Appendix 1: Case study
Updated 4 June 2024
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Gonorrhoea in a region of England
Detection
UKHSA was alerted to a reported increase in cases of gonorrhoea by a sexual health service (SHS) in a region of England. An outbreak control team (OCT) was convened to assess the risk to public health and instigate control measures. The OCT was chaired by the UKHSA Health Protection Team (HPT) and had representation from other UKHSA teams (Field Service, regional facilitator, BSHSH and the STI reference laboratory) and from partner organisations (sexual health commissioners, local authority public health colleagues and clinicians from commissioned SHS).
Investigation
Data from GUMCAD STI Surveillance System was only available from three months prior to the investigation and other data sources needed to be used to investigate the reported increase in cases. The following data sources were used by the UKHSA Field Service:
- routine UKHSA laboratory surveillance data for Neisseria gonorrhoeae to examine trends over time by age group, sex and local authority
- aggregate data submitted by SHS in the region to obtain more detailed demographic information and positivity rates
- local public health laboratory data to analyse trends in positivity over time
- raw GUMCAD STI Surveillance System data for the most recent time period
Findings
The analysis confirmed there was an increase in gonorrhoea infections in the region, affecting both men and women. There was a particular increase in infections among young people and notably among the 19-to-23-years age group.
All the data sources had limitations and the OCT decided that an enhanced questionnaire was needed to further understand the demographics and risk behaviours of cases within the region. Field Service colleagues developed an anonymous, online questionnaire, and OCT members advised on the format and appropriate terminology of the content. The questionnaire was only available in English.
SHS were asked to send a link to the questionnaire to all those aged over 15 years-old, newly diagnosed with gonorrhoea in a 3-month period. Individuals could also scan a QR code in the SHS to access the questionnaire. The data collected through the enhanced surveillance questionnaire was analysed by the Field Service and presented to the OCT. It provided valuable local intelligence indicating that the epidemiology differed across the region and that predominately younger heterosexual people (aged 23 years and under) and older (aged 24 years and over) GBMSM were affected.
Clinics also had a QR code for individuals to scan on their phones to access the survey. 108 responses were received. Enhanced surveillance provided valuable information on the groups affected and geographical variation. Risk factors and opportunities for interventions were also identified.
Control measures
Control measures were implemented by commissioners and SHS across the region, tailored to the population affected in their area. Examples included increased condom promotion and texts to raise awareness among student populations.
Communication
Local press releases were disseminated in the region, including information on the expansion of a condom scheme and urging the target group to get tested for gonorrhoea.