Registration of STD and HIV consultations at Regional Community Health Services in the Netherlands: Annual Report 1999

Public health nurses at the municipal health services keep a register of patients attending the MHS or STD clinic for diagnosis and treatment of STD or request for HIV-testing. Data are collected at a national level and are only registered for an actual STD or HIV consultation with confirmed diagnosis. Thirty-nine health services registered a total of 11,586 consultations with a confirmed diagnosis in 1999 (15% more than in 1998). About 75% of the patients were Dutch. Three-quarters of the men reported heterosexual contacts, 20% reported homosexual and bisexual contacts. Of the women, 21% reported to have worked as a commercial sex worker in the past 6 months prior to the consultation at the clinic. The number of cases of diagnosed STD had increased by 3% in 1999 (to 2934) with respect to 1998 (2844); for women 0% and for men 6%. An STD was actually diagnosed in 31% of the visitors who were tested for STD (1998: 36%). Patients with a confirmed STD were more often non-Dutch; the percentage with homosexual and bisexual contacts was higher than among the total group of patients. The most common STD for both men and women was chlamydia. The next most common STD for men were genital warts and gonorrhoea, for women bacterial vaginitis, candidiasis and genital warts. A rise of 20% in the number of gonorrhoea cases among men was observed, for women the number declined by 12%. In 1999 5027 patients consulted for HIV and requested HIV-testing; 0.9% were found positive. Just as in 1998, homosexual and bisexual men were most often represented among the HIV-positives.Bij de Gemeentelijke Gezondheidsdiensten (GGD's) wordt door sociaal-verpleegkundigen ten behoeve van de non-curatieve soa-bestrijding een registratie bijgehouden van de bezoekers ten behoeve van een SOA-hulpvraag of HIV-testverzoek. De gegevens van deze registratie worden landelijk verzameld en bewerkt. De registratie omvat alleen gegevens van geregistreerde bezoekers van een SOA of HIV spreekuur waarbij een sociaal-verpleegkundige aanwezig was. In 1999 registreerden 39 GGD's in totaal 11.586 consulten (stijging van 15% t.o.v. 1998). Ruim driekwart van de bezoekers was afkomstig uit Nederland. Van de mannelijke bezoekers had driekwart heteroseksueel en 20% homo- of biseksueel contact gehad. Van de vrouwen werkte 21% als prostituee in de zes maanden voorafgaand aan het consult. Het aantal gediagnosticeerde SOA steeg in 1999 met 3% tot 2934; 0% voor vrouwen en 6% voor mannen. Bij 31% van de bezoekers waarbij SOA onderzoek is gedaan, werd een SOA geconstateerd (1998: 36%). Opvallend is dat de groep waarbij een SOA was vastgesteld minder vaak uit Nederland afkomstig was, vaker homoseksuele contacten had en minder vaak prostituant was dan de groep bezoekers in de registratie waarbij geen SOA is vastgesteld. De meest voorkomende SOA bij zowel mannen als vrouwen was chlamydia; bij mannen gevolgd door genitale wratten en gonorroe en bij vrouwen gevolgd door bacteriele vaginose, candidiasis en genitale wratten. In 1999 was bij 5027 consulten sprake van een HIV-testverzoek (precounseling) waarbij 0,9% positief bleek te zijn. In de groep HIV-positieven waren de homo- en biseksuele mannen, net als in 1998, het meest vertegenwoordigd

How robust are the natural history parameters used in chlamydia transmission dynamic models? A systematic review

Transmission dynamic models linked to economic analyses often form part of the decision making process when introducing new chlamydia screening interventions. Outputs from these transmission dynamic models can vary depending on the values of the parameters used to describe the infection. Therefore these values can have an important influence on policy and resource allocation. The risk of progression from infection to pelvic inflammatory disease has been extensively studied but the parameters which govern the transmission dynamics are frequently neglected. We conducted a systematic review of transmission dynamic models linked to economic analyses of chlamydia screening interventions to critically assess the source and variability of the proportion of infections that are asymptomatic, the duration of infection and the transmission probability. We identified nine relevant studies in Pubmed, Embase and the Cochrane database. We found that there is a wide variation in their natural history parameters, including an absolute difference in the proportion of asymptomatic infections of 25% in women and 75% in men, a six-fold difference in the duration of asymptomatic infection and a four-fold difference in the per act transmission probability. We consider that much of this variation can be explained by a lack of consensus in the literature. We found that a significant proportion of parameter values were referenced back to the early chlamydia literature, before the introduction of nucleic acid modes of diagnosis and the widespread testing of asymptomatic individuals. In conclusion, authors should use high quality contemporary evidence to inform their parameter values, clearly document their assumptions and make appropriate use of sensitivity analysis. This will help to make models more transparent and increase their utility to policy makers

Effects of a short individually tailored counselling session for HIV prevention in gay and bisexual men receiving Hepatitis B vaccination

Background. There is currently a trend towards unsafe unprotected anal intercourse (UAI) among men who have sex with men. We evaluated a short individual counselling session on reducing UAI among gay and bisexual men. Methods. A quasi-experimental design was used to evaluate the counselling session. This session was conducted during consulting hours at four municipal health clinics during a Hepatitis B vaccination campaign. These clinics offered free vaccination to high-risk groups, such as gay and bisexual men. All gay and bisexual men attending health clinics in four cities in the Netherlands were asked to participate. Each participant in the intervention group received a fifteen-minute individual counselling based on the Theory of Planned Behaviour and Motivational Interviewing. Changes in UAI were measured over a 5-months period, using self-administered questionnaires. UAI was measured separately for receptive and insertive intercourse in steady and casual partners. These measures were combined in an index-score (range 0-8). Results. While UAI in the counselling group remained stable, it increased in the controls by 66% from 0.41 to 0.68. The results show that the intervention had a protective effect on sexual behaviour with steady partners. Intervention effects were strongest within steady relationships, especially for men whose steady-relationship status changed during the study. The intervention was well accepted among the target group. Conclusion. The fifteen-minute individually tailored counselling session was not only well accepted but also had a protective effect on risk behaviour after a follow-up of six months

Using Intervention Mapping to develop a programme to prevent sexually transmittable infections, including HIV, among heterosexual migrant men

<p>Abstract</p> <p>Background</p> <p>There is little experience with carefully developed interventions in the HIV/STI prevention field aimed at adult heterosexual target groups in the Netherlands. The ability to apply intervention development protocols, like Intervention Mapping, in daily practice outside of academia, is a matter of concern. An urgent need also exists for interventions aimed at the prevention of STI in migrant populations in the Netherlands. This article describes the theory and evidence based development of HIV/STI prevention interventions by the Municipal Public Health Service Rotterdam Area (MPHS), the Netherlands, for heterosexual migrant men with Surinamese, Dutch-Caribbean, Cape Verdean, Turkish and Moroccan backgrounds.</p> <p>Methods</p> <p>First a needs assessment was carried out. Then, a literature review was done, key figures were interviewed and seven group discussions were held. Subsequently, the results were translated into specific objectives ("change objectives") and used in intervention development for two subgroups: men with an Afro-Caribbean background and unmarried men with a Turkish and Moroccan background. A matrix of change objectives was made for each subgroup and suitable theoretical methods and practical strategies were selected. Culturally-tailored interventions were designed and were pre-tested among the target groups.</p> <p>Results</p> <p>This development process resulted in two interventions for specific subgroups that were appreciated by both the target groups and the migrant prevention workers. The project took place in collaboration with a university center, which provided an opportunity to get expert advice at every step of the Intervention Mapping process. At relevant points of the development process, migrant health educators and target group members provided advice and feedback on the draft intervention materials.</p> <p>Conclusion</p> <p>This intervention development project indicates that careful well-informed intervention development using Intervention Mapping is feasible in the daily practice of the MPHS, provided that sufficient time and expertise on this approach is available. Further research should test the effectiveness of these interventions.</p

[Sexually transmitted diseases in the Netherlands.]

Abstract niet beschikbaarThis report reviews the current status with respect to the most important sexually transmitted diseases (STD) from the public health perspective e.g. gonorrhoea, syphilis, infection with Chlamydia trachomatis, genital infection with the human papilloma virus (HPV), hepatitis B, genital herpes, infection with the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). In seven chapters the following aspects are discussed per disease: * the clinical features * the occurrence of STD in the Netherlands * prevention and intervention * comparison with the situation abroad. In the final chapter the contents from previous chapters is integrated and a comparison is made between several STD. The differences between bacterial and viral STD are highlighted as well as the way they indicate the choice for particular control programmes. The epidemiology, the differences and similarities between the occurence of and the risk factors for STD are considered together with strategies for prevention of STD. Finally the organisation and financial structure of the Dutch control programme for STD is briefly discussed.DGVGZ/PAO RIV

Registration of Sexually Transmitted Diseases at Municipal Health Services in the Netherlands: annual report 1996

In 1996 steeg het aantal consulten ten behoeve van een SOA-hulpvraag en HIV-testverzoek met 12,5% (vrouwen 18%; mannen 7%) tot 13.226. Het aantal gediagnostiseerde SOA steeg in 1996 met 10,1% (vrouwen 16,9%; 4,5% mannen) tot 4976. Voor zowel mannen als vrouwen is infectie met chlamydia trachomatis de meeste voorkomende SOA; voor mannen gevolgd door gonorroe en genitale wratten; voor vrouwen gevolgd door candidiasis, bacteriele vaginose en gonorroe. De forse stijging van chlamydia (32,8%; vrouwen 43,8%; mannen 22,8%) kon niet alleen worden verklaard door de toename in het aantal consulten maar waarschijnlijk ook door verbeterde diagnostiek en toegenomen alertheid. Chlamydia werd bij vrouwen zes keer zo vaak gesteld als gonorroe; bij mannen anderhalf keer. Er werden evenveel vrouwen als mannen met chlamydia geconstateerd hetgeen duidt dat chlamydia minder vaak lijkt voor te komen bij de klassieke risicogroepen, in tegenstelling tot gonorroe. Het aantal mannen met syfilis is flink gestegen en blijkt ook vaker voor te komen bij de etnische bevolkingsgroepen al dan niet gecombineerd met recente prostitutie-contacten. De diagnose syfilis wordt echter veel minder gesteld dan chlamydia en gonorroe. Bij ruim 6000 consulten was sprake van een HIV-testverzoek waarbij ongeveer 1% positief bleek te zijn. In deze groep waren de homo/biseksuele mannen het meest vertegenwoordigd. Ondanks de beperkingen van deze registratie, zal deze SOA/HIV-registratie in de toekomst de enige zijn op nationaal niveau. Verbeteringen in de gegevensverzameling zijn dientengevolge van belang voor de surveillance van SOA en HIV in het algemeen.In 1996 the total number of consultations on STD and HIV-testing at STD clinics and municipal health services was 13,226 and increased with 12.5% compared with 1995 (women 18%; men 7%). The total number of diagnosed STD was 4,976 and increased with 10.1% in 1996 compared with 1995 (women 16.9%; men 4.5%). In both men and women an infection with Chlamydia trachomatis was the most common STD; in men followed by gonorrhoea and genital warts; in women followed by candidiasis, bacterial vaginosis and gonorrhoea. The dramatic increase in the number of chlamydial infections (32.8%; women 43.8%; men 22.8%) could not be explained only by the increase in the number of consultations but probably by increased awareness and improved diagnostics as well. Chlamydial infection was diagnosed six times as much as gonorrhoea among women; among men one and a half times as much. However, an almost similar number of women and men were diagnosed with chlamydial infection suggesting that chlamydial infection is less restricted to specific risk groups like gonorrhoea. The number of men with syphilis increased enormously and appeared to be associated with ethnic groups and commercial sex. However, syphilis was diagnosed less often than chlamydial infection and gonorrhoea. Over 6000 consultations concerning HIV antibody testing resulted in 54 seropositive individuals (1% positive test results). Men having sex with men (MSM) were overrepresented in this group. Although this registration is suffering from some shortcomings, it will be the only surveillance system at a national level for STD and HIV in near future. Hence, improvements of the data collection are important for STD and HIV surveillance in general.IG

Registration of Sexually Transmitted Diseases at Municipal Health Services in the Netherlands: annual report 1996

In 1996 the total number of consultations on STD and HIV-testing at STD clinics and municipal health services was 13,226 and increased with 12.5% compared with 1995 (women 18%; men 7%). The total number of diagnosed STD was 4,976 and increased with 10.1% in 1996 compared with 1995 (women 16.9%; men 4.5%). In both men and women an infection with Chlamydia trachomatis was the most common STD; in men followed by gonorrhoea and genital warts; in women followed by candidiasis, bacterial vaginosis and gonorrhoea. The dramatic increase in the number of chlamydial infections (32.8%; women 43.8%; men 22.8%) could not be explained only by the increase in the number of consultations but probably by increased awareness and improved diagnostics as well. Chlamydial infection was diagnosed six times as much as gonorrhoea among women; among men one and a half times as much. However, an almost similar number of women and men were diagnosed with chlamydial infection suggesting that chlamydial infection is less restricted to specific risk groups like gonorrhoea. The number of men with syphilis increased enormously and appeared to be associated with ethnic groups and commercial sex. However, syphilis was diagnosed less often than chlamydial infection and gonorrhoea. Over 6000 consultations concerning HIV antibody testing resulted in 54 seropositive individuals (1% positive test results). Men having sex with men (MSM) were overrepresented in this group. Although this registration is suffering from some shortcomings, it will be the only surveillance system at a national level for STD and HIV in near future. Hence, improvements of the data collection are important for STD and HIV surveillance in general.In 1996 steeg het aantal consulten ten behoeve van een SOA-hulpvraag en HIV-testverzoek met 12,5% (vrouwen 18%; mannen 7%) tot 13.226. Het aantal gediagnostiseerde SOA steeg in 1996 met 10,1% (vrouwen 16,9%; 4,5% mannen) tot 4976. Voor zowel mannen als vrouwen is infectie met chlamydia trachomatis de meeste voorkomende SOA; voor mannen gevolgd door gonorroe en genitale wratten; voor vrouwen gevolgd door candidiasis, bacteriele vaginose en gonorroe. De forse stijging van chlamydia (32,8%; vrouwen 43,8%; mannen 22,8%) kon niet alleen worden verklaard door de toename in het aantal consulten maar waarschijnlijk ook door verbeterde diagnostiek en toegenomen alertheid. Chlamydia werd bij vrouwen zes keer zo vaak gesteld als gonorroe; bij mannen anderhalf keer. Er werden evenveel vrouwen als mannen met chlamydia geconstateerd hetgeen duidt dat chlamydia minder vaak lijkt voor te komen bij de klassieke risicogroepen, in tegenstelling tot gonorroe. Het aantal mannen met syfilis is flink gestegen en blijkt ook vaker voor te komen bij de etnische bevolkingsgroepen al dan niet gecombineerd met recente prostitutie-contacten. De diagnose syfilis wordt echter veel minder gesteld dan chlamydia en gonorroe. Bij ruim 6000 consulten was sprake van een HIV-testverzoek waarbij ongeveer 1% positief bleek te zijn. In deze groep waren de homo/biseksuele mannen het meest vertegenwoordigd. Ondanks de beperkingen van deze registratie, zal deze SOA/HIV-registratie in de toekomst de enige zijn op nationaal niveau. Verbeteringen in de gegevensverzameling zijn dientengevolge van belang voor de surveillance van SOA en HIV in het algemeen

Sexually Transmitted Diseases in the Netherlands; update 1996

Een volledig overzicht is gegevens van de huidige stand van zaken met betrekking tot de belangrijkste SOA: gonorroe, syfilis, infectie met Chlamydia trachomatis, genitale infecties met humaan papillomavirus (HPV) , hepatitis B, herpes genitalis, HIV-infectie en AIDS. Er wordt uitgebreid ingegaan op de surveillance van SOA, het voorkomen van SOA in Nederland in de periode 1991-1996 (incidentie, prevalentie, determinanten, morbiditeit en mortaliteit). Er wordt gesteld dat er slechts beperkt inzicht bestaat in het voorkomen van SOA in Nederland door gebrek aan uniform verzamelde gegevens. Door veranderingen in de wetgeving zal de aangifteplicht voor SOA vervallen: een alternatief surveillancesysteem wordt voorgesteld. De trends van gonorroe en syfilis zijn neerwaarts, SOA komt voornamelijk voor bij specifieke subgroepen van de bevolking. Recente verheffingen bleken wel gecorreleerd te zijn met hoog risicogroepen (i.e. personen met veel wisselende seksuele contacten, homoseksuele mannen, druggebruik). De prevalentie van chlamydia blijkt veel hoger dan werd verondersteld sinds het gebruik van de nieuwe gevoelige diagnostische methoden. Chlamydia lijkt ook veel minder geassocieerd met bepaalde risicofactoren. De incidentie van AIDS heeft zich gestabiliseerd sinds 1992, grotendeels door een afname bij homoseksuele mannen; het aandeel van druggebruik en heteroseksuele contacten als besmettingsbron is toegenomen. In het algemeen wordt geconcludeerd dat nationale bestrijdingsplannen voor chlamydia nodig zijn en dat de huidige surveillancesystemen voor SOA verbeterd dienen te worden om trends in de komende jaren te volgen, van zowel chlamydia als virale SOA.This report reviews extensively the current status with respect to the most important STD from a public health perspective, e.g. gonorrhoea, syphilis, infection with Chlamydia trachomatis, genital infection with the human papilloma virus (HPV), hepatitis B, genital herpes, infection with the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). The surveillance of STD in the Netherlands is discussed and the occurrence of STD (mainly from 1991-1996) is presented (incidence , prevalence, risk factors, morbidity and mortality). The current magnitude of the STD problem in the Netherlands cannot be accurately determined based on present surveillance systems. Due to a revision of the legislation the compulsory notification will not include STD anymore. An alternative model for STD surveillance is suggested. It is demonstrated that trends in gonorrhoea and syphilis are downwards and that these STD have become restricted to well-defined subgroups of the population. The prevalence of chlamydial infections seems to be higher than previously was assumed since currently sensitive diagnostics are available. Chlamydial infection seems to be less associated with risk factors. The incidence of AIDS appears to have stabilised since 1992 due to a drop in the number of cases among homosexual men: the percentage of drugusers and hetersexuals has increased in the same period. In general, it is stated that national control measures are needed for chalmydial infection and that the present surveillance sytem for STD needs to be improved to monitor trends in coming years, both for chlamydial infection and viral STD.IG

HIV en SOA in Nederland in 2003

De toename van seksueel overdraagbare aandoeningen (SOA), die de afgelopen jaren werd waargenomen, lijkt in 2003 enigszins te zijn gestabiliseerd. De continue toename in het aantal gevallen van syfilis en de epidemie van Lymphogranuloma venereum (LGV) bij homo/biseksuele mannen duidt echter op toename in onveilig seksueel gedrag. Continue alertheid is nodig om verdere verspreiding van SOA en HIV te voorkomen. Per augustus 2004 zijn 9767 personen met HIV geregistreerd, waarvan 847 gediagnosticeerd in 2003. Eind 2003 waren er naar schatting 16400 personen in Nederland geinfecteerd met HIV. Homo/biseksuele mannen vormden hierbij nog steeds de grootste groep. Het aandeel van heteroseksuelen met HIV steeg de laatste jaren, maar lijkt zich in 2003 te stabiliseren. De hoogste HIV prevalentie in Nederland werd gevonden bij homo/biseksuele mannen (0-22%) en injecterende druggebruikers (0-26%). De HIV prevalentie bij de heteroseksuele bevolkingsgroep varieerde van 0 tot 1,4%. Het aantal gevallen van Chlamydia is gelijk gebleven en gonorroe daalde met 16%. Het aantal gevallen van syfilis en virale SOA nam echter nog steeds toe. In 2000-2003 is het aantal gevallen van syfilis bij mannen meer dan verdubbeld. Deze forse toename van syfilis komt grotendeels op het conto van homo/biseksuele mannen. Genitale wratten zijn de meest voorkomende virale SOA. In 2003 is de resistentie tegen ciprofloxacin bij gonorroe toegenomen tot 9%. In Amsterdam wordt deze resistentie voor het eerst vaker gezien bij homo/biseksuele mannen dan bij heteroseksuelen. De epidemie van LGV bij, voornamelijk HIV positieve, homo/biseksuele mannen heeft tot intensivering van surveillance geleid. Op 1 september 2004 waren 92 gevallen gerapporteerd. Na (inter)nationale berichtgeving over deze epidemie worden gevallen nu ook vanuit andere Europese landen gemeld. In Nederland lijkt LGV nog steeds langzaam toe te nemen. Bekend HIV positieve personen nemen een belangrijk deel van de SOA voor hun rekening: 20% van alle gonorroe, chlamydia en syfilis in homo/biseksuele mannen wordt gezien bij HIV positieven. We concluderen dat het seksuele risicogedrag bij homo/biseksuele mannen onverminderd hoog is met een reeel risico op verdere verspreiding van SOA en HIV. Continue alertheid is geboden om verdere verspreiding van SOA en HIV te voorkomen en hierbij dient te worden gezocht naar innovatieve methoden in preventie en interventie.The increasing trend of Sexually Transmitted Infections (STIs), as observed in the last few years, seemed to have stabilised in 2003. The continuous increase of syphilis diagnoses and the outbreak of Lymphogranuloma venereum (LGV) among men who have sex with men (MSM), indicate an increase of sexual risk behaviour. Permanent alertness will be required to prevent a further spread of STIs and HIV. As of August 2004, a total of 9767 HIV cases were reported in the Netherlands, of which 847 were newly diagnosed in 2003. By the end of 2003, there were an estimated 16400 people living with HIV/AIDS in the Netherlands. MSM still accounted for the majority of the registered cases, although the proportion decreased over time. The increase of heterosexually acquired infections in recent years seemed to have levelled off in 2003. HIV prevalence in the Netherlands was highest among MSM (0-22%) and injecting drug users (IDUs) (0-26%). HIV prevalence among heterosexuals varied between 0-1.4%. In 2003, the number of diagnoses of genital chlamydial infection remained stable; the number of diagnoses of gonorrhoea decreased by 16%. However, diagnoses of syphilis and viral STIs continued to increase in 2003. Between 2000 and 2003, the number of syphilis diagnoses more than doubled among men. This sharp increase can largely be attributed to MSM. Genital warts were the most common viral STI. The percentage of ciprofloxacin resistance seemed to have increased fairly rapidly in 2003. In Amsterdam, the prevalence of gonococcal antimicrobial resistance was, for the first time, higher in MSM than in heterosexuals. Enhanced surveillance of LGV was started in the Netherlands in a response to the outbreak of LGV among, predominantly HIV infected, MSM. By September 2004, 92 cases of LGV had been reported. LGV had been reported by other European countries as well, following the international alerts in January 2004. Known HIV infected individuals accounted for an important part of STIs: 20% of all diagnoses of gonorrhoea, chlamydia and syphilis among MSM were seen in known HIV infected MSM. Therefore we can conclude that unsafe sex practices are on-going in MSM with a potential risk of a further spread of STI and HIV. Permanent alertness and innovative prevention and intervention methods will be needed to prevent a further spread of STIs and HIV.VW