Sexually Transmitted Infection Outbreak Report

1. Outbreak Identification

STI Name Date Outbreak Reported Reporting Unit / Facility Location (City/Region)

2. Case Information

Date of First Case Symptom Onset Total Number of Cases Number of Confirmed Cases Number of Suspected Cases Number of Deaths

3. Demographic Details

Age Group	Male	Female	Other	Total
< 15
15–24
25–49
> 49
Total

4. Clinical and Laboratory Information

Main Symptoms Laboratory Tests Performed Laboratory Confirmation

5. Epidemiological Information

Suspected Mode(s) of Transmission Known Risk Factors in Outbreak

6. Control Measures Taken

7. Additional Comments / Notes