Regional differences in chlamydia and gonorrhoeae positivity rate among heterosexual STI clinic visitors in the Netherlands: contribution of client and regional characteristics as assessed by cross-sectional surveillance data

Abstract

ObjectivesTo assess to what extent triage criteria, client and regional characteristics explain regional differences in Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (Ng) positivity in sexually transmitted infection (STI) clinics.DesignRetrospective cross-sectional study on the Dutch STI surveillance database of all 24 STI clinics.ParticipantsSTI clinic visits of heterosexual persons in 2015 with a Ct (n=101 495) and/or Ng test (n=101 081).Primary outcome measureCt and Ng positivity and 95% CI was assessed for each STI clinic. Two-level logistic regression analyses were performed to calculate the percentage change in regional variance (PCV) after adding triage criteria (model 1), other client characteristics (model 2) and regional characteristics (model 3) to the empty model. The contribution of single characteristics was determined after removing them from model 3.ResultsCt positivity was 14.9% and ranged from 12.6% to 20.0% regionally. Ng positivity was 1.7% and ranged from 0.8% to 3.8% regionally. For Ct, the PCV was 11.7% in model 1, 32.2% in model 2% and 59.3% in model 3. Age, notified for Ct (triage), level of education (other characteristics) and regional degree of urbanisation (region) explained variance most. For Ng, the PCV was 38.7% in model 1, 61.2% in model 2% and 69.1% in model 3. Ethnicity (triage), partner in risk group, level of education and neighbourhood (other characteristics) and regional socioeconomic status (SES) explained variance most. A significant part of regional variance remained unexplained.ConclusionsRegional variance was explained by differences in client characteristics, indicating that triage and self-selection influence positivity rates in the surveillance data.Clustering of Ng in low SES regions additionally explained regional variance in Ng; targeted interventions in low SES regions may assist Ng control. Including educational level as triage criterion is recommended. Studies incorporating prevalence data are needed to assess whether regional clustering underlies unexplained regional variance.

The Characteristics of Patients Frequently Tested and Repeatedly Infected with Neisseria gonorrhoeae

“…Differences in the characteristics between patients repeatedly infected with NG and those individuals repeatedly tested negative for NG could be indicative for different high-risk populations. However, similarities in the characteristics between those groups could suggest similar sexual networks and high risk behavior [9,10]. Furthermore, the extent to which patients with repeat NG infections account for the total number of diagnosed NG infections could provide insight into NG transmission routes [8].…”

Estimating nationwide cases of sexually transmitted diseases in 2015 from sentinel surveillance data in Japan

“…Interpreting these results is not easy. There may be several reasons for these differences, including the extent of access to sensitive diagnostics, differences in surveillance data collection, variations in national testing policies, the level of testing policy implementation, and actual differences in incidence rates [3,25,26]. We found 89 newly diagnosed cases of gonorrhea per 100,000 population, and a male-female ratio of 2.6.…”

“…The rate and male-female ratio in Japan were between those found in the United States and the average level in Europe. These differences in rates and male-female ratios between the United States, European countries and Japan might be linked to real differences as well as differences in healthcare systems, access to services, and surveillance data collection [3,26,27]. The WHO report showed that the rate in males aged 15-49 years in 2016-2017 varied between 0.0 and 387.5 per 100,000 population across 64 countries [2].…”

Contribution of general practitioners and sexual health centres to sexually transmitted infection consultations in five Dutch regions using laboratory data of Chlamydia trachomatis testing

“…The SHC of Amsterdam has a long history (since 1986) and a high familiarity, while the SHC at the Rotterdam PHS was established more recently (2009). 16,17 In addition to logistic aspects, regional differences in population characteristics, sexual risk behaviours and attitudes towards STI testing may explain the observed variation in test rate and GP contribution. 2,18 In Amsterdam, an estimated 10% of the male population is mainly or exclusively attracted to men, while this is 4% on a national level.…”