title: Trends in sexually transmitted infections in the Netherlands, combining surveillance data from general practices and sexually transmitted infection centers.
abstract: BACKGROUND
  Sexually transmitted infections (STI) care in the Netherlands is primarily provided by general practitioners (GPs) and specialized STI centers. STI surveillance is based on data from STI centers, which show increasing numbers of clients. Data from a GP morbidity surveillance network were used to investigate the distribution in the provision of STI care and the usefulness of GP data in surveillance.
  
  
  METHODS
  Data on STI-related episodes and STI diagnoses based on ICPC codes and, for chlamydia, prescriptions, were obtained from GP electronic medical records (EMRs) of the GP network and compared to data from STI centers from 2002 to 2007. Incidence rates were estimated for the total population in the Netherlands.
  
  
  RESULTS
  The incidence of STI-consultations and -diagnoses increased substantially in recent years, both at GPs and STI centers. The increase in consultations was larger than the increase in diagnoses; Chlamydia incidence rose especially at STI centers. GPs were responsible for 70% of STI-related episodes and 80-85% of STI diagnoses. STI centers attract relatively younger and more often male STI-patients than GPs. Symptomatic STIs like Herpes genitalis and genital warts were more frequently diagnosed at GPs and chlamydia, gonorrhea and syphilis at STI centers.
  
  
  CONCLUSIONS
  GPs fulfill an important role in STI care, complementary to STI centers. Case definitions of STI could be improved, particularly by including laboratory results in EMRs. The contribution of primary care is often overlooked in STI health care. Including estimates from GP EMRs can improve the surveillance of STIs.
authors.affiliation: Centre for Infectious Disease Control, RIVM National Institute of Public Health and the Environment, Bilthoven, The Netherlands. ingrid.van.den.broek@rivm.nl
authors.forename: Ingrid V F
authors.initials: IV
authors.lastname: van den Broek
authors.forename: Robert A
authors.initials: RA
authors.lastname: Verheij
authors.forename: Christel E
authors.initials: CE
authors.lastname: van Dijk
authors.forename: Femke D H
authors.initials: FD
authors.lastname: Koedijk
authors.forename: Marianne A B
authors.initials: MA
authors.lastname: van der Sande
authors.forename: Jan E A M
authors.initials: JE
authors.lastname: van Bergen
mesh_terms: D000328:Adult; D003151:Community Health Centers; D057286:Electronic Health Records; D017050:Episode of Care; D005194:Family Practice; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D012017:Referral and Consultation / Q000706:statistics & numerical data / Q000639:trends; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult