  8. Andrew Lee6,
  9. Gwenda Hughes1
  1. 1Blood Safety, Hepatitis, Sexually Transmitted Infections & HIV Division, Public Health England, London, UK
  2. 2Centre for Sexual Health & HIV Research, University College London, London, UK
  3. 3Bacteriology Reference Department, Public Health England Colindale, London, UK
  4. 4Leeds Sexual Health, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  5. 5Blood Safety, Hepatitis, Sexually Transmitted Infections & HIV Division, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
  6. 6Yorkshire & the Humber Health Protection Team, Public Health England, Leeds, UK
  1. Correspondence to Christa Smolarchuk, Blood Safety, Hepatitis, STI & HIV Division, Public Health England, London M1 3BN, UK; christa.smolarchuk{at}


Objectives To determine if media coverage of an outbreak of high-level azithromycin-resistant Neisseria gonorrhoeae (HL-AziR) impacted online search interest or was temporally associated with health-seeking behaviours in several English cities.

Methods A descriptive analysis of outbreak-related online media articles and relative search interest (RSI) using Google and an interrupted time series analysis using routine surveillance data from sexual health clinics (SHCs) in England (GUMCAD STI surveillance system). The main outcomes were adjusted incidence rate ratios (IRRs) of weekly attendances, gonorrhoea tests and diagnoses of gonorrhoea or ‘any STI’ in selected cities after media coverage of the outbreak in 2015 and 2016.

Results RSI for outbreak-related terms peaked during media coverage in September 2015 with smaller peaks coinciding with subsequent coverage. The greatest increase in RSI was in Leeds, which coincided with a 63% rise (n=1932; IRR 1.26, 95% CI 1.12 to 1.43) in SHC attendances by women. There was only a 7% (n=1358; IRR 1.01, 95% CI 0.91 to 1.11) increase in attendances by men. Modest increases in outcomes occurred in four other cities with a high RSI. There was no evidence of increases in outcomes in cities, other than Leeds, after subsequent media coverage of the outbreak.

Conclusions National and local media coverage of the HL-AziR outbreak coincided with peak RSI for related terms, and a transient increase in attendances, gonorrhoea tests and diagnoses of gonorrhoea or ‘any STI’ in some cities with a high RSI. Our analysis demonstrates the potential for media coverage to influence health-seeking behaviours during high-profile STI outbreaks.

  • outbreak
  • digital health
  • sexually transmitted infections
  • STI
  • interrupted time series
  • high-level azithromycin resistant gonorrhoea outbreak
  • hl-azir
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  • Handling editor Dr Joseph D Tucker

  • Contributors CS, HF and GH conceived of the work. CS designed the work and conducted the analysis with input from HM, MF and GH. CS prepared the manuscript with significant input from HM and GH. All other authors contributed to data interpretation and review of the final manuscript. All authors revised the work for important intellectual content and gave their final approval for publication. CS acts as guarantor and accepts full responsibility for the work. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding Undertaken as part of Public Health England-funded public health surveillance.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval As GUMCAD is a routine public health surveillance activity which collects de-identified data, no specific consent was required from the patients whose data were used in this analysis. In its role providing infectious disease surveillance, Public Health England has permission to process data obtained by GUMCAD under Regulation 3 of the HealthService (Control of Patient Information) Regulations 2002.

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

  • Data availability statement Data from Google Trends are publicly available. GUMCAD STI Surveillance System is the mandatory surveillance system for STIs in England. Public Health England collects pseudoanonymised, electronic data on all STI tests and diagnoses from all commissioned sexual health services in England. Some data are publicly available, and the principles for accessing, storing and sharing data are given in PHE’s HIV and STI data sharing policy found here:

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