| Summary: | 碩士 === 國立成功大學 === 公共衛生研究所 === 92 === Gonorrhea, caused by Neisseria gonorrhoeae, is one of the national notifiable diseases in Taiwan and the numbers of reported cases increase dramatically in the past decade. However, it is unclear if the marked increase of gonorrhea reported results from an improvement of the reporting system or is due to an outbreak. Since urethritis and cervicitis are the most common clinical manifestations of genital gonococcal infection, therefore, we would establish an active surveillance system on urethritis and cervicitis coupling with a highly sensitive and specific diagnostic method to evaluate the current gonorrhea national notifiable reporting system in Tainan, Taiwan in order to better understand the epidemiology of gonorrhea in this area. We would also identify the factors to affect health care workers to report gonorrhea cases to CDC by questionnaire.
This study included three parts. First, 6 clinics whose specialty are urology, gynecology, internal medicine or family medicine were invited to form the urethritis and cervicitis sentinel surveillance network. Patients of these 6 clinics with urethritis or cervicitis were recruited and were asked to provide first void urine specimens. The etiology of diseases was determined by the in-house multiplex polymerase chain reaction for the detection of N. gonorrhoeae and Chlamydia trachomatis in the urine specimen. In addition patient’s demographic characteristics and sexual behaviors were obtained by an anonymous questionnaire. Second, an anonymous mailed questionnaire was designed to understand factors to affect the reporting in the gonorrhea national notifiable system from points of view of the local health care workers. Third, we compared N. gonorrhoeae positive cases in this study with the reported gonorrhea cases from CDC in Tainan to understand the hidden epidemic of gonorrhea in the community.
We collected 317 patients diagnosed with urethritis or cervicitis from the physician based sentinel surveillance system during October in 2003 to May in 2004. There were 107(34.5%) urethritis cases, 198(63.9%) cervicitis cases and 5 cases with both diagnoses. The N. gonorrhoeae positive rate was 44.4% in individuals with urethritis and 1.5% in those with cervicitis. The chlamydial positive rate was 3.5% in individuals with urethritis and 6.3% in those with cervicitis. One (0.3%) patient was with both pathogens. Using multiple logistic regression to analyze the risk factor of infection, we found that “having multiple sexual partners” was the risk factor for gonorrheal infection in females and “having a sexual partner with genitourinary symptoms” was the risk factor for chlamydial infection.
The response rate of the mailed questionnaire was 14.2%. We found that 23.3% of respondents misclassified the gonorrhea’s category in the national notifiable diseases. Second, “not collecting patient’s specimen”, “not knowing that gonorrhea is the notifiable disease” and “worrying the encroachment of patient’s privacy” were the most frequent reasons which led physicians not to report gonorrhea cases. Third, “ensuring the protection of patient’s privacy”, “providing materials for laboratory diagnosis” and “providing the subsidy for laboratory diagnosis” were the most frequent reasons that can increase physician’s willingness to report gonorrhea cases.
In our study, we found an additional 48 N. gonorrhoeae positive cases in Tainan besides the 67 cases reported to Taiwan CDC during the same period of time. Therefore, at least a 41% underestimation of gonorrhea cases was observed in this area. Our results demonstrated that significant cases of gonorrhea were due to the current practice of gonorrhea national notifiable system. Therefore, we strongly suggest that the Department of Health should improve the current gonorrhea national notifiable surveillance system by using high sensitivity and specificity of nucleic acid amplification diagnostic assays to detect gonococcal infection and providing the subsidy for laboratory diagnosis.
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