The issue: Increased STDs due to unsafe sex
Area Health Authorities are finding more and more STDs. Some 15% of the over 121,000 tests in 2012 were positive. Have we become too nonchalant? STD specialist Eric van der Snoek: “Two-thirds of people who get tested have had unsafe sex.”
Are you busy?
“In terms of STDs (sexually transmitted diseases) things are better than expected at the Erasmus MC. Most people wind up at the Area Health Authority’s outpatients’ clinic. They’re really busy over there.”
The National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM) reported a 7% increase in the number of STD consults. Have you noticed anything in this regard?
“It seems that there is more LGV going around. This is an aggressive variation of – mostly – anal chlamydia, which can lead to flatulence, constipation, painful lesions, diarrhoea, blood loss and puss from the anus. According to the numbers the incidences have doubled. But that’s child’s play compared to your garden variety chlamydia. It's at number one and has been increasing for years, from less than 10,000 cases in 2009 to almost 15,000 new cases in 2012.”
A lot of fuss is being made about those LGV cases. Why is that?
“These cases are relatively few – a few hundred – but it’s an unpleasant disease for the risk group. If you are MSM it’s important to get checked.”
“That’s the term currently being used: men who have sex with men. In the past we’d say: There are homosexual men and heterosexual men – oh yes, and bisexual men. But, of course, there are also heterosexual men who sometimes have sex with a man. That’s why we agreed that we would not look at the sexual preference reported by patients but at what they do between the sheets. MSM are at an increased risk of an STD such as LGV. They need to get themselves tested regularly, especially if they have multiple partners."
Do you not need to worry about anything if you are a heterosexual?
“As regards LGV, not for the time being; but that does not apply to gonorrhoea, syphilis, herpes and HIV. These diseases have long no longer been the exclusive domain of homosexuals.”
What is the most unpleasant STD that you can get?
“The disease that is the most difficult to treat and can result in death. HIV is no longer fatal, but you do need to take medications for it your entire life. Hepatitis C has been a bit forgotten, but we are seeing it return somewhat in Amsterdam in particular. And herpes is very annoying because it’s never cured, just like a cold sore. So mostly the viral STDs. Compared to these, chlamydia is a picnic in regard to treatment.”
The fear of STDs appears to come in waves. There was a time when you’d be crazy to do it without a condom. This seems to have lessened a bit. Are people becoming less careful?
“Of the people who come to an STD clinic to get tested, two-thirds had unsafe sex with a temporary partner the last time they had intercourse. People have forgotten the danger a little because there is medication available, or because you see fewer of those gaunt people on TV. We call this HIV optimism. But just because you won’t die from it does not mean that it has suddenly become a pleasant illness.”
Other than the MSM group, who is most at risk?
“Young people. And if you break it down by ethnicity you see that Antillean and Surinamese young people have chlamydia more often than people with a Polish background, for example. And it’s a bit of an open door, but there are fewer cases of STDs in the country than in the city. Amsterdam is still the place with the most STDs. That’s where the most foreigners are and people go out more. It’s the port of call for MSM.” Laughing: “After all, a real homosexual lives in Amsterdam, doesn’t he?”
One group with a noticeable increase in the number of STD diagnoses is the 50+ group. How is this possible?
“Perhaps it’s the famous return match. They are back on the market and experiencing a second youth, so to speak.”
Nowadays you can let someone know anonymously that you may have infected them. Is that a good development?
“We prefer that people simply notify their former partners. But that can be slightly embarrassing. In this case the Area Health Authority can play a role by sending an anonymous text message. The smartest manner to fight infectious diseases is by tracking the path of infection.
How many people die of an STD every year?
The number is minimal compared to the number of infections. Syphilis, a disease that people used to die from by the dozen, is seen less and less. And HIV, which you essentially no longer die from, is also being pushed back. Then there is still a chance of infertility. But people are very shocked about this. Luckily, most people who get chlamydia remain fertile. If they are treated in time, of course.”
You’re a dermatologist. Is it logical that you treat STDs with your background?
“STDs have been associated with skin conditions for time immemorial. Syphilis, for example, caused sores, rash and odd lesions. You went to see a dermatologist for that. It wasn’t until later that chlamydia became popular, a disease that primarily causes internal symptoms. So now there is a discussion being waged as to whether STDs should not be included in the category of infectious diseases.”
Are there STDs that become extinct?
“In recent years we were able to say good-bye to a very simple one: crabs. But we mainly see new ones coming in, from other countries.”
There are plans to check people in risk groups more frequently. How does that work – do you get an invitation for this?
“That would suggest that the mayor has a thick book at the town hall that lists who is having sex with whom. And that nothing changes over the course of someone's life. No, that won’t work. However, MSM with multiple partners are told: Come by in six months.”
How big is the chance of getting an STD if you have unsafe sex once?
“That’s very difficult to say. A comprehensive chlamydia screening was done in Rotterdam. People sent in urine samples. Of the people who participated, 6% were positive. That’s a pretty substantial percentage. If you have unsafe sex with someone who has chlamydia, then the chance is about 70% that you will get it too. After only having sex once. But it is difficult to say, because the percentages differ for men and women. A woman has a greater chance than a man of becoming infected during sex.”
Does it cost anything to get yourself tested?
“Not if you go to the Area Health Authority. But people who are referred to us run the risk that this will impact their health care insurance deductible.”
Thursday 10th May 2013 (week 19)
The issue is a section in Erasmus Magazine, the opinion and information magazine of Erasmus University Rotterdam, in which an EUR-academic responds to a current-social issue.