1. Management of a gonorrhoea ‘outbreak’ among university students Gill Bell Nurse Consultant Sexual Health Adviser Sheffield

2. Guidance for managing STI Outbreaks & Incidents. Health Protection Agency 2010 What is an outbreak? Greater than expected number of cases Linked cases of public health significance Re-organisation of services / additional resources required Principles of management: Confidentiality Collaboration Communication

4. Phase 1: preliminary phase Alert raised by university health practice nurse Outbreak Control Team: – Health Protection Unit – Commissioners (Public Health) – Sexual Health Sheffield Clinical lead; health advisers; health promotion specialists – University health services – Microbiology

5. Gonorrhoea in Sheffield Aug 2013 – July 2014

6. Phase 2: Control phase Investigations – Epidemiological Case surveillance person, place, time Network analysis – Microbiological Resistance profiles

7. Investigation findings Demographics and resistance profiles reviewed – Two clusters identified autumn 2013 – both among students of one university – heterosexual cluster – fully sensitive to all antibiotics; contacts mostly students – MSM cluster: Resistant to Cipro and Penicillin; some contacts outside student population; met through Grindr

8. Gonorrhoea in Sheffield by gender and orientation. Aug 2013 – July 2014

11. Phase 2: Control phase Case finding – Contact tracing Review of all cases diagnosed by the lab. Follow-up of cases not referred to GUM with the GP to check if treated / offer assistance – Opportunistic screening ( 3/12 trial) GPs serving student populations asked to screen for gonorrhoea with chlamydia Chlamydia Screening Programme outreach to include gonorrhoea screening and target student venues

12. Phase 2: Control phase Prevention – Awareness raising of increased risk among students through screening events – Outreach health promotion sessions twice per week via MSM apps / websites Acess to Grindr, Gaydar, Squirt, Fitlads, Bareback RT, Growlr, Bendr Direct message or private chat available Majority of respondents local

13. Communications Outbreak Control Team responsible for communications Informed LA of a ‘rise in incidence’ No press release issued because: – Small number of cases - manageable through above strategies – Risk of stigma for students / university

14. Legacy Health adviser mechanisms for identifying an outbreak under review Gonorrhoea outbreak spreadsheet maintained and monitored weekly Data sharing agreement (age, gender, orientation partial postcode) with Health Protection Unit for support with monitoring and surveillance All positive GC and CT results from primary care now reported to and actioned by health advisers

17. Guidelines Guidance for managing STI Outbreaks & Incidents. Health Protection Agency 2010 Outbreak and incidents relating to sexually transmissible infections in England. Briefing for Directors of Public Health and Commissioners in local authorities. HPA 2012 Communicable Diseases Outbreak Management. Public Health England 2014