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Increase in Gonorrhea Incidence Associated With Enhanced Partner Notification Strategy

Schleihauf, Emily MAE*; Leonard, Erin DVM, PhD*; Phillips, Carrie MSc; Hatchette, Todd MD, FRCPC‡,§; Haldane, David MB, FRCPC‡,§; Arnason, Trevor MD*; Martin, Irene PhD; Whelan, Noella MN*

doi: 10.1097/OLQ.0000000000001060
Original Studies

Objectives Partner notification services for reportable sexually transmitted infections vary based on jurisdiction, resources, type of infection, and whether an outbreak has been reported. The objective of this study was to determine whether case finding increased after implementation of enhanced notification and follow-up activities for contacts of cases of Neisseria gonorrhoeae in Central Zone, the largest health authority in Nova Scotia, Canada.

Methods Enhanced contact tracing by public health professionals was implemented in May 2015. N. gonorrhoeae multiantigen sequence typing (NG-MAST) was conducted on all positive specimens. Epidemiologic and NG-MAST information for reported gonorrhea cases were captured and analyzed. Case numbers, rates, and NG-MAST results in the preintervention and postintervention periods were compared. Laboratory testing data were extracted and analyzed for association with reported incidence.

Results There was a significant increase in the number of reported gonorrhea cases per month when comparing the preintervention and postintervention periods. The reported gonorrhea rate in 2016 was 2.9 times that in 2014. This increase was not associated with changes in testing rates and was more pronounced among women than men. Larger groups of cases sharing the same NG-MAST profiles were detected postintervention.

Conclusions The implementation of an enhanced contact tracing program for N. gonorrhoeae resulted in increased case finding and a notable increase in the reported rate of cases per 100,000 population. Owing to these findings, the practice of enhanced partner notification was continued as standard public health practice in Central Zone. An understanding of case finding efforts is required when interpreting observed trends in rates of N. gonorrhoeae, as early infection is highly asymptomatic in women and can be asymptomatic in men.

A change from partner-referral to provider-referral for notification of partners of gonorrhea cases was associated with a significant increase in reported cases of gonorrhea.

From the *Public Health, Nova Scotia Health Authority, Dartmouth

National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg

Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority

§Department of Pathology, Division of Infectious Diseases Dalhousie University, Halifax, Canada

Acknowledgements: We thank the technologists working in the QEII laboratory, the public health nurses working with the Nova Scotia Health Authority, and the National Microbiology Laboratory.

Conflicts of Interest: None declared.

Correspondence: Emily Schleihauf, MAE, 51 Garland Avenue, Dartmouth, NS, Canada B3B 0J2. E-mail:

Received for publication June 13, 2019, and accepted August 25, 2019.

© Copyright 2019 American Sexually Transmitted Diseases Association