Surveillance of sexually transmitted diseases in France is based on voluntary networks of laboratories and clinicians. Despite the importance of incidence data in improving knowledge about the national context and in international comparisons, such data were not previously available. During nationwide quality control of laboratories, mandatory for all laboratories, we conducted a survey in June 2013 to estimate the incidence rates of gonococcal and chlamydial infections for 2012 and to estimate the proportion of diagnoses performed (coverage) by the country's two laboratory-based sentinel networks for these diseases. Estimated incidence rates for 2012 were 39 per 100,000 persons aged 15 to 59 years for gonorrhoea and 257 per 100,000 persons aged 15 to 49 years for chlamydia. These rates were consistent with the average levels for a group of other Western countries. However, different estimates between countries may reflect disparate sources of surveillance data and diverse screening strategies. Better comparability between countries requires harmonising data sources and the presentation of results. Estimated coverage rates of the gonococcal and chlamydial infection surveillance networks in France in 2012 were 23% and 18%, respectively, with substantial regional variations. These variations justify improving the representativeness of these networks by adding laboratories in insufficiently covered areas.
UNSTRUCTURED Background. Despite substantial screening for HIV, Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections in France, a great number of infected persons remain undiagnosed. In this context, Santé publique France experimented with a new screening approach for HBV, HCV, and HIV infection, based on home self-sampling using dried blood spot (DBS) for blood collection. The objectives of the BaroTest study were to assess the acceptability and feasibility of this approach and to update the prevalence estimates of HBV, HCV, and HIV infections in the general population. Methods/design. Participants were enrolled using the 2016 Health Barometer, a national cross-sectional telephone survey based on a large representative sample of the general population aged 15 to 75 years (N=15000). Upon completion of the questionnaire, eligible persons were invited to receive a self-sampling kit delivered by standard postal mail and to return the DBS card to the laboratory. The laboratory then was responsible for reporting the results to the study participant. Acceptability of the protocol was based on the percentage of eligible individuals agreeing to receive the self-sampling kit, on the proportion of people returning the DBS card and, finally, on the proportion of participants out of the total eligible population. The feasibility of the approach was based on the number of participants with adequately filled blood spots and the number of participants with blood spots for which at least one virological analysis could be performed. A complex system of reminders was implemented to increase the participation rate. Accordingly, we assumed that 35% of eligible persons would accept and return their DBS card, representing approximately 5,000 individuals. Since the highest expected prevalence was for HBV infection, estimated at 0.65% in 2004, 5,000 persons would make it possible to estimate this prevalence with an accuracy of approximately 0.22%. All indicators can be analysed according to the characteristics of the participants collected in the Health Barometer questionnaire. Discussion. The BaroTest results will help to inform new strategies for HIV, hepatitis B and C screening and - if the study’s acceptability and feasibility results prove conclusive – will encourage the expansion of the current screening offer to include home self-sampling. BaroTest was linked to a randomised telephone survey, which uses a complex call protocol to increase the likelihood of interviewing hard-to-reach individuals and to achieve a high response rate. The Health Barometer provides a reliable updated assessment of the burden of HBV, HCV and HIV infections in the general population in France, while reducing the costs typically associated with this type of research. Trial registration. BaroTest was approved by the French Ethics Committee (05/11/2015) and the Commission on Information Technology and Liberties (24/12/2015). The study has been registered by the French medical authority under number 2015-A01252-47 on 10/11/2015.
Diagnoses of bacterial sexually transmitted infections (STI) have been increasing in France since their resurgence in the late 1990s. This article presents recent epidemiological trends until 2016 and the patients' characteristics. STI surveillance relies on sentinel networks: a clinician-based network RésIST (clinical, biological and behavioural data for early syphilis and gonorrhoea), the lymphogranuloma venereum (LGV) network (clinical, biological and behavioural data for rectal LGV, and the laboratory networks Rénachla and Rénago (demographic and biological data for chlamydial infections and gonorrhoea, respectively). Here we describe trends between 2014 and 2016, using data from diagnostic centres which participated regularly during the study period. The number of early syphilis, gonorrhoea and LGV diagnoses increased between 2014 and 2016, particularly in men who have sex with men. An increase in syphilis and gonorrhoea cases was also observed in heterosexuals. Nevertheless, we observed a drop in 2016 for syphilis and chlamydial infections after two decades of increases. Under-reporting and shortage of benzathine penicillin in 2016 may explain this latest evolution. Regular screening of patients and partners, followed by prompt treatment, remains essential to interrupt STI transmission in a context where human immunodeficiency virus (HIV) prevention has expanded towards biomedical prophylaxis.
Les femmes représentent presque la moitié des personnes vivant avec le VIH dans le monde et plus de la moitié en Afrique sub-saharienne, en raison d'une transmission hétérosexuelle qui y est prédominante. La féminisation de l'épidémie se poursuit au niveau mondial et en particulier dans les pays où l'épidémie est plus récente (Asie, Amérique latine, Europe de l'Est). En Europe de l'Ouest et en France, cette féminisation semble se stabiliser et les femmes représentaient respectivement 35 % et 38 % des nouveaux cas d'infection par le VIH en 2005. En France, la moitié de ces femmes sont de nationalité d'un pays d'Afrique subsaharienne.Si l'intrication entre le VIH/sida et les autres infections sexuellement transmissibles est désormais bien documentée, les données épidémiologiques disponibles sur celles-ci sont plus parcellaires. Chez les femmes, la maladie sexuellement transmissible bactérienne la plus courante est l'infection à Chlamydia trachomatis. En France, sa fréquence semble avoir augmenté depuis la fin des années 1990, ce qui doit inciter à promouvoir son dépistage et à rester vigilant par rapport aux autres maladies sexuellement transmissibles, dont la recrudescence n'a pour l'instant concerné que les hommes.
We evaluated the performance of a fourth-generation antigen/antibody (Ag/Ab) assay for detecting HIV-1 infection on dried blood spots (DBS) both in a conventional laboratory environment and in an epidemiological survey corresponding to a real-life situation. Although a 2-log loss of sensitivity compared to that with plasma was observed when using DBS in an analytical analysis, the median delay of positivity between DBS and crude serum during the early phase postacute infection was 7 days. The performance of the fourth-generation assay on DBS was approximately similar to that of a third-generation (antibody only) assay using crude serum samples. Among 2,646 participants of a cross-sectional study in a population of men having sex with men, 428 DBS were found reactive, but negative results were obtained from 5 DBS collected from individuals who self-reported a positive HIV status, confirmed by detection of antiretroviral (ARV) drugs in their DBS. The data generated allowed us to estimate a sensitivity of 98.8% of the fourth-generation assay/DBS strategy in a high-risk population, even including a broad majority of individuals on ARV treatment among those HIV positive. Our study brings additional proofs that DBS testing using a fourth-generation immunoassay is a reliable strategy able to provide alternative approaches for both individual HIV testing and surveillance of various populations.
BackgroundSyphilis in blood donors (BD) has increased in many countries.AimWe aimed to describe trends in syphilis seroposivity in BD in France, to identify risk factors and assess if a non-treponemic test (NTT) could define BD having recovered from syphilis for more than 1 year.MethodsThe analysis covered the period 2007 to 2022 and 45,875,939 donations. Of the 474 BD syphilis-positive in 2022, 429 underwent additional investigations with an NTT. History of syphilis was obtained at the post-donation interview or based on serology results for repeat donors.ResultsUntil 2021, positivity rates remained stable (mean: 1.18/10,000 donations, range: 1.01-1.38). An increased rate was observed in 2022 (1.74/10,000; p = 0.02). Over the whole study period, prevalence was 2.2 times higher in male than in female BD (4.1 times higher in 2022). The proportion of males with an identified risk factor who have sex with men increased from 16.7% in 2007 to 64.9% in 2022. Based on NTT, 79 (18%) of the donors who were seropositive in 2022 were classified as having been infected in the previous year. History of syphilis was available for 30 of them. All had an infection within the previous 3 years. Among seven donors with a syphilis < 12 months before testing, one had an NTT titre ≥ 8, three a titre between 1 and 4, three were negative.ConclusionSyphilis seropositivity increased considerably in BDs in 2022, mostly in males, notably MSM. Available data did not allow appropriate evaluation of the NTT to distinguish recent from past infection.
BackgroundGenomic surveillance using quality-assured whole-genome sequencing (WGS) together with epidemiological and antimicrobial resistance (AMR) data is essential to characterise the circulating Neisseria gonorrhoeae lineages and their association to patient groups (defined by demographic and epidemiological factors). In 2013, the European gonococcal population was characterised genomically for the first time. We describe the European gonococcal population in 2018 and identify emerging or vanishing lineages associated with AMR and epidemiological characteristics of patients, to elucidate recent changes in AMR and gonorrhoea epidemiology in Europe.MethodsWe did WGS on 2375 gonococcal isolates from 2018 (mainly Sept 1–Nov 30) in 26 EU and EEA countries. Molecular typing and AMR determinants were extracted from quality-checked genomic data. Association analyses identified links between genomic lineages, AMR, and epidemiological data.FindingsAzithromycin-resistant N gonorrhoeae (8·0% [191/2375] in 2018) is rising in Europe due to the introduction or emergence and subsequent expansion of a novel N gonorrhoeae multi-antigen sequence typing (NG-MAST) genogroup, G12302 (132 [5·6%] of 2375; N gonorrhoeae sequence typing for antimicrobial resistance [NG-STAR] clonal complex [CC]168/63), carrying a mosaic mtrR promoter and mtrD sequence and found in 24 countries in 2018. CC63 was associated with pharyngeal infections in men who have sex with men. Susceptibility to ceftriaxone and cefixime is increasing, as the resistance-associated lineage, NG-MAST G1407 (51 [2·1%] of 2375), is progressively vanishing since 2009–10.InterpretationEnhanced gonococcal AMR surveillance is imperative worldwide. WGS, linked to epidemiological and AMR data, is essential to elucidate the dynamics in gonorrhoea epidemiology and gonococcal populations as well as to predict AMR. When feasible, WGS should supplement the national and international AMR surveillance programmes to elucidate AMR changes over time. In the EU and EEA, increasing low-level azithromycin resistance could threaten the recommended ceftriaxone–azithromycin dual therapy, and an evidence-based clinical azithromycin resistance breakpoint is needed. Nevertheless, increasing ceftriaxone susceptibility, declining cefixime resistance, and absence of known resistance mutations for new treatments (zoliflodacin, gepotidacin) are promising.FundingEuropean Centre for Disease Prevention and Control, Centre for Genomic Pathogen Surveillance, Örebro University Hospital, Wellcome.
Since 2022, Europe has had 4 cases of extensively drug-resistant Neisseria gonorrhoeae, sequence type 16406, that is resistant to ceftriaxone and highly resistant to azithromycin. We report 2 new cases from France in 2023 involving strains genetically related to the 4 cases from Europe as well as isolates from Cambodia.
