Published: 09.02.05 Updated: 09.02.2005 18:04:09
Gonorrhoea is a notifiable disease in the entire region. In Norway and Sweden cases are reported anonymously using a non-unique identifier. All the countries report only laboratory confirmed cases. Due to an increase in private and informal health systems, the number of non-reported cases in Northwest Russia has probably increased during the last few years.
Figure 10. Number of cases of gonorrhoea notified in 2003 per 100 000 population (1).
In the Nordic countries, gonorrhoea incidence continued to fall during the early 1990s. Since the late 1990s, the incidence rates have levelled off. However, Norway and Sweden have during the last few years seen a slight increase mainly due to more cases among men who have sex with men. An increasing number of male patients in the Nordic countries have acquired their infection in the Far East, notably Thailand (11,12). Fifteen percentage of the patients infected abroad and diagnosed in Finland in 2003 acquired their infection in Russia (13). Among females, the infections are mainly domestically acquired.
Figure 11. Number of cases of gonorrhoea notified per 100 000 population 1999- 2003 by groups of countries or regions (1). Komi, Pskov, Novgorod and Vologda regions not included.
In the Baltic countries and Northwest Russia heterosexual transmission dominates with a high number of cases among the young and the unemployed. In the early 1990s the Baltic countries and all regions of Northwest Russia experienced record high incidence rates of gonorrhoea. This may be attributed to political and social changes, resulting in changing sexual behaviour patterns and delays in treatment that cause patients to remain infectious for longer periods. In Northwest Russia, the incidence peaked around 1993-94. For the three Baltic countries, the incidence has decreased since 1999 (figure 11). The incidence rates in the eastern part of the region are still high compared with the western part of the region. This is especially the case for the younger age groups.
Antibiotic resistance is a growing problem in the Nordic countries. Studies have shown that 15-30% of the isolates are either penicillinase-producing or quinolone-resistant strains or both (12, 13). Most gonorrhoea strains acquired in the Far East are quinolone-resistant. Less is known about resistance patterns in the Eastern part of the region.
Easy access to testing and treatment, contact tracing, condom availability and risk information are essential parts of the preventive strategies in the entire region. In the Nordic countries, much emphasis is put on active contact tracing and prevention among high-risk groups like men who have sex with men. In Russia, active contact tracing has in recent years suffered by increased privatisation of STI care and loss of state control.