General practitioners in the Netherlands miss opportunities to test for STI/HIV during STI-related consultations.

Background Whereas the majority of STI-related consultations in the Netherlands take place in general practise (GP), national surveillance of STI predominantly uses data from STI centres, focussing at trends in high-risk groups. To also explore determinants of STI in the GP setting, an STI questionnaire was introduced in a nationwide GP-network. Methods Since 2008, GPs of the Dutch Sentinel GP network (45 practises; 125,000 patients) are asked to complete a questionnaire for each STI-related episode, comparable to data collection in STI centres, and report laboratory results. Data included patient demographics, sexual behaviour and sex-life history. Results Annually, for 0.4% of GP patients an STI consultation was recorded, mainly among young heterosexuals of Dutch origin, a profile comparable to STI centre visitors, though specific high-risk groups like MSM and CSW were reported less by GPs. GPs requested one or more laboratory tests in 83% of consultations; an STI was diagnosed in 34%, most frequently chlamydia (21%), condylomata (9%) and herpes (6%). Higher risk profiles were, depending on the STI: < 25 years old (chlamydia), MSM (gonorrhoea/syphilis), ethnic minorities (gonorrhoea), > 25 years old (syphilis) or having symptoms (any STI). GP guidelines on multiple testing in high-risk groups (5 STI) were rarely fully adhered to, with many missed opportunities to test for HIV in patients with casual sexual contacts or originating from HIV-endemic countries. Discussion STI consultation rates were lower than estimates based on electronic registers, probably due to underreporting. Patients who consulted a GP for STIs were comparable to persons attending STI-centres. Where STI-centres routinely test patients for chlamydia, syphilis, HIV and gonorrhoea, GPs test more selectively, resulting in higher case detection rates. This diverges from national GP guidelines and STI diagnoses may be missed. Opportunities for a more proactive role of GPs in STI and HIV testing should be explored