Acknowledgements

Summary

Important

• 
  If surveillance data show that STI transmission is occurring, then HIV transmission is likely occurring as well.
  

• 
  World Health Organization estimates that 340 million new, curable STI cases occurred globally in 1999. Of these, 69 million (20.3%) occurred in the Caribbean.
  

• 
  There are two different ways to diagnose and manage STI cases. These are syndromic diagnosis and reporting, and aetiologic diagnosis and reporting. In syndromic diagnosis, four syndromes are used for STI surveillance. In aetiologic diagnosis, an exact microbiologic diagnosis is given (for example, gonorrhoea).
  

• 
  Diagnosis of STI syndromes should be based on standard case definitions, which use readily identifiable and consistent clinical criteria. Uniform case definitions should be used throughout the country to enable comparability of the data arising from the reporting systems.
  

• 
  Only curable STIs with acute onset and short duration, such as gonorrhoea, chlamydia, chancroid, trichomoniasis, primary and secondary syphilis, and the syndromes they cause are important as a tool for assessing STI incidence and prevalence.
  

• 
  Some components of an STI surveillance system are more important for surveillance purposes (for example, STI case or aggregate reporting sentinel surveillance, and combined STI/HIV behavioural surveillance surveys).
  

• 
  Other STI surveillance components are more important for STI control programme activities. For example:
  

• 
  assessing syndrome aetiologies
  
• 
  anti-microbial resistance monitoring.
  

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  The most feasible STI surveillance system in the Caribbean is STI universal reporting and or STI sentinel surveillance. The STI reporting process involves healthcare providers reporting numbers of persons with new episodes of STIs over a given time period to public health authorities from the parish/county level up to the national level. In universal STI reporting, minimum data on STI cases are collected from all the health facilities in the country.
  

• 
  STI surveillance can occur through universal STI reporting, sentinel STI surveillance, or a combination of the two.
  

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  At sentinel surveillance sites, more data on STI cases are recorded and reported. Trends from these sites are used to infer trends of STIs in other health facilities. The major advantage of this system is that higher quality and more consistent information is obtained.
  

• 
  Sentinel surveillance produces higher quality and more consistent surveillance data than universal reporting, at lower cost. However, you cannot assume that sentinel surveillance data are representative of the general population, while you can make that assumption with universal reporting data.
  

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  In countries using the syndromic approach to STI treatment, it is important to monitor the actual aetiologies of urethral discharge syndrome in men, and genital ulcer diseases in men and women. These findings are used to refine national STI treatment guidelines.
  

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  Prevalence assessment is the determination of prevalence of certain STIs by laboratory testing among persons screened in defined populations. Prevalence monitoring is the monitoring of trends in prevalence over time.
  

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  Combined STI/HIV and behavioural surveys combine STI and HIV prevalence assessments with behavioural surveys. These can be done in the general population (as in DHS+) or in specific high-risk populations.
  

Small group

discussion

Get into small groups to discuss these questions.

1. 
   Describe the system for forwarding STI surveillance reports from the health facility level to the national level in your country. Describe what happens to the forms at each level and indicate the responsible officers.
   

2. 
   What core data elements are required for reporting through the STI universal reporting system?
   

Apply what

you’ve learned/

case study

Try this case study. We’ll discuss the answers in class.
You are the national STI surveillance officer for Cariba. You rely primarily on syndromic surveillance using a universal reporting system. You have noticed an increase in the number of reported cases of male non-vesicular genital ulcer disease in the St. James Parish, one of five districts in the country.
Number of reported cases of male non-vesicular genital ulcer disease by district and year, Cariba.

Parish	Year
	1998	1999	2000	2001	2002	2003
St. Mary	40	42	38	54	45	38
Kingstown	60	70	72	84	65	58
Arima	47	50	42	40	41	39
St. James	53	87	76	95	107	197
Yotown	49	49	36	72	65	48

a. What are some possible causes of this increase?

Arima and Yotown, parishes that border St. James, are primarily rural areas, whereas St. James has an urban centre with a recently refurbished and expanded health centre.

b. Could these differences between the parishes account for the increase in STI cases in St. James?

c. How would you investigate this?

Apply what you’ve learned/case study, continued

Parish of residence	Positive syphilis tests	Total tested	Percentage positive
Arima	10	60
St. James	25	150
Yotown	3	80

d. Calculate the prevalence by parish of residence. How could these data be used for STI control? For HIV control?