Surveillance of an infectious syphilis outbreak in south London, UK: a comparison of reporting systems

Abstract

Rising heterosexual syphilis in south London in 2002 prompted Local Enhanced Syphilis Surveillance (LESS) in five of the 10 genitourinary medicine clinics. LESS reported a fall in heterosexual infectious syphilis in 2004 that was corroborated by the National Enhanced Syphilis Surveillance (NESS). However, mandatory clinic Korner Codes 60 (KC60) coding did not support the reported fall; therefore database discrepancies were evaluated. Three databases (KC60, NESS and LESS) were compared in 2004 at selected clinics using clinical notes as the reference. Six clinics participated in NESS. Four clinics participated in both LESS and NESS and three of these clinics were visited. Only 48% (79 of 163) of KC60 infectious syphilis cases were heterosexual, 36% (58 of 163) were men who have sex with men and the rest were incorrectly coded. The NESS and LESS databases captured 80% and 68% of the confirmed heterosexual syphilis cases, respectively. Despite the inaccuracy in mandatory KC60 returns, this surveillance system captured additional heterosexual syphilis cases.

Variations in the epidemiology of primary, secondary and early latent syphilis, England and Wales: 1999 to 2008

“…NESS began in 1999 in the North West, while Wales and most other English regions followed from 2003, the East of England and East Midlands regions submitting data for the first time in 2007. Coding accuracy varies between the two datasets 6. For example, the patient management software used in some clinics automatically defaults male sexuality to ‘heterosexual’, leading to the incorrect assignment of some patients to this category.…”

The public health response to the re-emergence of syphilis in Wales, UK

“…All GU medicine clinics across Wales were invited to participate in a scheme for enhanced surveillance of infectious syphilis using a data collection form based on that used in a London outbreak. 5 Data collection commenced in December 2002, with retrospective data collection from January 2002. The aim of the scheme was to improve the timeliness of surveillance of new cases of infectious syphilis (compared with the routine quarterly, aggregate data returns based on Korner Codes [KC60]) and to provide more detail on the behavioural characteristics of cases.…”

Enhanced surveillance of syphilis cases among men who have sex with men in London, October 2016–January 2017

“…Historically, in response to rising rates of syphilis, two enhanced surveillance systems were put into place between 1999 and 2002 which provided additional information confirming that there was a high incidence of syphilis in MSM, high prevalence of HIV coinfection, and a high proportion of MSM using social/ sexual networks to meet new partners. 4,5 While demographics for syphilis infection in MSM in London are well described, 2 behavioural risk factors are insufficiently understood, and detailed information on risk behaviours of syphilis cases is not currently routinely collected. In the context of continued and increasing rates of syphilis infections in MSM, this lack of information is a barrier to ensuring that health promotion interventions are targeted appropriately.…”

“…Historically, in response to rising rates of syphilis, two enhanced surveillance systems were put into place between 1999 and 2002 which provided additional information confirming that there was a high incidence of syphilis in MSM, high prevalence of HIV coinfection, and a high proportion of MSM using social/sexual networks to meet new partners. 4,5…”