In 2012, the number of new consultations at Sexually Transmitted Infections (STI) clinics in the Netherlands increased by 7% over the previous year. Meanwhile, general practices report a 14% increase in the number of STI diagnoses in the period 2010 to 2011. The percentage of people testing positive for STIs increased largely due to more cases of chlamydia in young heterosexuals, and more cases of gonorrhea in MSM. The number of new HIV infections within the group known as men who have sex with men (MSM) decreased in 2012, but remained stable amongst heterosexuals.
The Centre for Infectious Disease Control (CIb) at the National Institute for Public Health and the Environment (RIVM) presented its annual report, ‘Sexually transmitted infections, including HIV, in the Netherlands in 2012’ at an Expert Meeting on STIs and HIV, held in Bilthoven on 14th June 2013. This newest report, prepared in collaboration with the 26 regional STI clinics, the HIV Monitoring and HIV Treatment Centres Foundation (SHM), the Dutch Institute for Health Services Research (NIVEL) and the information system (OSIRIS), shows a 1.3% increase in new cases of chlamydia, particularly in heterosexual men and women younger than 25 years of age, compared with 2011. GPs also reported that cases of chlamydia increased by 13% in 2011 compared with 2010 rates. Furthermore, numbers of cases of Lymphogranuloma venereum (LGV), an aggressive form of chlamydia rarely seen outside the tropics before 2003, increased sharply in 2012, with 184 new diagnoses compared with 69 in 2011.
Gonorrhoea strains resistant to antibiotics
The number of new cases of gonorrhoea also increased in 2012, the majority of the cases (57%) found amongst MSM. These figures are especially important at a time when antibiotic resistant strains of the gonorrhoea bacterium, some resistant to third generation cefalosporines, are becoming increasingly prevalent worldwide. GPs also reported a steep increase in the number of gonorrhoea cases in 2011 compared to 2010, especially in women.
HIV cases down
At STI clinics, a total of 358 HIV infections were diagnosed in 2012. Within MSM, the numbers were slightly down compared with 2011, whereas HIV positivity remained stable at 0.1% within the heterosexual group attending the clinics. The national HIV database, coordinated by SHM, shows an increase in the annual number of HIV diagnoses amongst people aged 50 and older. The proportion of people being diagnosed as HIV positive at a later stage has decreased to 43% in 2012 compared with 60% in 2000. These proportions were lower in the MSM group (34%) compared with the heterosexual group (58%).
Change in testing policy
Dutch STI clinics target all groups at high risk of infection which are tested free of charge. Until recently, all these groups, including MSM (20% of all attendees in 2012), people originating from STI/HIV endemic areas of the world (26%), and people younger than 25 (49%), were mandatorily tested for chlamydia, gonorrhoea and syphilis, with an opt-out policy for HIV. However since 2012, people younger than 25 are only tested for chlamydia; should that test prove positive, only then is this group tested for gonorrhoea, syphilis and HIV.