High annual figures of sexually transmitted infections (STIs) are diagnosed in the Netherlands despite significant efforts to control them. Herein, we analyse trends and determinants of STI diagnoses, co-infections, and sexual risks among visitors of 26 STI clinics between 2007 and 2011. We recorded increased positivity rates of STIs (chlamydia, syphilis, gonorrhoea, and/or HIV) in women and heterosexual men up to 12.6% and 13.4%, respectively, in 2011, while rates in men having sex with men (MSM) were stable but high (18.8%) through the documented years. Younger age, origin from Surinam/Antilles, history of previous STI, multiple partners, or a previous notification are the identified risk factors for an STI in this population. Known HIV-infected men (MSM and heterosexuals) were at highest risk for co-infections (relative rate heterosexual men: 15.6; MSM: 11.6). STI positivity rates remained high (MSM) or increased over time (women and heterosexual men), a fact that highlights the importance of continuing STI prevention. Most importantly, the very high STI co-infection rates among HIV-positive men requires intensified STI reduction strategies to put an end to the vicious circle of re-infection and spread of HIV and other STIs.

26.1% (19.1%-34.5%). Discomfort with using online/telephone services was more common amongst those not receiving STIrelated services 26.0% (17.4%-36.9%) than for contraception services 6.7% (3.4%-12.8%).Interviewees described how some services were unavailable, while others were disrupted. Many were offered and received alternatives to in-person service (e.g. telephone/online) and some had to use different contraceptive methods. Most understood attempts to limit SARS-CoV-2 transmission and found alternatives convenient, though others saw them as inferior due to interaction limitations. Tenacity was required to access some services. Several participants described how they had avoided or deprioritised their own needs. Fears of contracting COVID-19 and of judgement for having sex against restrictions deterred help-seeking. Conclusion While some people were unable to access an anticipated service, many were offered alternatives with varied consequences. Services may need to adapt further to improve access by offering efficient face-to-face and remote provision while emphasising lack of judgement and validating help seeking.

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resort community with an international, transient and disproportionally large young adult population. A local sexual health clinic operates at capacity. There is no provincial or national outreach CT screening campaign. Methods Series of 15 outreach CT screening sessions, each 2e3 h duration, held in Whistler, BC, Canada in 2009 & 2010 Sessions were held at resort staff-housing dinners, staff-housing lounge, entertainment, educational and sport events. Men and women <30 years were offered free CT nucleic acid amplification tests on urine. Positive cases were notified, with treatment and partner notification per standard of care. Primary outcome measures were age, gender and infection rates of outreach participants compared to <30 age cohort tested for CT at the sexual health clinic during same calendar years. Anonymous, post-test survey queried interval since last CT test, intention to test, health insurance, and satisfaction with the outreach experience. Unpaired t test & c 2 analysis. Results 112 tests for CT were obtained through outreach; 87.5% response rate to post-test survey. Mean outreach age of 23.3 years was 14.4 months younger than comparison age cohort tested at clinic (p¼0.0001). Males were tested at outreach in greater proportion than at clinic (57.1% vs 46.5%, p¼0.04). Proportion of asymptomatic cases was greater at outreach than clinic (90% vs 46.6%, p¼0.01), yet positive test rates at outreach (8.9%, 10/112) and clinic (8.5%, 58/686) were comparable (p¼0.87). On survey, 43.9% had never previously tested for CT, 53.7% were not already considering a test, 61.7% would not have gone for a test within the next 2 months. Only 27.6% had Canadian health insurance. 93.9% were satisfied or very satisfied with CT screening in an outreach setting. Conclusions Intermittent, free, event-based outreach CT screening was operationally feasible, effective at increasing case detection, and highly acceptable to participants. Outreach attracted a younger age and more men than clinic. A large proportion of participants were first-time testers, over half were without prior intent to test or likelihood to test in near future, and most would have had to pay up-front for CT testing in a clinic setting. This study demonstrates both need and benefit of expanded CT screening efforts in the international resort setting.

Results 400 surveys were returned from 402 women recruited (response rate >99%), age range 17-57 (mean 25.2) years.75% disagreed/strongly disagreed with the statement 'taking my own samples was difficult'. 72% agreed/strongly agreed that they felt confident taking their own swabs but 30.5% agreed/ strongly agreed they felt uncomfortable taking their own swabs; of these 53 (43%) stated they had never had anal sex. 42% agreed/strongly agreed that they would prefer to take their own samples compared to 34% who agreed/strongly agreed they would prefer clinician-taken swabs. 66% agreed/strongly agreed they would be happy to take the samples themselves in a nonclinic setting.Free comments covered themes of 'more confidence if had clinician samples taken before', 'concerns if self-swabbing would give correct results'. Nine commented specifically on discomfort, but none disagreed with the statement 'I would be happy to take my own swabs in a non-clinic environment'. Conclusion Extra-genital sampling was highly acceptable to the majority of women, with high levels of confidence and low reports of discomfort. This has positive implications for the future of extra-genital testing in women, especially in non-clinic settings.