Sexually Transmitted Infections, Including HIV, in the Netherlands in 2007
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Sexually transmitted infections, including HIV, in the Netherlands 2007 Sexually transmitted infections, including HIV, IVF van den Broek | FDH Koedijk | MG van Veen | ELM Op de Coul | AI van Sighem | MAB van der Sande Sexually transmitted infections, RIVM National Institute including HIV, in the for Public Health and the Environment P.O. Box 1 Netherlands in 2007 3720 BA Bilthoven The Netherlands www.rivm.nl Sexually transmitted infections, including HIV, in the Netherlands in 2007 Authors: IVF van den Broek1, FDH Koedijk1, MG van Veen1, ELM Op de Coul1, AI van Sighem2, MAB van der Sande1 Department: Epidemiology and Surveillance, Centre for Infectious Disease Control Institute: 1. National Institute for Public Health and the Environment 2. HIV Monitoring Foundation Contact: Ingrid van den Broek, Epidemiology and Surveillance, [email protected] SExuALLy transmittED infections in tHE NEtHErlands in 2007 COLOFON Report prepared by: Centre for Infectious Disease Control, National Institute for Public Health and the Environment In collaboration with: StI centres HIV Monitoring Foundation & HIV treatment centres ISIS/Osiris Cover: ton Koene photography, Amsterdam; www.tonkoene.nl A publication by the National Institute for Public health and the Environment P.O. Box 1 3720 BA Bilthoven the Netherlands www.rivm.nl All rights reserved © 2008 rIVM-CIb-EPI reproduction is authorised, provided the source is acknowledged rIVM report number: 210261004 / 2008 ISBN 978-90-6960-209-7 4 Rapport in HEt kort RappORt IN Het kORt Seksueel overdraagbare aandoeningen, waaronder HIV, in Nederland in 2007 Chlamydia, gonorroe, syfilis Net als in 2006 was chlamydia in 2007 de meest gediagnosticeerde bacteriële geslachts- ziekte in de soacentra, vooral bij jongeren. Het percentage positieve chlamydiatesten onder heteroseksuele mannen en vrouwen daalde enigszins, voor het eerst sinds vier jaar (van 10,6% naar 10,1%). In 2006 stabiliseerde dit percentage bij mannen die seks hebben met mannen (MSM), en die trend zette door in 2007. Het percentage positieve gonorroe-, syfilis- en hivtesten nam net als voorgaande jaren af in 2007 (respectievelijk 2,4%, 0,9% en 0,5%). Deze infecties werden het meest gediagnosticeerd bij MSM. Hiv In 2007 zijn er 306 nieuwe hivdiagnoses gesteld in de soacentra, ongeveer een derde van de 864 hivpositieven die dat jaar landelijk in de hivcentra zijn gemeld. Eind 2007 waren in totaal 14.019 personen in Nederland met hiv geregistreerd. Het aandeel van MSM onder de nieuw hivinfecties nam in 2007 verder toe. Net als eerdere jaren werd in de soacentra bij MSM die bekend zijn met hun positieve hivstatus vaak nog een andere geslachtsziekte gevonden (45%). In deze groep is sinds 2004 regelmatig LGV, een agres- sieve variant van chlamydia, en sinds 2007 hepatitis C gediagnosticeerd. Versterkte surveillance en innovatieve interventies zijn nodig om verdere verspreiding onder MSM en naar andere groepen te voorkomen. Migranten Onder bepaalde migrantengroepen in Nederland (onder andere afkomstig uit Suriname, de Nederlandse Antillen en Aruba) komen hiv, chlamydia, gonorroe en syfilis relatief vaker voor dan onder autochtone Nederlanders. Ook deze constatering vraagt om vernieuwende maatregelen die op de bevolkingsgroepen zijn toegespitst. De soacentra bieden soazorg aan hoogrisicogroepen. In 2007 hebben ruim 78.000 perso- nen zich daar laten testen, een toename van 13% ten opzichte van 2006. trefwoorden: hiv/aids, soa, surveillance, trends, Nederland 5 ContENtS CONteNtS Rapport in HEt kort 5 Abstract 9 Preface 11 Samenvatting 13 SuMMAry 15 List of abbreviations 17 INtroduCtion 19 1 MEthodology of StI AND HIV Surveillance 21 1.1 National surveillance at StI centres 21 1.2 Antimicrobial resistance of gonococci in the Netherlands 22 1.3 National HIV screening 22 1.4 Anonymous HIV surveillance at StI clinics 23 1.5 HIV incidence data 23 1.6 National registration of HIV treatment centres 23 1.7 Blood donors 24 1.8 Notification of hepatitis B and C 24 1.9 Molecular epidemiology of acute HBV 24 2 StI clinic Attendees 25 2.1 Key points 25 2.2 StI consultations 25 2.3 Characteristics of attendees 26 2.4 Behavioural surveillance in StI centres 27 3 BactErIAL StI 29 3.1 Chlamydia and Lymphogranuloma venereum 29 3.2 Gonorrhoea 37 3.3 Syphilis 43 7 SExuALLy transmittED infections in tHE NEtHErlands in 2007 4 VIrAL StI 47 4.1 HIV and AIDS 47 4.2 Hepatitis B 62 4.3 Hepatitis C 67 4.4 Genital warts 69 4.5 Genital herpes 71 5 FOCuS on specific GrOuPS 73 5.1 MSM 73 5.2 Young people 74 5.3 Ethnic minority populations 75 5.4 Injecting drug users 76 5.5 CSW and clients 76 6 GENErAL conclusions AND recommendations 79 6.1 Recommendations 81 rEFErences 83 Appendix A. Tables AND figures StI Surveillance 85 Appendix B. Tables AND figures HIV AND AIDS Surveillance 99 Appendix C. NAtional Surveillance of StI CENtres 113 Appendix D. HIV MonitOring FOundation 115 8 Abstract abStRaCt Sexually Transmitted Infections, including HIV, in the Netherlands in 2007 Chlamydia, gonorrhoea and syphilis In 2007, chlamydia was the most common bacterial sexually transmitted infection (StI) diagnosed in Dutch StI centres. Similar to previous years, infections were reported especially in young heterosexuals. the proportion of positive chlamydia tests among heterosexual men and women decreased slightly for the first time in four years (from 10.6% to 10.1%). In 2006, this proportion had stabilized in men who have sex with men (MSM) with the trend continuing in 2007. the positivity rate for gonorrhoea (2.4%), syphilis (0.9%) and HIV (0.5%) continued to decrease in 2007. these infections were most frequently diagnosed in MSM. HIV In 2007, 306 new positive HIV cases were diagnosed in StI centres in the Netherlands. this number amounts to about one third of the total number of 864 positive HIV cases registered nationally. At the end of 2007, a total of 14,019 HIV cases in care were regis- tered in the Netherlands. the proportion of MSM among new HIV cases rose further in 2007. In line with previous years, concurrent StIs were diagnosed very frequently among MSM visiting StI centres (45%) who had known HIV positive status. In this group of men, Lymphogranuloma Venereum (LGV) an aggressive type of chlamydia, has been reported frequently since 2004; this has also been the case for hepatitis C since 2007. In this group of men, strengthened surveillance and innovative interventions are warranted in order to prevent further transmission both among MSM and to other population groups. Migrant populations In some specific migrant groups in the Dutch population -- for example, people from Surinam, the Netherlands Antilles and Aruba -- HIV, chlamydia, gonorrhoea and syphilis are more common than in the autochthonous Dutch population. this indicates the need for targeted intervention by risk profile. the specialised StI centres in the Netherlands offer StI testing and care targeted at high risk groups. In 2007, approximately 78,000 people used this service amounting to a rise of 13% compared to 2006. Key words: HIV/AIDS, STI, surveillance, trends, the Netherlands 9 Preface pReFaCe this annual report presents the national surveillance data and a review of the epidemiology of sexually transmitted infections (StI), including HIV/AIDS, in the Netherlands in 2007. the report aims to produce an overview of recent trends and current developments in the field of StI from data sources available. We expect that this report contributes to a better understanding of the distribution and determinants of StI, including HIV, in the Netherlands, resulting in further targeting of (preventive) interventions and assessment of their effectiveness on StI transmission. the information is directed at policy makers, researchers in the field of StI and related subjects as well as others interested in StI trends in the Netherlands. More information on StI and HIV in the Netherlands is available at www.soahiv.nl and www.hiv-monitoring.nl. A copy of this report can also be downloaded in PDF format from www.soahiv.nl. Acknowledgements We gratefully acknowledge the cooperation of physicians, public health doctors and nurses, microbiologists, epidemiologists, dermatologists, behavioural scientists, preven- tion workers and other professionals working in the field of StI and HIV. We would like to thank the following organisations for their continuing collaboration in collecting data: the StI centres (StI clinics and municipal health services), HIV Monitoring Foundation (HMF) and GGD Nederland. We also thank SOA AIDS Nederland, rutgers Nisso Group, HIV Vereniging, Schorer Stichting, SWAB, NIGZ, ISIS, Nederlandse Werkgroep Klinische Virologie, as well as the other units in the Centre for Infectious Disease Control: Labora- tory for Infectious Disease and Screening (LIS) and Policy, Management and Advice unit (BBA), COM (Consultant Microbiologists), LCI (Preparedness and response unit) and the connected quality working group (landelijke kwaliteitswerkgroep aanvullende curatieve soa zorg) for their support. Further information Any comment or suggestion to improve the usefulness of this report is much appreciated and can be sent to [email protected]. 11 Samenvatting SameNVattINg In 2007 werden in totaal 78.062 nieuwe soaconsulten uitgevoerd bij de soacentra, waarmee het aantal bleef stijgen, met 13% ten opzichte van 2006. De soacentra richten zich op hoogrisicogroepen door toepassing van een landelijk geadviseerd triagesysteem. Deze hoogrisicogroepen, zoals mannen die seks hebben met mannen (MSM, 28% van de mannelijke bezoekers in 2007), personen afkomstig uit soa/hiv endemische gebieden (15%) en jongeren (41% beneden de 25 jaar oud), worden gratis getest. In de tweede helft van 2007 voldeed 94% van de soaconsulten aan de gestelde criteria voor hoogrisico of gaf aan anoniem getest te willen worden. Bacteriële soa In 2007 was chlamydia opnieuw de meest gediagnosticeerde bacteriële soa in de soacen- tra met 7801 gerapporteerde gevallen. Het percentage positieve chlamydiatesten bij heteroseksuele mannen en vrouwen daalde voor het eerst in 5 jaar (10,1%).