Descriptions:
| Term | description type | Language/acceptability | Language/acceptability | Case significance |
|---|---|---|---|---|
[course] [periods of life] sexually transmitted [morphology] of [body structure] caused by [organism] (disorder) | FSN | us:P | gb:P | ci |
[course] [periods of life] sexually transmitted [morphology] of [body structure] caused by [organism] | SYN | us:P | gb:P | ci |
Concept model:
| Attribute cardinality | Attribute | Value | role group number |
|---|---|---|---|
1..1 | 0 | ||
| 0..1 | |||
| 1 | |||
1..1 | |||
0..1 | [body structure] < 442083009 |Anatomical or acquired body structure (body structure)| | ||
0..1 | [organism] << 410607006 |Organism (organism)| | ||
| 0..1 | |||
| 0..1 |
Applies To
<< 8098009 |Sexually transmitted infectious disease (disorder)|
Definition status:
900000000000073002 |Defined (core metadata concept)|
Rules for description generation:
- Apply General rules for generating descriptions for templates
- Replace [morphology] by the word 'infection' if associated morphology is absent;
- Replace [morphology] by the word 'infection' if associated morphology is 409774005|Inflammatory morphology (morphologic abnormality)| or 23583003|Inflammation (morphologic abnormality)|.
- Replace [Periods of life] by the word 'acquired' if occurrence is 767023003|Period of life beginning after birth and ending before death (qualifier value)|.
14 Comments
Yongsheng Gao
Hi Penni Hernandez, it is better to include finding site as optional. Please include body structure in the description template and a note for description that "of [body structure]" can be removed if it is not present in the logic model. The range for associate morphology will depend on the outcome from the discussion at Infection caused by [bacteria].
Peter G. Williams
Yongsheng Gao, Penni Hernandez are you happy for me to change the pathological process here to DESCENDANT OR SELF of 441862004 |Infectious process (qualifier value)| ? It seems right that a parasitic process (for example - as a descendant of infectious process) is a valid attribute value for an STI ?
Penni Hernandez
Peter G. Williams Yongsheng Gao I think that changing pathologic process is ok here, but I may have run off the rails otherwise. I'm not sure how the terming for the FSN is going to work here. E.g. should "sexually transmitted" be part of the FSN? feedback welcomed.
Jim Case
Yes, changing the PATHOLOGICAL PROCESS to <<441862004 |Infectious process (qualifier value)| is appropriate as there are sexually transmissible diseases caused by organisms that we have characterized as "parasitic" (e.g. Trichomonas vaginalis infection)
Yongsheng Gao
It is always good to be explicit for terminology. However, I am not sure that "sexually transmitted" should be part of the FSN. Two reasons. 1. potential sensitivity about terms in clinical records in some social contexts. 2. we need to clarify if this concept is intended to represent conditions that can ONLY be sexually transmitted, e.g. HIV can be STI, but it can be spread by other means. https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524
Jim Case
Yongsheng Gao, I think it is clinically important that the notion of sexual transmission be included as this is a trigger for public health to contact others that might have come in contact with the infected individual. The notion of sexual transmission may not always be the case, but in situation where an infection can be transmitted sexually or through other means, we should have two concepts.
Yongsheng Gao
Jim Case, I see your point about descriptions to highlight for public health that diseases are sexually transmissible to others. In this sense, the concept |Sexually transmitted infectious disease| seems to represent the state/phase of diseases that is transmissible or not.
I think there is a difference between sexually 'transmitted' and sexually 'transmissible'. For example, HIV can be a sexually transmitted disorder for a patient. This indicates the cause of condition. If HIV were caused by needle use, it should be represented by a concept, such as 'HIV infection due to exposure to needle use' that is not sexually transmitted. Whereas, HIV is sexually transmissible, HIV under proper treatment is not transmissible to other people.
Most commonly used clinical terms do not have 'sexually transmitted/transmissible' as part of descriptions. Would this use case be supported better by SNOMED CT hierarchical relationship?
Jim Case
Yongsheng Gao, that is a good point. So what we need to do is to determine what is meant when the concept is used. My impression in an instance use of a concept that the intent is to represent what the clinical condition of the patient is at the time of evaluation. So in cases where a disease can be transmitted in multiple ways that are of clinical importance, we need the concept to be specific about the mode of transmission. In the example you give above, we have 'Sexually transmitted HIV infection" and "Non-sexually transmitted HIV infection". The intent of the "Sexually transmitted infectious disease" should represent those diseases that are known to be sexually transmitted at the time of diagnosis. Some are only sexually transmitted, some would require the addition of the mode of transmission to specify how the disease was acquired.
For public health, it is important to know whether a disease was sexually transmitted. In the use of SNOMED CT in clinical records, I think we are trying to provide a clinical concept, which at the time of use, specifies that the disease identified in the patient at the time, was sexually transmitted, not that the disease may be sexually transmissible, although that is implied.
Hope I am reasonable clear on my distinction...
Yongsheng Gao
Thanks Jim Case, I think we are in agreement. Just try to make it explicit in descriptions and hierarchy by the HIV example. We need to make clear distinction between sexually transmitted and sexually transmissible. A sexually transmitted infection cannot guarantee that it is a sexually transmissible infection, and vice versa.
Sexually transmitted infection - interpreted as Infection due to sexual contact. HIV is not a subconcept of STI because of other causes of HIV infection. Sexually transmissible or not would depend on stage and treatment of disease. So, we cannot assume that it is at transmissible stage/phase.
Sexually transmitted infection - interpreted as Sexually transmissible infection. It would have different hierarchical relationships comparing to the above interpretation. We cannot assume that a sexually transmissible infection is due to sexual contact because it might not be the case.
If we include both high level concepts for sexually transmitted and sexually transmissible. They are siblings rather than sub/superconcept. The hierarchy would look like:
I am fine with any of the above three options. The additions of content would depend on clinical requirement. We may need to seek clarification for content submitted as subconcepts of STI or STD.
Jim Case
I do not think we need to go to the extent of defining "sexually transmissible disease" as that would open up the Pandora's box of "Propensity of disease to be transmitted sexually (finding)" similar to the modeling of hypersensitivity. Potential modes of transmission are all just potential until they happen, then the mode may be important. The idea of identifying a sexually transmissible disease as being contracted by non-sexual transmission does not add anything; otherwise we would have been more diligent in making sure that mode of transmission was more specifically represented in the disease concept model.
So IMHO, the idea of a "sexually transmissible disease" is more of a finding about a condition than the condition itself. We do not need to explicitly represent it.
Yongsheng Gao
Hi Jim Case if we only need to take the option 1 for sexually transmitted disease. Then, the synonyms and subconcepts with term 'sexually transmissible disease' need to be reviewed. I think the changes are out of the scope for the QI project. Should this topic be addressed in a separate ticket?
Penni Hernandez
I have created a tracker for the review of this subhierarchy: IHTSDO-1111 - Getting issue details... STATUS
Jim Case
Yongsheng Gao, Penni Hernandez,
Is there a need for additional discussion on this or are we ok with kicking this down the road with a tracker. I agree that this is a clinical quality issue, not structural.
Yongsheng Gao
Jim Case we can kick this down the road with a tracker IHTSDO-1111.