Antibiotic-resistant gonorrhoea on the rise

Each year, an estimated 78 million people are infected with gonorrhoea, which can infect the genitals, rectum, and throat. Complications of gonorrhoea disproportionally affect women and can include pelvic inflammatory disease, ectopic pregnancy and infertility, as well as an increased risk of HIV.

Data from 77 countries show that antibiotic resistance is making gonorrhoea more difficult, and sometimes impossible, to treat. Some countries – particularly high-income ones, where surveillance is best – are finding cases of the infection that are untreatable by all known antibiotics. These cases may just be the tip of the iceberg, as gonorrhoea is more common in lower-income countries.

Currently, in most countries, ESCs are the only single antibiotic that remain effective for treating gonorrhoea. But resistance to cefixime – and more rarely to ceftriaxone – has now been reported in more than 50 countries. As a result, WHO issued updated global treatment recommendations in 2016 advising doctors to give 2 antibiotics: ceftriaxone and azithromycin.

For more information about Antibiotic-resistant gonorrhoea on the who.int website

Hepatitis A outbreak in Europe

Between June 2016 and May 2017, an unusual increase in cases of hepatitis A affecting mainly men who have sex with men (MSM) has been reported by low endemicity countries in the European Region.

15 countries (Austria, Belgium, Denmark, Finland, France, Germany, Ireland, Italy, the Netherlands, Norway, Portugal, Slovenia, Spain, Sweden, and the United Kingdom) reported 1173 cases related to the 3 distinct multi-country hepatitis A outbreaks. Most of the affected countries have routinely recommended hepatitis A vaccine for MSM, but there is currently limited availability of this vaccine worldwide.

In Spain, hepatitis A cases reported in 2017 are almost 8 times higher than the average number of cases reported during the same period between the years 2012 and 2016. Most cases are men aged between 15 to 45 years old, and MSM are the most affected group.

For more information about preventing Hepatitis A outbreaks on the euro.who.int website

HIV & Hepatitis in Europe

There are 53 countries in the WHO European Region and within those countries there are 15 million people living with hepatitis C and 13.3 million people living with hepatitis B, the vast majority of whom are unaware of their infection and therefore at risk of developing cirrhosis or liver cancer. On average, fewer than 3% of patients with chronic hepatitis C receive treatment. In addition, there are 2.5 million people living with HIV, almost half of whom are unaware of their infection.

Safe and effective treatments exist that allow people living with HIV and/or viral hepatitis B to lead healthy and long lives. Those living with hepatitis C can be cured. Knowing your health status, however, is the prerequisite to accessing treatment and the WHO strongly supports the European HIV-Hepatitis initiative which aims to break the silence around HIV and viral hepatitis and build momentum to stop these epidemics by 2030.

Read more about HIV and Hepatitis in Europe on the euro.who.int website

Over 2 million HIV cases in Europe

The cumulative number of HIV cases in the WHO European Region has risen to a new high of more than 2 million, with 153,000 new HIV cases identified in 2015 – a 7% increase compared to the previous year and the highest annual number since reporting began in the 1980s.

A new report “HIV/AIDS surveillance in Europe 2015“, also states that 1 in 7 people living with HIV in the European Economic Area (122,000 people) are unaware of their condition.

The main transmission mode also varied by geographical area. HIV infections increased consistently among men who have sex with men in the western and central parts of the Region, while in the eastern part heterosexual transmission increased. Transmission through injecting drug use still accounted for one third of new cases in eastern European countries.

For more information about HIV/AIDS in Europe from the euro.who.int website

Antibiotic resistance changes treatment for STIs

It is estimated that 131 million people are infected with chlamydia, 78 million with gonorrhoea, and 5.6 million with syphilis every year. These are the three most common sexually transmitted infections (STIs) and the WHO has issued new guidelines for their treatment in response to the growing threat of antibiotic resistance.

Chlamydia, gonorrhoea and syphilis are all caused by bacteria and are generally curable with antibiotics but they often go undiagnosed and are becoming more difficult to treat, with some antibiotics now failing as a result of misuse and overuse.

Resistance of these STIs to the effect of antibiotics has increased rapidly in recent years and has reduced treatment options. Of the 3 STIs, gonorrhoea has developed the strongest resistance to antibiotics. Strains of multidrug-resistant gonorrhoea that do not respond to any available antibiotics have already been detected. Antibiotic resistance in chlamydia and syphilis, though less common, also exists, making prevention and prompt treatment critical.

When left undiagnosed and untreated, these STIs can result in serious complications and long-term health problems for women, such as pelvic inflammatory disease, ectopic pregnancy and miscarriage, and untreated gonorrhoea and chlamydia can cause infertility in both men and women. Infection with chlamydia, gonorrhoea and syphilis can also increase a person’s risk of being infected with HIV two- to three-fold. An untreated STI in a pregnant woman increases the chances of stillbirth and newborn death.

Download the guidance for treating these sexually transmitted infections from the who.int website

Hepatitis – the “silent killer”

Hepatitis is often called the silent killer because globally 95% of people with hepatitis are unaware of their infection as most sufferers show no symptoms.

Over 13 million people in the European Region are estimated to be living with hepatitis B virus (HBV) infection, and over 15 million with chronic hepatitis C virus (HCV) infection. More than 400 people across the WHO European Region die from causes related to viral hepatitis every day.

Hepatitis B and C usually occur as a result of blood-to-blood contact with infected body fluids: for example, from blood transfusions or invasive medical procedures using contaminated equipment. They can also be transmitted through sexual contact, although this is less common with hepatitis C.

There is an action plan to address viral hepatitis in the WHO European Region and eliminate it as a public health threat by 2030.

To read more about the plan to eliminate viral hepatitis on the euro.who.int website

Sexual health in the over 50s

People in their 50s, 60s, 70s and 80s are having sex with new partners but many don’t think safer sex applies to them, perhaps because they are past child-bearing age and/or because they have recently come out of a long-term relationship and haven’t had to think about safe sex issues for many years.

As a result, sexually transmitted infections are increasing in this age group. However many older adults missed out on safe sex education and the result is they are diagnosed with an STI when it is too late to benefit from the medications available for treatment of diseases in their early stages.

This project (SHIFT) is looking for funding from the Interreg 2Seas programme to raise awareness and knowledge of both clinicians and the general public so that attitudes are changed, the older generation is engaged and empowered through the provision of better information, and delivery strategies are improved.

This will lead to reduced rates of STIs, and therefore lower health care costs and a better trained healthcare workforce able to offer fit-for-purpose services.

We are actively looking for partners but already have interest from Medway Council, Canterbury Christ Church University, KCC, KentCHT, Brighton and Hove and the Metro charity in the UK as well as Eurasante in France and Vives in Belgium.

Action plans on HIV/AIDS and viral hepatitis

Over 142 000 new HIV infections were diagnosed in the WHO European Region in 2015, the highest number ever. The HIV epidemic is driven by cases in the eastern part of the Region, where the number of new diagnoses has more than doubled during the past decade.

Over 13 million people in the Region are living with chronic hepatitis B infection and over 15 million with chronic hepatitis C infection. Two-thirds of those infected are in eastern Europe and central Asia. Hepatitis B and C infections lead to 400 deaths in the Region every day.

Two advisory committees met in April 2016 to guide new action plans on HIV/AIDS and viral hepatitis for the WHO European Region 2016–2021. The aim of the new HIV/AIDS plan is to boost efforts initiated with the 2012–2015 plan to achieve zero new HIV infections, zero discrimination and zero AIDS-related deaths in the Region.

For more information about the Action Plans on the euro.who.int website

 

HIV prevention programmes

Quality Action, a Joint Action of European Union member states, aimed to promote the health of the community by maximising the quality of HIV prevention projects and programmes.

Its final conference earlier this year brought together more than 120 representatives from governmental and non-governmental organisations to share their experiences in applying five quality improvement tools. Over a three year period, Quality Action has trained more than 400 prevention experts in use of these tools and there has been more than 80 practical applications of the tools across Europe.

The Quality Action Charter for Quality in HIV Prevention also provides key principles for reinforcing the effectiveness of HIV prevention through quality improvement.

To find out more about Quality Action on their qualityaction.eu website

Improving quality in HIV prevention

Quality Action is the EU co-funded ‘Joint Action on Improving Quality in HIV Prevention’ involving 45 partner organisations from 26 Member States.

It promotes practical tools and materials to maximise the quality of HIV prevention projects and programmes. Five practical quality improvement tools are ready, and more than 80 practical applications of the tools have been carried out and documented in case studies.

Quality Action has also developed a policy kit which offers concrete actions for integrating quality improvement into HIV prevention policies, strategies and action plans. The ‘Charter for Quality in HIV Prevention’ summarises quality principles, criteria and key activities to put quality improvement into practice and offer practitioners, experts, policy makers and all other stakeholders the opportunity to commit to improving their work in HIV prevention.

More information about Quality Action on the qualityaction.eu website