BACKGROUND: In May 2015, the Canadian province of Alberta began observing a statistically significant increase in the number of reported gonorrhea (GC) cases compared to previous years. Within the province, the Edmonton Zone was found to have the highest rate, compared to the other four health zones, for January to April 2015 (38.4 infections per 100,000 population). An investigation was launched to describe the populations at risk and the sexual networks within the Edmonton Zone to support the development of targeted interventions.
METHODS: A descriptive summary of all GC cases reported in the Edmonton Zone from January to August 2015 was conducted using routinely collected data. Descriptive analyses were also completed on information from chart reviews of STI Clinic cases and selected community diagnosed cases about how and where people were meeting their sexual partners. A social network analysis was conducted to identify populations at risk and common meeting places. A core group of cases, identified from the social network analysis, were selected for re-interview to enhance information on how cases meet their sexual partners.
RESULTS: There were 1,088 GC cases reported from the Edmonton Zone from January to August 2015. Fifty five percent (n=593) of cases were male. Forty three percent of female cases and 21% of male cases self-identified as Aboriginal. Of the male cases, 21% reported same sex partners (n=126). The use of online applications and websites was the most frequently mentioned method of meeting sexual partners. There were 523 sexual networks identified, the majority comprising five or fewer people. Only 5 of 18 cases selected for re-interview could be reached and interviewed using the enhanced investigation form. All Aboriginal females selected for re-interview (n=5) were unable to be contacted.
CONCLUSIONS: Men who have sex with men (MSM) and Aboriginal females were overrepresented in this cohort of GC cases. Targeted interventions including weekly MSM clinics, online ads on MSM dating sites, and increased outreach activities directed towards Aboriginal females were initiated based on results of our investigation. Aboriginal women were more difficult to re-connect with STI services; therefore, engagement with Aboriginal community organizations has begun. It was also recommended that current investigation forms be modified to more systematically and prospectively collect venue/meeting place information from GC cases.