HSE warns GPs as gonorrhoea cases among women soars

A trebling of the number of cases of women with gonorrhoea within a month was of such concern that the HSE took the step of writing to doctors to highlight best practice in managing suspected and confirmed infections.

HSE warns GPs as gonorrhoea cases among women soars

In her letter to GPs, the HSE’s national clinical lead for sexual health, Dr Fiona Lyons, said cases were “occurring in young women compared to previous years, with a median age of 20”. Previously, the median age had been 22.

The action was also prompted by an alarming 52% increase in gonorrhoea rates among males in 2016, rising from 1,294 in 2015 to 1,964 last year, according to figures from the Health Protection Surveillance Centre.

Among women, there were 52 confirmed cases in November, triple the October figure. Approximately half of the male cases were among men who have sex with men (MSM).

The letter from Dr Lyons and Dr Derval Igoe of the HPSC, begins with “Dear Doctor, this letter is to alert you to a large national increase in cases of gonorrhoea” (in 2016).

“This increase has been seen in men who have sex with men (MSM), men in general, and more recently in women,” the letter said.

With almost one third of all cases diagnosed in general practice, including 50% of all female cases, the HSE contacted the Irish College of General Practitioners just before Christmas to ask if it would contact its members directly to highlight the “alarming increase” and to forward members information from the national guidelines for prevention and control of gonorrhoea.

The ICGP, via Dr Miriam Daly, director of its Women’s Health Programme, contacted its members last week.

The HSE set up a national multi-sectoral response group earlier last year, of which Dr Igoe is chair, to respond to increases in cases of HIV and STIs seen in MSM since 2015.

A review of the epidemiological data identified two particular groups in whom these increases are occurring:

  • Migrant MSM particularly from Latin America, who are either presenting in Ireland with known HIV or have HIV detected when here;
  • HIV positive MSM in whom increasing numbers of syphilis cases are occurring.

The HSE said targeted interventions have been implemented “including increasing capacity for STI screening in MSM in the Gay Men’s Health Service in Dublin and the appointment of temporary outreach workers to work with the gay community and particularly with Latin American MSM to promote condom use and raise awareness of the need for regular HIV and STI testing”.

Dr Lyons and Dr Igoe said they were writing to doctors “to inform you of these developments and to highlight the most recent recommendations for the management of suspected or confirmed gonorrhoea”.

The new guidelines recommend the establishment of a national multidisciplinary forum to advise on prevention, treatment and control of gonorrhoea.

They also recommend testing in primary care for those who are symptomatic, those at high risk (MSM, sex workers, those who change partners frequently or engage in casual sex) and contacts of cases. Partner notification is recommended for all cases of gonorrhoeal infection.

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