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Effective sexually transmitted infection (STI) control requires opportunities for appropriate testing, counselling and treatment. In the Netherlands, people may attend general practitioners (GPs) and sexual health centres (SHCs; also known as STI clinics) for STI consultations. We assessed the contribution of GPs and SHCs to STI consultations in five Dutch regions with different urbanization levels, using data of urogenital Chlamydia trachomatis (CT) testing. Data (2011–2016) were retrieved from laboratories, aggregated by gender and age group (15–24 and 25–64 years). Results show that test rates and GP contribution varied widely between regions. GP contribution decreased over time in Amsterdam (60–48%), Twente (79–61%), Maastricht (60–50%) and Northeast-Netherlands (82–77%), but not in Rotterdam (65–67%). Decreases resulted from increases in SHC test rates and slight decreases in GP test rates. GPs performed more tests for women and those aged 25–64 years compared to SHCs (relative risks ranging from 1.49 to 4.76 and 1.58 to 7.43, respectively). The average yearly urogenital CT positivity rate was 9.2% at GPs and 10.7% at SHCs. Overall, GPs accounted for most STI consultations, yet SHC contribution increased. Continued focus on good quality STI care at GPs is essential, as increasing demands for care can not be entirely covered by SHCs.

Background Dutch estimates suggest that general practitioners (GPs) perform two-third of all STI consultations, and centres for sexual health (CSH) account for most of the remaining consultations. Yet, a comparison of consultation rates by both providers is hampered due to separate surveillance systems. We assessed the distribution of STI consultations (defined as urogenital Chlamydia trachomatis (CT) test-rates) in five regions. Methods Data (2011 to 2016) on laboratory testing and diagnosis of urogenital CT were retrieved from CSH at public health services and laboratories in five Dutch geographical regions, aggregated by sex and age category (15–24 and 25–64 years). Regions included Amsterdam, Rotterdam, Northeast –Netherlands (N-NL), Twente and Maastricht. Using negative binomial regression, we tested for time-trends in CT test-rate per 10,000 population at GPs and CSH within five regions and differences between the providers by region. Results The five regions included in this study varied from mostly rural (N-NL) to highly urban (Amsterdam and Rotterdam). The relative contribution of GPs in consultation rate decreased over time in Amsterdam (60.0–47.8%), Twente (78.6–61.4%), Maastricht (59.2–47.2%), N-NL (82.4–76.9%), but not in Rotterdam (65.4–67.0%). This decrease resulted from an increase in all CSH consultation rates and a slight decrease in GP consultation rate (except for Rotterdam). Women and persons aged 25–64 years were more likely to be tested by GPs compared to CSH (relative risks of 5 regions ranging from 1.47–4.76; 1.58–7.43 respectively). All regions combined, the average yearly positivity rate was 9.2% at the GP and 10.7% at the CSH. Conclusion GPs are still a major contributor in STI consultations, yet the CSH- contribution has increased between 2011 and 2016. In urban regions, the CSH has a considerable role, whereas in rural areas the GP provides most consultations. An explanation for differences may be CSH accessibility. Disclosure No significant relationships.

In the revised Dutch guidelines, faeces testing for Shigella is advised for all household contacts if the index person is less than 6 years old and for persons with symptoms. We argue that in most cases there is no need for faeces testing. Clusters of shigelloses have become rare, and hygienic measures are sufficient to prevent transmission. The statistical significance of shigella transmission in children under 6 years old, on which the revised guideline is based, has no clinical relevance. In fact, the infection rate is only 7% even among the high-risk contacts of the index patients under 6 years old and only 1 infection per 4 index persons (25/104). Hygienic measures and exclusion from childcare centres or school in the event of symptoms are sufficient measures to prevent transmission.