Sexually transmitted infections continue to be a major public health concern and the rates of new diagnoses are increasing nationally. If left undiagnosed and untreated, curable STIs can cause a range of health consequences including fertility problems, adverse pregnancy outcomes and neonatal infections. Those aged 15-24 years, black minority ethnic (BME) populations, men who have sex with men (MSM) and people living in deprived areas are disproportionately affected. Furthermore, antimicrobial resistance has been detected among STIs which has reduced the options for treatment.
Public Health England (PHE) publish annual data tables on the number of new diagnoses of STIs in specialist services however, non-commissioned primary care providers are not required to contribute to this. The extent of STI diagnoses, prescribing and referrals in primary care for the management of a breadth of STIs, as well as the quality of this data in the CPRD records, is not well understood. Therefore, we aim to describe the incidence, testing and management of a comprehensive list of STIs in UK primary care. This cohort study will analyse the CPRD records from 2010 to 2019, to examine attendances for a comprehensive list of STIs to determine trends in incidence, consultation rates, and, subject to data quality, testing rates and diagnosis rates. This will establish the quality of the CPRD data on recording STI testing and management in primary care and, subject to this, the extent to which STI management is taking place within UK primary care and how successfully this adheres to current guidelines.
Background and rationale:
There were 447,694 new diagnoses of STIs in specialist sexual health services (SHSs) in England in 2018, an increase of 5% from 2017. Non-commissioned primary care providers are not required to contribute to the Genitourinary Medicine Clinic Activity Dataset (GUMCAD) STI Surveillance System - the mandatory reporting system for STI diagnoses. Therefore, the extent of STI testing, diagnoses, prescribing and other management within UK primary care is not well understood. Studies looking at individual STIs suggest that general practitioners are contributing to STI management but a recent survey among GPs suggest that they do not consistently adhere to standards of STI management. CPRD can be used to improve understanding of the STI testing, diagnoses and management taking place within primary care. This will first require the establishment of the quality of the recording of STI activity in the CPRD.
Objectives:
To describe the quality of data recording on STI testing, diagnoses and management in CPRD records.
To describe the incidence and management of a comprehensive list of STIs in the UK primary care setting using the CPRD.
Methods:
Cohort study to determine the testing rate and diagnosis rate using analysis of READ codes in CPRD records from 2010 to 2019 corresponding to PHEs list of new STI diagnoses.
Analysis:
1. Poisson models, with person years as the offset, to estimate incidence rate ratios and their confidence intervals for males and females separately and by age, ethnicity, IMD of patient, IMD of practice and region of practice.
2. The incidence rate epidemiology estimated from CPRD records and compared with national surveillance data collected by PHE.
3. The consultation rate for all STI consultations estimated from the CPRD records.
4. Testing rates estimated for males and females, for all ages and grouped by age (16-44, >44 years).
1) Overall STI incidence rate per year.
2) Incidence rate ratios and their confidence intervals for males and females separately and by age, ethnicity, IMD of patient, IMD of practice and region of practice per year.
3) Rate per year for all consultations involving STI diagnoses, testing and management.
4) Testing rates per year will be estimated for males and females, for all ages and grouped by age; also for ethnic group, IMD of patient, IMD of practice and region of practice.
5) Positive testing percentage overall and by sex, age, ethnicity, IMD of patient, IMD of practice and region of practice. *
6) % positive tests treated. *
7) % positive tests referred. *
8) % positive tests given partner notification service. *
9) % positive tests given health promotion services. *
*Outcomes 5-9 subject to the assessment of the feasibility of measuring these using CPRD records.
Martin Gulliford - Chief Investigator - King's College London (KCL)
Emma Rezel-Potts - Corresponding Applicant - King's College London (KCL)
Jackie Cassell - Collaborator - Brighton and Sussex Medical School
Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation