SURVEILLANCE OF SEXUALLY-TRANSMITTED DISEASES IN FRANCE - RECENT TRENDS AND INCIDENCE

Objective-To present recent trends in sexually transmitted diseases (S TDs) in France and to estimate the gonorrhoea incidence in 1990. Metho ds-Trends were analysed from data of three surveillance systems: (1) S TD clinics: number of diagnoses, (2) a sentinel voluntary General Prac titioner (GP) network: mean number of acute male urethritis/week/GP, c haracteristics of the notified urethritis (age, presence of discharge, sexual orientation), (3) a sentinel voluntary laboratory network: mea n number of gonorrhoea isolates/month/laboratory, characteristics of p atients with positive isolates (sex, age, site of sampling) and of str ains (PPNG and TRNG rates). To estimate the gonorrhoea incidence in Fr ance in 1990, results of a study held among a national sample of labor atories were used, combined with data from surveillance systems and sp ecific studies. Results-Decreasing trends in gonorrhoea in STD clinics and in the laboratory network as well as in acute male urethritis in the GP network have been observed since implementation of the networks in 1985. The rate of PPNG strains has regularly increased in the labo ratory network to reach 14% in 1991. Data suggest that the incidence i n some acute non recurrent STDs could have increased among homo/bisexu al men since 1988. Chlamydia trachomatis is now the most frequent diag nosis in STD clinics. Estimation of male gonorrhoea incidence rate in France in 1990 of 74/100 000 inhabitants (15-59 years) is consistent w ith figures observed in England and Wales, where the age distribution is very similar. On the other hand, the estimated female gonorrhoea in cidence rate of 14/100 000, which concerns only microbiologically asce rtained cases, is one third in France than that observed in England an d Wales. Conclusion-The consistency of the decreasing trends in gonorr hoea and acute male urethritis observed from the different networks re duces the possibility of a bias due to any change in notification or i n prescription. Trends in Chlamydia trachomatis will be better apprais ed in the near future with the recent implementation of new systems. T he French STD surveillance appears quite satisfactory for male infecti ons and has been able to show a marked decrease in the incidence of so me STDs in the last years. Surveillance of female STDs is to be improv ed, in terms of monitored diagnoses and selected health care facilitie s. Differences between the female gonorrhoea incidence rate observed i n England and Wales and the one computed for France could be attribute d to differences in contact tracing policies between the two countries or to differences in sexual lifestyles. tion or in prescription. Chla mydia trachomatis will be better appraised in the near future with the recent implementation of new systems. The French STD surveillance app ears quite satisfactory for male infections and has been able to show a marked decrease in the incidence of some STDs in the last years. Sur veillance of female STDs is to be improved, in terms of monitored diag noses and selected health care facilities. Differences between the fem ale gonorrhoea incidence rate observed in England and Wales and the on e computed for France could be attributed to differences in contact tr acing policies between the two countries or to differences in sexual l ifestyles.