title: Consultations for sexually transmitted infections in the general practice in the Netherlands: an opportunity to improve STI/HIV testing.
abstract: OBJECTIVE
  In the Netherlands, sexually transmitted infection (STI) care is provided by general practitioners (GPs) as well as by specialised STI centres. Consultations at the STI centres are monitored extensively, but data from the general practice are limited. This study aimed to examine STI consultations in the general practice.
  
  
  METHODS
  Prospective observational patient survey.
  
  
  METHODS
  General practices within the nationally representative Dutch Sentinel GP network (n=125 000 patient population), 2008-2011.
  
  
  METHODS
  GPs were asked to fill out a questionnaire at each STI consultation addressing demographics, sexual behaviour and laboratory test results. Patient population, testing practices and test positivity are reported.
  
  
  METHODS
  Patients attending a consultation concerning an STI/HIV-related issue.
  
  
  RESULTS
  Overall, 1 in 250 patients/year consulted their GP for STI/HIV-related problems. Consultations were concentrated among young heterosexuals of Dutch origin. Laboratory testing was requested for 83.3% of consultations. Overall consult positivity was 33.4%, highest for chlamydia (14.7%), condylomata (8.7%) and herpes (6.4%). 32 of 706 positive patients (4.5%) were diagnosed with multiple infections. Main high-risk groups were patients who were <25 years old (for chlamydia), >25 years old (syphilis), men who have sex with men (MSM; for gonorrhoea/syphilis/HIV) or having symptoms (for any STI). Adherence to guideline-recommendations to test for multiple STI among high-risk groups varied from 15% to 75%.
  
  
  CONCLUSIONS
  This study found that characteristics of patients who consulted a GP for STIs were comparable to those of patients attending STI centres regarding age and ethnicity; however, consultations of high-risk groups like MSM and (clients of) commercial sex workers were reported less by the general practice. Where the STI centres routinely test all patients for chlamydia/syphilis/HIV/gonorrhoea, GPs tested more selectively, even more restricted than advised by GP guidelines. Test positivity was, therefore, higher in general practice, although it is unknown how many STIs are missed (particularly among high-risk groups). Opportunities for a more proactive role in STI/HIV testing at general practices in line with current guidelines should be explored.
authors.affiliation: Epidemiology and Surveillance Unit, National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands.
authors.forename: Suzan C M
authors.initials: SC
authors.lastname: Trienekens
authors.forename: Ingrid V F
authors.initials: IV
authors.lastname: van den Broek
authors.forename: Gé A
authors.initials: GA
authors.lastname: Donker
authors.forename: Jan E A M
authors.initials: JE
authors.lastname: van Bergen
authors.forename: Marianne A B
authors.initials: MA
authors.lastname: van der Sande