Sexually Transmitted Infections in Europe, 2012 European Centre for Disease Prevention and Control

Chlamydia Chlamydia continues to be the most frequently reported STI in Europe In 2012: 385 307 cases of chlamydia reported from 26 EU/EEA Member States Overall rate of 184 per 100 000 population Rate of 211 per 100 000 in women and 153 per 100 000 in men 68% of all chlamydia cases reported in young people (15-24 years); highest rates among women aged 20 to 24 years (1 684 cases per 100 000) Heterosexual transmission accounted for 88% of cases.

Chlamydia Trends: General trends in a number of countries show an increase Among countries reporting consistently between 2003 and 2012, reporting rate increased by 90% Increases most likely due to increased case detection; improved diagnostic tools; improved surveillance systems; chlamydia screening programmes in a few countries. Decreasing or low rates in some countries may reflect changes in healthcare systems; lack of accurate diagnostic tools or diagnostic capacity rather than a genuinely low prevalence of chlamydia. True incidence of chlamydia likely to be considerably higher, as differences in testing methods, coverage and surveillance systems across Europe mean that many infections are not diagnosed or not reported.

Chlamydia male-to-female ratio in 26 EU/EEA countries, 2012 The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Chlamydia cases by age group, EU/EEA countries with comprehensive systems reporting consistently, 2003 (n=157 488) and 2012 (n=319 124) The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Age and gender-specific rate of reported chlamydia cases per 100 000 population, EU/EEA, 2012

Number and percentage of chlamydia cases by transmission category and gender (n=55 257), EU/EEA, 2012 The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Reported chlamydia cases per 100 000 population in nine EU/EEA countries with consistent reporting, by gender, 2003–2012

Gonorrhoea In 2012: 47 387 gonorrhoea cases were reported in 29 EU/EEA Member States Overall rate of 15.3 per 100 000 population Reported more often in men than in women: rate of 25.7 per 100 000 in men and 9.2 in women 41% of cases reported among young adults Transmission among men who have sex with men accounted for 38 % of cases Since 2008, rate of gonorrhoea increased by 62%; most EU/EEA countries report increasing trends. Trends must be interpreted with caution due to the heterogeneity in national reporting and healthcare systems.

Number of gonorrhoea cases per 100 000 population, EU/EEA, 2012 The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Gonorrhoea male-to-female ratio in 27 EU/EEA countries, 2012 The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Percentage of gonorrhoea cases by age group, 2003 (n=31 481) and 2012 (n=35 364), EU/EEA countries reporting consistently The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Age and gender-specific rates of reported cases of gonorrhoea per 100 000, EU/EEA, 2012 The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Number and percentage of gonorrhoea cases by transmission category and gender (n=47 387), EU/EEA, 2012 The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Percentage of gonorrhoea cases diagnosed in MSM, EU/EEA, 2012 The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Trend in number of reported gonorrhoea cases per 100 000 population, 15 EU/EEA countries with consistent reporting, 2003–2012 The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Relative change in notification rates, 21 EU/EEA countries with consistent reporting, 2008–2012

Relative change in the number of reported gonorrhoea cases, EU/EEA, 2008–2012

Syphilis In 2012: 20 802 syphilis cases were reported in 30 EU/ EEA Member States Overall rate of 5.1 per 100 000 population Syphilis was reported more often in men than in women; rate of 7.7 per 100 000 in men and 1.7 in women Young people between 15 and 24 years of age account for only 15 % of cases 48% of the syphilis cases reported among men who have sex with men Overall rate decreased between 2003 and 2012, mainly due to substantial decrease in countries that reported very high rates in the past. In many countries, however, dramatic increases were noted, appearing to be mainly among older MSM.

Number of syphilis cases per 100 000 population, EU/EEA, 2012 The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Syphilis male-to-female ratio in 27 EU/EEA countries, 2012 The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Percentage of syphilis cases by age group, EU/EEA countries reporting consistently, 2003 (n=17 446) and 2012 (n=14 576) The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Age and gender-specific rate of reported cases of syphilis, EU/EEA, 2012 The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Number and percentage of syphilis cases by transmission category and gender (n=9 365), 2012 The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Percentage of syphilis cases diagnosed in MSM, EU/EEA, 2012 The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Percentage of syphilis cases by stage of infection, as reported by 14 EU/EEA countries, 2012 (n=4 856) The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Relative change in notification rates, 21 EU/EEA countries with consistent reporting, 2008–2012 The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Relative change in the number of reported syphilis cases, EU/EEA, 2008–2012

Congenital syphilis In 2012: 91 congenital syphilis cases were reported from 23 EU/EEA Member States Overall rate of 3.4 per 100 000 live births. Trend of reported congenital syphilis cases has remained stable over the years, but it is suspected that there is considerable underreporting: eight countries do not report congenital syphilis, and a further 12 reported zero cases in 2012

Number of reported congenital syphilis cases per 100 000 live births; number of countries reporting congenital syphilis data, 24 EU/EEA countries, 2003–2012 The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Lymphogranuloma venereum In 2012: 830 cases of lymphogranuloma venereum (LGV) were reported in eight countries The number of reported cases in 2012 has increased by 17% compared with 2011 A number of countries have reported no cases, but it is likely that there is considerable underreporting of LGV due to limited availability of diagnostics

Number of reported LGV cases in five EU countries, 2004–2012 The trend of Chlamydia infections is increasing in many countries, though divergent trends exist. In 2009, 345.000 cases were reported by 23 countries, an overall rate of 185 per 100 000 population. Of those cases, 60% is reported by the United Kingdom. The overall trend is affected by the completeness of reporting and the overall coverage across Europe; if we analyse the data for the eight countries that have reported consistently in 2000-08, then the trend looks as shown on the slide, with an overall rate of 337 / 100.000 population (Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Sweden, United Kingdom). The sharp increase in 2008 is due to UK that has introduce a new surveillance system that captures data from outside the STI services as well. The interpretation of the trend is difficult as it is the result of diverging trends in different countries and is highly influenced by changes in testing practices and surveillance systems. However, the trend shows a consistent higher rate in women than in men.

Percentage of LGV cases by age group, EU/EEA (n=829), 2012