Trends in sexually transmitted infections in the Netherlands, combining surveillance data from general practices and sexually transmitted infection centers

Abstract

BackgroundSexually transmitted infections (STI) care in the Netherlands is primarily provided by general practitioners (GPs) and specialized STI centers. STI surveillance is based on data from STI centers, which show increasing numbers of clients. Data from a GP morbidity surveillance network were used to investigate the distribution in the provision of STI care and the usefulness of GP data in surveillance.MethodsData on STI-related episodes and STI diagnoses based on ICPC codes and, for chlamydia, prescriptions, were obtained from GP electronic medical records (EMRs) of the GP network and compared to data from STI centers from 2002 to 2007. Incidence rates were estimated for the total population in the Netherlands.ResultsThe incidence of STI-consultations and -diagnoses increased substantially in recent years, both at GPs and STI centers. The increase in consultations was larger than the increase in diagnoses; Chlamydia incidence rose especially at STI centers. GPs were responsible for 70% of STI-related episodes and 80-85% of STI diagnoses. STI centers attract relatively younger and more often male STI-patients than GPs. Symptomatic STIs like Herpes genitalis and genital warts were more frequently diagnosed at GPs and chlamydia, gonorrhea and syphilis at STI centers.ConclusionsGPs fulfill an important role in STI care, complementary to STI centers. Case definitions of STI could be improved, particularly by including laboratory results in EMRs. The contribution of primary care is often overlooked in STI health care. Including estimates from GP EMRs can improve the surveillance of STIs.

Chlamydia trachomatisIgG seroprevalence in the general population of the Netherlands in 1996 and in 2007: differential changes by gender and age

“…For example, the number of STI-related episodes reported by GPs increased by 44%, from 664 per 100 000 patients to 955 per 100 000 patients between 2002 and 2007 2. At STI clinics the number of consultations increased from 11 378 in 1996 to 78 062 in 2007 29.…”

“…Chlamydia trachomatis (CT), an obligate intracellular bacterium, is the cause of the most commonly reported bacterial sexually transmitted infection (STI) in the Netherlands 1 2. A population-based study in 2002/2003 reported a CT prevalence of 2.5% and 1.5% in 16–29-year-old women and men, respectively 3.…”

“…CT reporting rates from STI clinics and GPs have shown a rising trend in the past two decades in the Netherlands 1 2. This trend is difficult to interpret, as increased intensity of CT transmission may have occurred, but also the increased availability of DNA amplification testing and the introduction of proactive screening programmes since 1995 might be major contributors to the increasing CT positivity rates.…”

Who tests whom? A comprehensive overview ofChlamydia trachomatistest practices in a Dutch region among different STI care providers for urogenital, anorectal and oropharyngeal sites in young people: a cross-sectional study

“…Each of these STI care providers or programmes will contribute to CT control, yet a comprehensive assessment of their relative contribution in terms of testing, diagnosis and the populations that they serve is thus far unavailable. Sentinel data from Dutch GPs suggest that GPs diagnose the lion's share of CT cases, with estimates reaching 70% (vs 30% in STI clinics) 7. Data from the National Chlamydia Screening Programme (year 2013) in the UK (15–24 year olds) show that the contribution of GPs seems smaller, accounting for 14% of all positive tests (vs >40% by genitourinary (GUM) clinics) 8.…”

The cost of managing genital warts in the UK

“…18 Notably, Woodhall et al 5 reported that 42% of patients among new and recurrent GU medicine cases had attended a GP for GW management prior to attending a sexual health clinic, but did not include these costs in their estimate. The current study estimated that approximately 48,695 GW episodes were seen at a GP.…”