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Introduction Substance use to enhance sexual pleasure and performance is well known among men who have sex with men (MSM). Studies report a higher Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) prevalence among MSM who use substance before or during sex. Limited data exist on substance use in relation to CT and NG prevalence among young heterosexuals. Methods CT and NG tested men and women aged Results CT prevalence was 13.6% (n=300) for women, 15.4% (n=153) for heterosexual men and 10.6% (n=35) for MSM. For NG this was 1.0% (n=23), 1.4% (n=14), and 15.8% (n=52) respectively. Substance use before or during sex varied between 26%–40% for drugs, 44%–67% for alcohol and 51%–64% for cigarette smoking. Among drug users, 39%–45% used multiple drugs, most often marihuana (84%), ecstasy (81%) and cocaine (51%). In young heterosexuals, smoking was independently associated with CT in women (OR 1.3 95% CI 1.1–1.7), and ketamine use in men (OR 4.5, 95% CI 1.6–12.7). For MSM, GHB use was independently associated with CT (OR 3.8, 95% CI 1.2–12.2) and ketamine use with NG (OR 4.7, 95% CI 1.3–16.9). Conclusion Substance use before or during sex was reported often among young heterosexuals and MSM, and led to greater CT and NG (for MSM) risk. Different substance use was associated with different STI in different risk groups, therefore targeted care is an imperative. Prevention in STI clinics should include discussing drug use before or during sex, also in heterosexual youngsters.

Introduction Although routine diagnostic methods for detection of Chlamydia trachomatis (CT) are based on Nucleic Acid Amplification Tests (NAAT) the detection of antibodies can also be used as an additional tool, especially for surveillance. People with a CT infection develop serum IgG and IgA, which are a marker for past infection and in women are correlated with infertility. Although seroprevalence of CT has been well studied in women, little is known about the seroprevalence of CT in men, especially in the high risk group men who have sex with men (MSM). The aim of this study is to assess the seroprevalence of CT in MSM and the development of seroconversion over time. Methods A seroprevalence study was conducted in 291 MSM visiting the STI clinic of the Public Health Service South Limburg, the Netherlands, at least twice between January 2011 and December 2013. Sera from the last consultation (T2) were tested for the presence of IgG and IgA (Medac, Germany). Individuals with positive serology at T2 were additionally tested one year before (T1) to determine seroconversion. Prevalence data were calculated from the number of IgG and IgA positive sera at T2 and incidence data were calculated from the seroconversion rates between T1 and T2. Results Thirty-one percent (n=91/291) of MSM was NAAT CT positive in the study period. In 98% (286/291) MSM sera were available for testing. In total, 32% of MSM (91/286) were IgG positive and 17% were IgA positive (48/286), of which 44 were positive for both. The overall prevalence was 33% based on the presence of IgG and/or IgA antibodies (n=95). Seroconversion rate between T1 and T2 showed that 3,8% (n=11) seroconverted for IgG and 4,5% (n=13) for IgA, of which 1.7% (n=5) seroconverted for both. The overall incidence rate was 6,6% (n=19) based on seroconversion of IgG and/or IgA. Conclusion This study showed that one third of MSM visiting an STI clinic were seropositive for CT. The incidence rate was about 6%. Association of CT seropositivity with sexual behaviour determinants and actual CT positivity will be further studied.

Introduction To date, there is limited data on Neisseria gonorrhoeae (NG) bacterial load in relation to transmission and symptoms of NG infection. Also, extra-genital sites are not often tested apart from specific risk groups. This could lead to untreated infections that potentially facilitate transmission of NG. In this study we describe the NG bacterial load in relation to sample site, sexual orientation, and age. Methods Routine diagnostics samples of the STI clinic of the South Limburg Public Health Service between 2012 and May 2016 were used. In this period, 1141 samples (883 male and 258 female) from 836 patients were NG positive, among which 237 urine samples, 130 genital swabs, 394 anorectal swabs, and 380 oropharyngeal swabs. Bacterial load was determined by interpolation of a standard curve using the COBAS 4800. Multiple linear regression was used to describe bacterial load in which sample site, sexual orientation, and age were the determinants. Results In 471 of 629 (74.9%) patients with an extra-genital NG positive sample, only the extra-genital sample was positive, among these were 367 men who have sex (MSM) with men, 34 heterosexual men (HSM), and 70 women. Most patients were positive at a single sample site, 221 oropharyngeal (130 MSM, 32 HSM, and 59 women) and 165 anorectal respectively (154 MSM, 2 HSM, and 9 women). Sample site and age were significant determinants for load (both p Conclusion NG bacterial load is for a large part driven by sample site. Oropharyngeal NG infections are often asymptomatic which could be related to a lower bacterial load. However, the role of the observed load differences in transmission and symptoms should be addressed in future studies.

Introduction: Mycoplasma genitalium (MG) is increasingly seen as a clinically relevant sexually transmitted infection (STI), with a clinical spectrum similar to Chlamydia trachomatis (CT) and Neisseria gonorhoeae, including pelvic inflammatory disease and adverse reproductive outcomes. In the Netherlands, MG testing is not currently recommended for first-line STI screening despite a~4% background prevalence. Very little is known about co-infections with CT or NG as patients are usually only tested after negative CT/NG tests. We therefore studied the co-occurrence of MG and CT in both low- and high-prevalence populations. Methods 1024 CT-positive participants from the Dutch general population (participants in the Chlamydia Screening Intervention-study) (60.3%; 462 ♀) and STI-clinic in South Limburg, the Netherlands (39.6%; 259 ♀) were retrospectively tested for MG. Men provided urine samples and women self-collected vaginal swabs. Samples were tested for human cells to ensure adequate sampling. CT/MG co-infections were investigated and correlated to symptoms. Statistical testing was performed using Chi-square test. Results Of 1024 CT-positive patients, 5.5% had a co-infection with MG. CT/MG co-infections were present in 6.3% of the general population, compared to 4.2% of STI-clinic visitors. 3.9% of STI-clinic women had a CT/MG co-infection, compared to 7.4% in the general population. STI-clinic and general population men had a similar MG prevalence of 3.2% and 4.7%. Symptoms were reported by 37.3% of patients; 37.2% in single CT-infections and 39.3% in CT/MG co-infections. Conclusion CT/MG co-infections are at least as common (5.5%), and in some populations more common (up to 7.4%), than in the general (CT-negative) population. As MG-testing is currently not routine practice in most clinics, these women go undiagnosed and receive inferior treatment, which likely contributes to current 30%–45% azithromycin resistance in MG. However, the higher prevalence of MG in the general population and the similar frequency of symptoms in both groups questions the clinical relevance of this pathogen.

Introduction In prior studies it is demonstrated that, in women, the prevalence of anorectal infections with Chlamydia trachomatis (CT) is comparable to genital CT. Yet, the clinical relevance and the role in overall transmission of anorectal CT in women is still under debate. The assessment of CT viability will gain new insight in current knowledge gaps. Recently, we validated the viability-PCR (V-PCR) method to assess CT viability in genital CT positive samples. In this study, V-PCR was utilised to assess CT viability in anorectal samples from CT positive women. Methods COBAS 4800 CT/NG routine testing was used for CT diagnosis. Women positive for genital and/or anorectal CT (n=66), collected self-taken vaginal and anal swabs at our outpatient STI clinic (South Limburg Public Health Service) prior to treatment at the initial screening and at treatment consultation. V-PCR and culture were used to assess CT viability. Results V-PCR results showed that in up to 31% (8/26) of anorectal positive samples less than 1% of the detected CT DNA originated from viable bacteria. However, in 62% (16/26) of anorectal positive samples more than 10% of the detected CT DNA originated from viable CT. In this category, routine COBAS results also showed a stable bacterial load between initial screening and treatment consultation, further supporting the presence of large amounts of viable CT. Finally, culture results confirmed results of V-PCR and showed a direct relation to the proportion of viable CT in clinical samples. Conclusion Although the cohort was relatively small, results in this study showed that a substantial amount of anorectal CT positive samples contained viable CT. Overall, these results provide further evidence that anorectal CT infections in women are clinically relevant. In a currently ongoing larger cohort study, clinical samples from CT positive women (n=400) will be assessed for viability before and after treatment (FemCure Study).

© 2015 Dukers-Muijrers et al.Background: Anorectal and pharyngeal infections with Chlamydia trachomatis (CT) and Neisseria gonorrheae (NG) are commonly observed in men who have sex with men (MSM). There is increasing evidence that such infections at extra

Tussen 30 oktober 1998 en 27 mei 1999 werd bij 222 IDs uit Heerlen en Maastricht een bloedmonster en een vragenlijst naar risicogedrag afgenomen. De IDs werden geworven via methadon-posten (63%), laagdrempelige instellingen voor druggebruikers (19%), straatwerving (10%) en arrestantenverblijven (7%). Van de 214 IDs waren 30 deelnemers HIV-positief (prevalentie 14,0%; 95% betrouwbaarheidsinterval [BI] 9,7 - 19,4%). De HIV-prevalentie was hoger in Heerlen (21,6%) dan in Maastricht (5,1%). In Heerlen was een stijgende trend te zien ten opzichte van eerdere metingen (1994: 10%). Van de 134 actueel spuitende IDs had 14% in de laatste zes maanden een gebruikte spuit of naald van een ander geleend. Van hen was 11% HIV-positief. Dertien procent had een spuit of naald uitgeleend. Vijfenveertig procent van de IDs had langer dan zes maanden voor het onderzoek spuiten/naalden van een ander geleend, waarvan 24% HIV-positief was. Veertig procent van de IDs had in de laatste zes maanden een vaste seksuele partner gehad. Bij 36% hiervan was deze partner geen druggebruiker, bij 21% een niet-injecterende druggebruiker. Met de vaste seksuele partner werd in 89% van de contacten niet altijd een condoom gebruikt. Met losse partners en klanten worden condooms vaker gebruikt (niet altijd condoom gebruikt: losse partners 49%, klanten 25%). Door de aanwezigheid van spuitgerelateerd en seksueel risicogedrag in combinatie met een hoge HIV-prevalentie is het risico op HIV-transmissie aanwezig.

Between October 30 1998 and May 27 1999, a serum sample and a questionnaire on risk behaviour were obtained from 222 IDU in Heerlen and Maastricht. Participation was on a voluntary basis and anonymous. Participants were recruited at methadone treatment sites (63%), low-threshold daytime care projects (19%), 'on the street' (10%), and in detainment sites (7%). Of 214 IDU, 30 persons were found to be infected with HIV (prevalence 14.0%, 95% confidence interval [CI] 9.7 - 19.4). Seroprevalence was higher in Heerlen (21.6%) than in Maastricht (5.1%) and has increased in Heerlen since 1994 (11%). Eighteen (14%) out of 134 currently injecting IDU borrowed syringes or needles in the last 6 months (1996: 17%, 1994: 19%, not significant). These percentages seem to be similar in the other cities in our surveillance studies. Condom use was very low during sexual contact between steady partners; this was found consistently for the total group (89% not always using a condom). 26% of the IDU have a non-drug user as a steady sexual partner. In spite of several prevention programmes, residual injecting and sexual risk behaviour continues. The presence of high risk behaviour in combination with a high HIV-prevalence indicates the risk of further spread of HIV infection