Sexually transmitted infections in the Netherlands in 2017
2018
In 2017, a total of 150,593 consultations were registered at the Dutch Sexual Health Centres (SHC), an increase of 5% compared to 2016. This increase was highest among MSM (+12.9%), and less strong among women (+2.6%) and heterosexual men (+0.5%). Of all SHC visitors, 46% was female (69,375 consultations), 23% heterosexual male (35,242 consultations) and 30% MSM (45,553 consultations). In 416 consultations (0.3%), the client was transgender.
Similar to 2016, 16% of SHC visitors had two or more registered visits in 2017. This percentage was highest among MSM (35%) and lower among heterosexual men (9%) and women (11%).
The percentage of people with a positive STI test (chlamydia, gonorrhoea, infectious syphilis, HIV or infectious hepatitis B) was 18.4% in both 2016 and 2017. The positivity rate among heterosexual men increased from 13.9% in 2013 to 19.6% in 2017 (19.2% in 2016). Among women, the positivity rate increased from 13.2% in 2013 to 16.3% in 2017, but remained stable compared with 2016 (16.2%). The positivity rate among MSM varied between 19.2% and 21.7% over time (20.5% in 2017). Positivity rates were highest among visitors who were notified for STI (33.0%) and among HIV-positive visitors (32.5%), though the positivity rates among HIV-positive people were lower compared to previous years. Positivity rates were also high among those who reported STI symptoms (26.1%) and people who had an STI in the past year (25.1%). Overall positivity rates varied between 14.7 and 21.7% in the SHC regions.
The total number of STI-related episodes recorded at general practices (GP) (based on a selection of 350 GPs in the Netherlands and extrapolated to the total Dutch population) is almost twice the number reported at SHC, with an estimated 281,300 episodes (STI infections and ‘fear of STI’) in 2016. This is an increase from the 267,400 episodes recorded in 2015. The reporting rate of STI-related episodes at the GP increased mainly among people aged 25 years
or older (from 15.9/1,000 population to 16.9/1,000 population).
Bacterial STI
In 2017, chlamydia was diagnosed 21,404 times at the SHC, an increase of 3% compared to 2016. Most chlamydia infections were diagnosed in people younger than 25 years of age (64%). There is an increasing trend in the chlamydia positivity rate among heterosexual men: from 10.6% in 2008 to 18.3% in 2017 (18.0% in 2016). Among women, the positivity rate also increased in the same period, but remained stable in 2017 (15.4%) compared to 2016 (15.3%).
The positivity rate among MSM has fluctuated around 10.0% in recent years (9.5% in 2017).
Among HIV-positive MSM, a decrease in positivity rate was seen from 17.6% in 2014 to 14.6% in 2017. The number of lymphogranuloma venereum (LGV, an infection caused by an invasive strain of chlamydia) diagnoses increased again in 2017, but the positivity rate remained stable. Of those with LGV, 55% were known to be HIV-positive. The number of estimated chlamydia episodes reported in general practice (36,500) was fairly stable compared to the previous year,
but slightly increased among people aged 25 and older. Reporting rates of chlamydia episodes per 1,000 population were the same in both 2016 and 2015.
The number of reported acute hepatitis B cases in the notification data was similar in both years (114 in 2017 versus 111 in 2016). Sexual contact was the most reported transmission route (69%). The number of reported acute hepatitis C cases has fluctuated around 60 cases from 2011 onwards (58 in 2017). The main reported transmission route for acute hepatitis C was sexual contact between men.
In conclusion, the number of STI tests continues to increase both at SHC and the GP. However, in contrast with increases in the previous years, positivity rates remained fairly stable in 2017 compared to 2016. It is important to maintain an integrated surveillance of STIs and STI risks among high-risk groups that visit SHC. Keeping track of lower risk groups/the general population, who test mainly though other care providers or self-testing, is also important.
As in previous years, SHC data show that groups at high risk for STI, as reflected in high positivity rates, were people notified for STI by their (ex) partner, people who reported STI symptoms, were HIV-positive, and those who had an STI in the past year. Although high-risk groups are more strongly prioritised in SHC, this suggests that further efforts, such as promotion of condom use, repeat testing, and more effective (timely and complete) partner notification are needed to ensure that people in high-risk groups are effectively targeted.
Testing and treatment strategies need to be optimised to maximize the effect of control efforts and to reach those most in need of care. (aut. ref.)
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