HIV and Sexually Transmitted Infections in the Netherlands in 2003

The increasing trend of Sexually Transmitted Infections (STIs), as observed in the last few years, seemed to have stabilised in 2003. The continuous increase of syphilis diagnoses and the outbreak of Lymphogranuloma venereum (LGV) among men who have sex with men (MSM), indicate an increase of sexual risk behaviour. Permanent alertness will be required to prevent a further spread of STIs and HIV. As of August 2004, a total of 9767 HIV cases were reported in the Netherlands, of which 847 were newly diagnosed in 2003. By the end of 2003, there were an estimated 16400 people living with HIV/AIDS in the Netherlands. MSM still accounted for the majority of the registered cases, although the proportion decreased over time. The increase of heterosexually acquired infections in recent years seemed to have levelled off in 2003. HIV prevalence in the Netherlands was highest among MSM (0-22%) and injecting drug users (IDUs) (0-26%). HIV prevalence among heterosexuals varied between 0-1.4%. In 2003, the number of diagnoses of genital chlamydial infection remained stable; the number of diagnoses of gonorrhoea decreased by 16%. However, diagnoses of syphilis and viral STIs continued to increase in 2003. Between 2000 and 2003, the number of syphilis diagnoses more than doubled among men. This sharp increase can largely be attributed to MSM. Genital warts were the most common viral STI. The percentage of ciprofloxacin resistance seemed to have increased fairly rapidly in 2003. In Amsterdam, the prevalence of gonococcal antimicrobial resistance was, for the first time, higher in MSM than in heterosexuals. Enhanced surveillance of LGV was started in the Netherlands in a response to the outbreak of LGV among, predominantly HIV infected, MSM. By September 2004, 92 cases of LGV had been reported. LGV had been reported by other European countries as well, following the international alerts in January 2004. Known HIV infected individuals accounted for an important part of STIs: 20% of all diagnoses of gonorrhoea, chlamydia and syphilis among MSM were seen in known HIV infected MSM. Therefore we can conclude that unsafe sex practices are on-going in MSM with a potential risk of a further spread of STI and HIV. Permanent alertness and innovative prevention and intervention methods will be needed to prevent a further spread of STIs and HIV