Improving provider-initiated testing for HIV and other STI in the primary care setting in Amsterdam, the Netherlands: Results from a multifaceted, educational intervention programme.

Background: In the Netherlands, general practitioners (GPs) play a key role in HIV testing. However, the proportion of people diagnosed with late-stage HIV remains high, and opportunities for earlier diagnosis are being missed. We implemented an educational intervention to improve HIV and STI testing in primary care in Amsterdam, the Netherlands.

Improving indicator-condition guided testing for HIV in the hospital setting (PROTEST 2·0): A multicenter, interrupted time-series analysis.

Background: Indicator-condition (IC) guided HIV testing is a feasible and cost-effective strategy to identify undiagnosed people living with HIV (PLHIV), but remains insufficiently implemented. We aimed to promote IC-guided HIV testing in seven ICs.

Methods: Relevant departments in five hospitals of the Amsterdam region participated.

Controversies and evidence on Chlamydia testing and treatment in asymptomatic women and men who have sex with men: a narrative review.

Background: Chlamydia trachomatis (CT) is the most common bacterial sexually transmitted infection (STI) worldwide. CT is mainly asymptomatic. Test-and-treat strategies are widely implemented to prevent transmission and complications.

Routine universal testing versus selective or incidental testing for oropharyngeal Chlamydia trachomatis in women in the Netherlands: a retrospective cohort study.

Background: Pharyngeal Chlamydia trachomatis in women might contribute to autoinoculation and transmission to sexual partners. Data for effectiveness of different testing practices for pharyngeal C trachomatis are scarce. We therefore aimed to assess the prevalence of pharyngeal C trachomatis, determinants, and effectiveness of different testing practices in women.

Pharyngeal Chlamydia trachomatis in Men Who Have Sex With Men (MSM) in The Netherlands: A Large Retrospective Cohort Study.

Pharyngeal Chlamydia trachomatis (CT) was diagnosed in 1.2% and pharyngeal-only CT in 0.5% of routinely universally tested men who have sex with men (MSM).

Who is providing HIV diagnostic testing? Comparing HIV testing by general practitioners and sexual health centres in five regions in the Netherlands, 2011-2018.

Objectives: General practitioners (GPs) and sexual health centres (SHCs) are the main providers of HIV testing and diagnose two-thirds of HIV infections in the Netherlands. We compared regional HIV testing and positivity by GPs versus SHCs to gain insight into strategies to improve HIV testing, to enable timely detection of HIV infections.

Methods: Laboratory data (2011-2018) on HIV testing by GPs and SHCs in five Dutch regions with varying levels of urbanisation were evaluated.

Feasibility of anorectal chlamydia testing in women: a cross-sectional survey among general practitioners.

Background: Anorectal Chlamydia trachomatis (CT) may be clinically relevant for women in general practice. Although anorectal CT testing in this setting may prevent underdiagnosis and undertreatment, its feasibility is questioned as GPs currently rarely order anorectal CT tests, for yet unknown reasons.

Objective: To explore the feasibility of anorectal CT testing in women in general practice.

Promoting HIV indicator condition-guided testing in hospital settings (PROTEST 2.0): study protocol for a multicentre interventional study.

Background: Late presentation remains a key barrier towards controlling the HIV epidemic. Indicator conditions (ICs) are those that are AIDS-defining, associated with a prevalence of undiagnosed HIV > 0.1%, or whose clinical management would be impeded if an HIV infection were undiagnosed.

Where to go to in chlamydia control? From infection control towards infectious disease control.

Objectives: The clinical and public health relevance of widespread case finding by testing for asymptomatic chlamydia infections is under debate. We wanted to explore future directions for chlamydia control and generate insights that might guide for evidence-based strategies. In particular, we wanted to know the extent to which we should pursue testing for asymptomatic infections at both genital and extragenital sites.

Rationale, design and initial results of an educational intervention to improve provider-initiated HIV testing in primary care.

Objectives: In the Netherlands, general practitioners (GPs) perform two-thirds of sexually transmitted infection (STI) consultations and diagnose one-third of HIV infections. GPs are, therefore, a key group to target to improve provider-initiated HIV testing. We describe the design and implementation of an educational intervention to improve HIV testing by Amsterdam GPs and explore trends in GPs' testing behaviour.

Pregnancies and Time to Pregnancy in Women With and Without a Previous Chlamydia trachomatis Infection.

Background: A Chlamydia trachomatis infection (chlamydia) can result in tubal factor infertility in women. To assess if this association results in fewer pregnant women, we aimed to assess pregnancy incidences and time to pregnancy among women with a previous chlamydia infection compared with women without one and who were participating in the Netherlands Chlamydia Cohort Study (NECCST).

Methods: The NECCST is a cohort of women of reproductive age tested for chlamydia in a chlamydia screening trial between 2008 and 2011 and reinvited for NECCST in 2015 to 2016.

Who cares for syphilis? A cross-sectional study on diagnosis and treatment of syphilis by GPs in Amsterdam, the Netherlands.

Background: Syphilis is a re-emerging infection. Sexually transmitted infection (STI) clinics and GPs are important providers of STI care in the Netherlands. The role of GPs in syphilis care is assumed to be small, since most men who have sex with men (MSM) visit STI clinics for STI care.

[HPV vaccination with quadrivalent or nonavalent vaccine: an opportunity to eliminate genital warts as well].

The impact of genital warts on psychological, social and sexual wellbeing is often overlooked, as is the magnitude of the problem. In 2017, the number of consultations in primary care in the Netherlands was 42,000. Real-world evidence shows compelling and impressive results regarding the reduction of genital warts in other countries.

Antibody Testing in Estimating Past Exposure to C in the Netherlands Chlamydia Cohort Study.

The asymptomatic course of (CT) infections can result in underestimated CT lifetime prevalence. Antibody testing might improve this estimate. We assessed CT antibody positivity and predictive factors thereof in the Netherlands Chlamydia Cohort Study.

Is reaching 90-90-90 enough to end AIDS? Lessons from Amsterdam.

Purpose Of Review: Although cities present opportunities for infectious pathogens such as HIV to spread, public health infrastructure within these cities also provides opportunities to design effective approaches to eliminate transmission of these pathogens. The HIV Transmission Elimination AMsterdam (H-TEAM) Initiative, a consortium of relevant stakeholders involved in HIV prevention and care, designed an integrated approach to curb the HIV epidemic in Amsterdam, including providing preexposure prophylaxis (PrEP), increasing awareness of acute HIV infection, offering same-day test and treat, and improving indicator disease-driven HIV testing.

Recent Findings: In 2013, approximately 230 people in Amsterdam were newly diagnosed with HIV, largely belonging to one of two key affected populations, namely MSM and people with a migration background.

Low gonorrhoea antimicrobial resistance and culture positivity rates in general practice: a pilot study.

Objective: In the Netherlands, the Gonococcal Resistance to Antimicrobials Surveillance (GRAS) programme is carried out at Centres for Sexual Health (CSH), which provide care for sexual high-risk populations. However, half of gonorrhoea infections are diagnosed in general practice (GP). We performed a pilot study to explore expanding GRAS to GPs using laboratory-based surveillance.

Trends in antimicrobial management of gonorrhoea by general practitioners in Amsterdam, the Netherlands, between 2010 and 2016: a cross-sectional study.

Background: Sexually transmitted infections (STI) caused by multidrug resistant Neisseria gonorrhoea are an emerging threat to global health. In the Netherlands, the general practitioner (GP) provides the major part of STI care. In 2013 an update of the Dutch guideline was published, recommending a single dose of intramuscular ceftriaxone as treatment for gonorrhoea infections.

Relation between infection and pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in a Dutch cohort of women previously tested for chlamydia in a chlamydia screening trial.

Objectives: A better understanding of infection (chlamydia)-related sequelae can provide a framework for effective chlamydia control strategies. The objective of this study was to estimate risks and risk factors of pelvic inflammatory disease (PID), ectopic pregnancy and tubal factor infertility (TFI) with a follow-up time of up until 8 years in women previously tested for chlamydia in the Chlamydia Screening Implementation study (CSI) and participating in the Netherlands Chlamydia Cohort Study (NECCST).

Methods: Women who participated in the CSI 2008-2011 (n=13 498) were invited in 2015-2016 for NECCST.

[A young man with a scrotal rash; bedbugs or something else?].

A 21-year-old man had painful lesions on his scrotum for 4 days. Recently, bed bugs were discovered in the student accommodation of his girlfriend. We also observed vesicular lesions on the patient's buttock.

[Chlamydia: a pill for the partner? Results of the PICC-UP project on patient-initiated partner therapy].

Objective: Effective partner notification and partner treatment are essential to prevent reinfection with Chlamydia trachomatis. For this reason we investigated the possibilities for patient-initiated partner therapy (PIPT) in the Netherlands.

Design: Database research, questionnaires and interviews.

[Epidemiology of sexually transmitted infections; how should the Dutch data be interpreted?].

Surveillance of sexually transmitted infections (STIs) in the Netherlands is based on data from the public health service (GGD) centres for sexual health and the Netherlands institute for health services research (NIVEL) data on primary care registrations. Epidemiological data show a strong increase in the number of bacterial STIs seen in recent decades, but the significance of this trend is unclear. Tests are, performed much more often and are more sensitive, and tests are carried out more often in people from selected high-risk groups; changes in the triage of testing behaviour can, therefore, influence interpretation of trends.

National prevalence estimates of chlamydia and gonorrhoea in the Netherlands.

Objectives: National prevalence estimates of (chlamydia) and (gonorrhoea) are important for providing insights in the occurrence and control of these STIs. The aim was to obtain national prevalence estimates for chlamydia and gonorrhoea and to investigate risk factors associated with infection.

Methods: Between November 2016 and January 2017, we performed a national population-based cross-sectional probability sample survey among men and women aged 18-34 years in the Netherlands.

Development and evaluation of a blended educational programme for general practitioners' trainers to stimulate proactive HIV testing.

Background: In the Netherlands, a substantial proportion of newly diagnosed HIV patients present late for care, therefore, we investigated the effectiveness of a blended educational programme for trainers of GPs designed to stimulate proactive HIV testing.

Methods: GP trainers at the Academic Medical Center in Amsterdam were invited to participate in a two days training programme incorporating evidence-based practice guidelines and multiple teaching strategies, including interactive lectures, discussion groups, e-learning and quality improvement targets. The GP trainers completed questionnaires before and after the programme to evaluate the effect of the programme.