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Notifiable
STDs
The
South Australian STD Surveillance System
|
Notification of Syphilis, Gonorrhoea,
Chlamydia, HIV Infection, Hepatitis B and Hepatitis C Infection
The
Public
& Environmental Health Act (1987)
as
amended, provides a general legal framework for the collection of
Notifiable Disease data and facilitates notification of the above
infections by:
-
Placing
a duty upon doctors and laboratories to forward relevant data on cases
of these Notifiable Diseases, as designated in Section 30 of the Act,
to STD Services, South Australian Department of Human Services (DHS).
-
Absolving
the reporting doctor and laboratory from any legal liability
concerning consent to release information required for notification.
Thus consent does not arise as an issue with regard to notifications
made in good faith.
It is wise to inform the patient that their case will be notified and
that they may be contacted during further investigation.
-
Preventing
release of identifying data by the DHS (or designated authorities).
Notification data containing personal details can only be secured by
court order.
The
format of reports, quantity and nature of data are determined by the
appropriate DHS collection authority.
Further information about disease notification in South
Australia can be found on the South Australian Department
of Human Services website.
STD Notification System
The dual notification system in South Australia involves
information from both laboratories and medical practitioners.
Medical Notification
There is a legal requirement for the attending clinician to notify all
cases of syphilis, gonorrhoea, chlamydia, HIV, AIDS, hepatitis B
infection, donovanosis and hepatitis C
infection.
Medical notification forms.
Laboratory Notification
There is a legal requirement for laboratories to notify positive
laboratory tests for syphilis, gonorrhoea, chlamydia, donovanosis, HIV, hepatitis B and
hepatitis C. STD Services is notified of the patient’s name, doctor’s
name and phone number.
The purpose of this system is to monitor medical notification and to
contact the attending doctor rapidly when such notification is not
forthcoming. The objectives of notification cannot be achieved by
laboratory notification alone.
Notification of Gonorrhoea, Syphilis and/or
Chlamydia
Purpose of notification is twofold
- to enable epidemiologic analysis for control activities, and
- to facilitate contact tracing which reduces spread of disease in the
community and probability of reinfection in the treated patient.
Clinicians indicate on notification forms whether they wish STD
Services to undertake contact tracing or whether they would prefer to
investigate the case themselves.
Notification forms and reply paid envelopes are sent out from STD
Services.
Medical notification forms.
Syphilis Case Definitions
Terminology
Syphilis may be congenital (acquired in utero) or acquired
(acquired by sexual or other physical contact with an infected
individual).
Acquired syphilis may be primary (chancre at site of
inoculation), secondary (classical features include fever,
lymphadenopathy, symmetrical maculo-papular rash, patchy alopecia,
condylomata lata), latent (a quiescent stage with no signs of
disease) or tertiary (comprising benign, cardiovascular,
neurosyphilis).
Syphilis may be symptomatic or asymptomatic. Primary and
secondary syphilis are symptomatic. Latent syphilis is asymptomatic.
Congenital and tertiary syphilis may be symptomatic or asymptomatic.
Syphilis may be described as early or late, which are
synonymous with infectious and non-infectious, respectively.
Although secondary relapses may occur up to 4 years after infection, most
occur within the first year of infection and are rare after the second
year. Consequently early syphilis is defined as the first 2 years of
infection (and includes primary, secondary and early latent infection).
NOTE: Congenital syphilis may be transmitted up to 8 years after a
woman becomes infected.
Tertiary syphilis usually manifests decades after infection, but
neurosyphilis may occur much sooner after infection.
Case definitions
Congenital syphilis
Proven: Requires identification of T. pallidum by dark field
microscopy, fluorescent antibody, or other specific stains in specimens
from lesions, autopsy material, placenta or umbilical cord.
Other indicators (some or all of which might be used for
epidemiological purposes):
Other indicators (some or all of which might be used for
epidemiological purposes):
-
a reactive serological test for syphilis in a stillborn
-
a reactive VDRL test in CSF of the infant
-
a reactive serological test for syphilis in an infant with any of
the following signs: snuffles, condylomata lata, osteitis, periostitis
or osteochondritis, ascites, skin and mucous membrane lesions,
hepatitis, hepatomegaly, haemolytic anemia, splenomegaly, nephrosis,
nephritis.
-
fourfold or greater rise in titre of a nontreponemal test (VDRL/RPR)
over a 3- month period
-
a reactive treponemal test or non-treponemal test that does not
revert to non-reactive within 6 months.
Primary syphilis
A chancre (typically solitary, indurated and painless)
plus
demonstration of T. pallidum by darkfield microscopy or
fluorescent antibody techniques (not valid for oral lesions as
commensal spirochaetes may be indistinguishable from T. pallidum)
or
serological criteria , such as:
seroconversion or increasing titre associated with the lesion
or
a fourfold rise in reagin titre before therapy
or
fourfold decline or return to seronegativity within three months of
treatment.
Secondary syphilis
Typical lesions of secondary syphilis
plus
demonstration of T. pallidum in lesions
or
reagin titre of 1:16 or greater
Early latent syphilis
Absence of signs or symptoms
plus
a positive treponemal test (TPHA/FTA-ABS)
plus
documented seroconversion within the previous 2 years or
a fourfold rise in reagin titre in the absence of treatment or
a fourfold decline in reagin titre following treatment (within 6
months)
Late latent syphilis
Absence of signs or symptoms
plus
a positive treponemal test
plus
lack of a fourfold reagin titre change either before or after
treatment.
NOTE: In the absence of supporting historical information it is
rarely possible to distinguish late latent syphilis from adequately
treated syphilis.
Asymptomatic neurosyphilis
Cerebrospinal fluid findings of a positive VDRL
plus
A white cell count exceeding 5/mm3
or
total protein exceeding 40 mg/100 ml indicates active neurosyphilis.
A negative FTA-ABS in the CSF excludes neurosyphilis. There are many
cases where neurosyphilis can be neither confirmed nor excluded.
NOTE: The foregoing criteria are not valid during secondary
syphilis as 30% of such patients have indicators of neurosyphilis
but do not have an outcome differing from those lacking the indicators.
Notification of HIV Infection
Purpose of HIV notification:
- to enable surveillance of HIV infection in SA
- to facilitate contact tracing/partner notification; medical officers
notifying the infection can either initiate contact tracing and send
relevant information to the HIV epidemiologist or, after consultation
with the client, request the HIV epidemiologist to investigate the
case.
Notification forms and reply paid envelopes are sent out from STD
Services.
Notification of Hepatitis B Infection
Purpose of HBV notification:
- to define HBV infection (both acute cases and chronic carriers) in
South Australia for epidemiologic analysis
- to follow up individuals with acute infection
Notification forms and reply paid envelopes are sent out from STD
Services.
Notification of Hepatitis C Infection
Purpose of HCV notification:
- to define HCV infection in South Australia for epidemiologic
analysis
- to follow up individuals with recently acquired infection and those
whose risk factor was not stated.
Notification forms and reply paid envelopes are sent out from STD
Services.
STD Services
STD Services (Royal Adelaide
Hospital) aims to reduce the impact of STDs in the community by
- reducing the incidence of disease
- reducing the duration of infection
- reducing the complications or anxiety associated with infection
- decreasing the nett cost of managing individual cases.
To facilitate these goals, the service operates a walk-in clinic (no
appointment is necessary) at Clinic 275 (275 North Terrace) which is open
from:
10.00 am to 4.30 pm: Monday, Thursday and Friday,
11.30 am to 6.30 pm: Tuesday and Wednesday.
A full consultation service is available to all clinicians by
contacting the Director, Dr Russell Waddell , on 8222 2529.
Role of General Practitioners
Important requirements for providing adequate investigation and
management of patients who may have STD include
- access to laboratory testing for the most common STDs - gonorrhoea,
chlamydia, NSU, genital herpes, syphilis, trichomoniasis and bacterial
vaginosis
- an interest in STDs and a sensitivity to the psycho-social needs of
patients with STDs and
- familiarity with appropriate systematic approaches to investigating
patients for STDs.
Consultation is always available to assist clinicians with
investigation and management. Alternatively, clinicians may wish to refer
some or all patients to Clinic 275 for investigation and management.
Medical notification forms. |
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