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PubMed2003

Low risk of cervical cancer during a long period after negative screening in the Netherlands.

A condition for effective cervical cancer screening is a low incidence of cervical cancer after negative screening compared to that in the absence of screening. This relative risk was studied for the period 1994-1997 in the Netherlands and compared with previous studies. All cases of invasive cervical cancer diagnosed from 1994 to 1997 in the Netherlands were related to woman-years at risk, stratified by age, number of preceding negative screenings and time since the preceding negative screening. These incidence rates were compared with that before screening started in the Netherlands. The relative risk increases from 0.13 in the first year after screening to 0.24 after more than 6 years after screening for women with one previous negative screening. These figures reduce to 0.06 and 0.18, respectively, for women with two or more previous screenings. However, these estimates are less favourable when account is taken of the likely decrease in risk for cervical cancer in the period studied. Our data show a low relative risk of cervical cancer for several years following the last negative Pap smear. However, the denominator of the relative risk, that is, the incidence without screening, may have been overestimated. This applies also to the IARC multicountry study, and may have caused too optimistic expectations about the effectiveness of cervical cancer screening.

Adult↗
PubMed2004

Breast cancer risk among first-generation migrants in the Netherlands.

We investigated breast cancer incidence in migrants in the Netherlands in 1988-1998. The standardised incidence ratio for breast cancer in Northwest-Netherlands was statistically significantly reduced for women born in Surinam (0.56), Turkey (0.29) and Morocco (0.22). The proportion of women with advanced stages (III and IV) did not differ significantly between migrants and women born in the Netherlands.

Adult↗
PubMed2002

Time trends in lipid lowering drug use in The Netherlands. Has the backlog of candidates for treatment been eliminated?

AIMS: To assess time trends in lipid lowering drug use in The Netherlands. METHODS: Data were obtained from the PHARMO-database, comprising pharmacy records of approximately 300 000 people in The Netherlands. In the period from 1991-98, we estimated prevalence of lipid lowering drug use on the first Wednesday of October. A patient was defined as incident user if (s)he filled a prescription for lipid lowering medication after a 360 days lipid lowering drug free interval. Both prevalence and incidence estimates were weighted for the sex and age distribution of the general Dutch population. RESULTS: From 1991 to 1998, the prevalence of lipid lowering drug use increased from 0.5% (95% confidence interval (CI): 0.5, 0.6) to 2.3% (95% CI: 2.2, 2.4) in women and from 0.6% (95% CI: 0.6, 0.6) to 2.9% (95% CI: 2.8, 3.0) in men. Prevalence increased with increasing age and was highest in the age category 60-69 years (in 1998: 9.9% (95% CI: 9.4, 10.4) in women and 11.6% (95% CI: 11.0, 12.1) in men). In 1992, the estimated incidence of lipid lowering drug use was 251(95% CI: 226, 277)/100,000 person years in women and 251(95% CI: 225, 276)/100,000 person years in men. The largest incidence estimates were observed in 1996 (685(95% CI: 644, 726)/100,000 person years in women and 881(95% CI: 834, 928)/100,000 person years in men). After 1996, incidence stabilized in 1997 and decreased in 1998 to 599(561, 637)/100,000 person years in women and 731(688, 773)/100,000 person years in men. Most of the patients (approximately 95%) were treated with one lipid lowering agent. Statins were used by over 90% of patients from 1996 onwards. In 1998, 35% of the patients started with a statin that was not a first choice drug (mainly atorvastatin). CONCLUSIONS: In the period from 1991-98, prevalence of lipid lowering drug use significantly increased in The Netherlands. However, incidence stabilized and decreased after 1996 which may be explained by the fact that the number of patients eligible for treatment was reached. The question remains whether lipid lowering medication was targeted to the appropriate patients.

Age Factors↗
PubMed2000

Development of the Nursing Minimum Data Set for the Netherlands (NMDSN): identification of categories and items.

Development of the Nursing Minimum Data Set for the Netherlands (NMDSN): identification of categories and items Rationale Currently, there is no systematic collection of nursing care data in the Netherlands, while pressure is growing from the profession, policy-makers and society to justify the contribution of nursing and its costs. A nursing minimum data set can provide data to demonstrate nursing's contribution to health care as it can be used to describe the diversity of different patient populations and the variability of nursing activities, and to calculate the associated nursing workload. Objective To identify categories and items for inclusion in the Nursing Minimum Data Set for the Netherlands. Design A multimethod, exploratory approach was used. This included interviews, document analysis, consensus rounds, seeking validation in the literature, and drawing up lists of most frequently occurring patient problems, interventions and outcomes of care. Eight hospitals, with a total of 16 wards, participated in the study. Results Relevant categories and items emerged after analysis and grouping of the material and included: five hospital-related items, six patient demographics items, seven medical condition items, 10 nursing process items, 24 patient problems, 32 nursing interventions, four outcomes of nursing care, and three complexity of care items. Almost every item could be located in the existing documentation systems, the lists of patient problems, outcomes and interventions, or in the literature. Conclusion A set of categories and items of nursing data has been identified. The content validity of this set is partly supported by its consistency with the literature, findings from practice and the judgement of potential users. Nursing outcomes need further development. The data set will be tested in practice to find out whether the categories and items are useful, and whether they can be minimized.

Attitude of Health Personnel↗
PubMed2002

Epidemiology of neonatal group B streptococcal disease in The Netherlands 1997-98.

Group B streptococcal (GBS) infection is still an important cause of morbidity and mortality in newborn infants. In The Netherlands, there are no published data on the incidence of neonatal GBS infection. We collected data of all infants with GBS disease during the first 3 months of life, as reported to the Dutch Paediatric Surveillance Unit (DPSU) during a period of 2 years (1997-98). Neonates with early-onset GBS disease (both sepsis and probable sepsis) were included for further analysis. The level of completeness of the DPSU data was determined by capture-recapture techniques. The incidence of early-onset GBS disease in The Netherlands in 1997-98, as calculated from the DPSU data, was 0.9 per 1000 live births. After correction for under-reporting, the incidence was estimated to be 1.9 per 1000 live births. The case fatality rate of early-onset GBS disease was only 5%. Despite the decrease in the mortality rate during the last decades, it remains a serious condition with potential irreversible brain damage. Therefore, formal guidelines for the prevention of neonatal early-onset GBS disease in The Netherlands were introduced in 1999. The data collected in this study may serve as baseline data for evaluation of the effect of these guidelines.

Adolescent↗
PubMed1996

Decreasing bladder cancer mortality in The Netherlands.

OBJECTIVE: To evaluate the prediction that the observed increasing trend in male bladder cancer mortality in the Netherlands between 1955 and 1988 would change to a decreasing trend. MATERIALS AND METHODS: Using demographic and mortality data from the Netherlands Central Bureau of Statistics, male and female bladder cancer mortality per 10(5) person-years from 1955 to 1994 were calculated. Changes in the age structure of the Dutch population were adjusted using direct standardization to the European "standard' population. The effects of age, calendar period and birth cohort on the temporal trend in mortality were evaluated using log-linear modelling. RESULTS: Male mortality from bladder cancer increased from 6.2 per 10(5) in 1955 to 12.6 per 10(5) in 1990, but decreased thereafter. Female mortality from bladder cancer has remained stable throughout the study period, at 2.8 and 2.7 per 10(5) in 1955 and 1994, respectively. The changing trend among men is consistent with an increasing risk for successive birth cohorts until the 1910 cohort and a decreasing risk for cohorts born after 1930. This cohort effect is probably caused by changes in the smoking behaviour of the male Dutch population. There were no differences in risk for successive birth cohorts of females. CONCLUSION: Male mortality from bladder cancer in the Netherlands will probably decrease for at least another decade. A future increase in female mortality from bladder cancer, as recorded for lung cancer, is unlikely.

Adult↗
PubMed2001

Employment status, job characteristics, and work-related health experience of people with a lower limb amputation in The Netherlands.

OBJECTIVES: To describe the occupational situation of people with lower limb amputations in The Netherlands and to compare the health experience of working and nonworking amputee patients with a nonimpaired reference population. DESIGN: Cross-sectional study in which patients completed a questionnaire about their job participation, type of job, workplace adjustments to their limb loss, their position in the company, and a general health questionnaire. SETTING: Orthopedic workshops in The Netherlands with a population of lower limb amputees. PATIENTS: Subjects were recruited from orthopedic workshops in the Netherlands. They ranged in age from 18 to 60 years (mean, 44.5yr) and had a lower limb amputated at least 2 years (mean, 19.6yr) before this study. MAIN OUTCOME MEASURES: A self-report questionnaire, with 1 part concerning patient characteristics and amputation-related factors, and the other concerning job characteristics, vocational handicaps, work adjustments, and working conditions; and a general health questionnaire (RAND-36) to measure health status. RESULTS: Responses were received from 652 of the 687 patients (response rate, 95%) who were sent the questionnaire. Sixty-four percent of the respondents were working at the time of the study (comparable with the employment rate of the general Dutch population), 31% had work experience but were not presently working, and 5% had no work experience. After their amputations, people shifted to less physically demanding work. The mean delay between the amputation and the return to work was 2.3 years. Many people wished their work was better adjusted to the limitations presented by their disability and they mentioned having problems concerning possibilities for promotion. Seventy-eight percent of those who stopped working within 2 years after the amputation said that amputation-related factors played a role in their decision. Thirty-four percent said that they might have worked longer if certain adjustments had been made. The health experience of people who were no longer working was significantly worse than that of the working people with amputations. CONCLUSIONS: Although amputee patients had a relatively good rate of job participation, they reported problems concerning the long delay between amputation and return to work, problems in finding suitable jobs, fewer possibilities for promotion, and problems in obtaining needed workplace modifications. People who had to stop working because of the amputation showed a worse health experience than working people.

Adult↗
PubMed2003

Cost-effectiveness of diagnostic imaging work-up and treatment for patients with intermittent claudication in The Netherlands.

OBJECTIVE: to determine the societal cost-effectiveness of various management strategies, including both the diagnostic imaging work-up and treatment, for patients with intermittent claudication in The Netherlands. METHODS: a decision-analytic model was used and included probability and quality of life data available from the literature. A cost-analysis was performed in a university setting in The Netherlands. Imaging work-up options included magnetic resonance angiography (MRA), color-guided duplex ultrasound, or intraarterial digital subtraction angiography (DSA) and treatment options were percutaneous transluminal angioplasty with selective stent placement if feasible or bypass surgery. Management strategies were defined as combinations of imaging work-up and treatment options. A conservative strategy with no imaging work-up and walking exercises was considered as reference. Main outcome measures were quality-adjusted life years (QALYs), lifetime costs (euro), and incremental cost-effectiveness (CE) ratios. The base-case analysis evaluated 60-year-old men with severe unilateral intermittent claudication of at least one year duration. RESULTS: the range in QALYs and costs across management strategies that considered angioplasty as only treatment option was small (maximum difference: 0.0033 QALYs and 451 euros). Similarly, the range was small across management strategies that considered angioplasty if feasible otherwise bypass surgery (maximum difference: 0.0033 QALYs and 280 euros). MRA in combination with angioplasty (6.1487 QALYs and 8556 euros) had a CE ratio of 20,000 euros/QALY relative to the conservative strategy. The most effective strategy was DSA in combination with angioplasty if feasible otherwise bypass surgery (6.2254 QALYs and 18,583 euros) which had a CE ratio of 131,000 euros/QALY relative to MRA in combination with angioplasty. CONCLUSION: the results suggest that the imaging work-up with non-invasive imaging modalities can replace DSA for the work-up of patients with intermittent claudication without a substantial loss in effectiveness and a minimal cost-reduction. Management strategies including angioplasty are cost-effective in the Netherlands but although strategies including bypass surgery are more effective, their incremental costs are very high.

Adult↗
PubMed2000

[Euthanasia in Europe--ten countries with special consideration of the Netherlands and Germany].

This article presents an overview of the current situation of euthanasia in Europe. Emphasis is given to the positions discussed in the Netherlands and in Germany. The current situation, the development of the legal positions, and the resulting debate are established by analysing English and German anesthesiological and medical-ethical journals. It has to be noted that many physicians are not satisfied with the terminology of euthanasia. The traditional concepts of euthanasia do not cover the aspect of accompanying terminally ill persons until they have died. The differentiation of active, passive, and indirect euthanasia does not correspond to the practical handling of the problem. Many physicians are in need of an open discussion of euthanasia-related issues. The way euthanasia is practiced in the Netherlands has strongly influenced the further development of the debate in Europe. Even though the Dutch model is rejected by the jurisdications of virtually all other countries, and official statements of medical corporations stick to the disapproval of active euthanasia, studies examining the attitudes towards euthanasia and the treatment of it in daily routine show that active interventions to shorten life are performed to different degrees outside of the Netherlands as well.

Europe↗
PubMed2003

[The practice of needs assessment for the supply with technical aids in The Netherlands].

In Germany the assessment of needs for technical aids occurs widely unsystematic and without the possibility to verify the advice process. A systematic assessment of individual needs for technical aids that follows standardised indication criteria so far has not been paid much attention. Compared with this, the advice and supply measures in the Netherlands are increasingly based on a systematic and comprehensible analysis of the individual inquiry. This analysis is called "indication and selection advice" and is usually carried out by therapists. Under Dutch law, consultants can act rather independently of any commercial interest. The basics of the analysis derive from the ICIDH and theoretical models of occupational therapy. Besides an overview of the legislation on the supply with technical aids in the Netherlands, the procedure of needs assessment plus a specific instrument based on occupational therapy knowledge are presented. The realization of advice as a defined part of the supply process required a new definition of tasks for occupational therapists. The resulting changes in the comprehension of professional roles are briefly described, too. The results of this investigation regarding the practice of needs assessment in the Netherlands suggest that changes are also required in the German service delivery system and its legal basis. Because of their specific expert knowledge of indication and selection of suitable technical aids, a more extensive involvement of occupational therapists in this key process of measures of home adaptation and the supply with technical aids is recommended in Germany, too. The development of practicable, standardised instruments to assess individual needs is advisable because it will contribute to increased efficiency of the supply with technical aids.

Adult↗
PubMed2005

Bioaccumulation of elements in bryophytes from Serra da Estrela, Portugal, and Veluwezoom, the Netherlands.

BACKGROUND, AIMS AND SCOPE: Pollution by heavy metals over large areas and long periods of time may cause chronic damage to living organisms and must be carefully controlled. One way to determine the extent of environmental contamination is by measuring the levels of contaminants in plants. The use of mosses as biomonitors is a convenient method to determine levels of (atmospheric) deposition, as terrestrial mosses obtain most of their supply of mineral elements from precipitation and dry deposition of airborne particles. Mosses have therefore received increasing attention as a suitable tool for monitoring regional patterns of elemental deposition from the atmosphere in large-scale studies in various countries, in areas close to industrial installations as well as in areas not expected to be contaminated. Although this technique is widely known, ecological studies of this type have rarely been done in Portugal. The aim of this paper is to evaluate and compare the spatial distribution of heavy metals in Hypnum cupressiforme, Pleurozium schreberi, Dicranum scoparium and Polytrichum piliferum collected from the Serra da Estrela natural park in Portugal and in the Veluwezoom natural park in the Netherlands. The selected species are the most widely used bryophytes for biomonitoring in the boreal region. The popularity of these species for this purpose is due to their wide ecological amplitude and distribution. METHODS: At 54 sampling sites in both nature parks, samples of Hypnum cupressiforme, Pleurozium schreberi, Dicranum scoparium and Polytrichum piliferum were collected. Plant digests were analysed for Al, Ba, Ca, Cr, Fe, K, Mg, Mn, Ni, Sr, V, Zn, Pb, Cu, Cd, N and P. Differentiations between sampling sites in terms of concentrations of elements in mosses were evaluated by ANOVA and the least significant difference was calculated. The normality of the analysed features was checked with the chi square test. After standardization, the matrix of 54 samples and 10 heavy metals was subjected to numerical classification to detect groups of samples with similar patterns of metal concentrations. The clustering algorithm was prepared with Ward's method, and the City Block Manhattan method was used for the similarity measure. Metals and samples were also subjected to ordination to reveal possible gradients of heavy metal levels, using PCA. Correlations were calculated between concentrations of metals and factors 1 and 2, allowing the dependence between the concentration of metals and factors (factor loading) to be estimated. RESULTS AND DISCUSSION: All species examined in both areas contained elevated levels of Mn and Pb. For each particular species, concentrations of N, P and Pb were significantly higher at Serra da Estrela, while concentrations of Cu were significantly higher at the Veluwezoom. Mosses from Portugal and the Netherlands differed significantly mainly in the concentrations of Al, Ba, Cr, Fe, Mn, Ni, Pb and V. This differentiation did not exceed that within the mosses from Portugal. CONCLUSIONS: Mosses from Portugal and the Netherlands differ significantly mainly in the concentrations of Al, Ba, Cr, Fe, Mn, Ni, Pb and V. This differentiation does not exceed the differentiation within the mosses from Portugal. RECOMMENDATION AND OUTLOOK: Further research is required into the origin and deposition of the polluting elements in other environmental compartments.

Bryophyta↗
PubMed2004

Coeliac disease in The Netherlands.

BACKGROUND: The prevalence of adult coeliac disease in The Netherlands was studied in the Dutch Coeliac Disease Society and in blood donors but not in the general population. We therefore studied the prevalence of recognized and unrecognized coeliac disease in a large cohort, representative of the adult Dutch general population. Blood samples were available for anonymous research, as well as data on dietary habits, self-reported physical characteristics, health problems, quality of life and socio-economic circumstances. METHODS: Subjects included 50,760 individuals who had previously participated in two large population-based studies on health status in relation to lifestyle factors. Recognized coeliac disease was studied in all subjects by identification of self-reported adherence to a gluten-free diet and subsequent confirmation of the diagnosis of coeliac disease. Unrecognized coeliac disease was studied in a random sample of 1440 out of the 50,760 subjects through serologic screening and human lymphocyte antigen (HLA) typing. RESULTS: The prevalence of recognized coeliac disease was 0.016% (95% confidence interval 0.008-0.031) and of unrecognized coeliac disease 0.35% (95% confidence interval 0.15-0.81). Menarcheal age was higher in women with recognized coeliac disease than in women without coeliac disease. CONCLUSIONS: The prevalence of adult recognized coeliac disease in The Netherlands is one of the lowest in Europe, while the prevalence of unrecognized coeliac disease is comparable with that in other European countries. Adult coeliac disease is strongly under diagnosed in The Netherlands. The higher menarcheal age in women with recognized coeliac disease may be explained by diagnostic delay.

Adult↗
PubMed2000

Aujeszky's disease virus eradication campaign successfully heading for last stage in The Netherlands.

The Aujeszky's disease virus (ADV) eradication campaign in The Netherlands is based on compulsory vaccination and certification of ADV-free herds and consists of three stages: reduction of transmission of ADV, tracing and elimination of remaining sources of ADV, and, in the last stage prohibition of vaccination. This paper summarizes the progress made in the first two stages of the eradication. Between 1994-1999, ADV seroprevalence decreased sharply in all four regions in The Netherlands, both in the sow and the finishing pig population. In the sow population, the mean ADV prevalence in the northern, eastern and western regions decreased to less than 0.5% in the first quarter of 1998, and to approximately 1% in the southern region. For the finishing pig population, the mean ADV prevalence decreased to less than 0.6% in all four regions in the first quarter of 1998. The proportion of sow herds that were certified ADV-free increased steadily from approximately 40% in the last quarter of 1996 to 96% in the first quarter of 1999. The proportion of finishing pig herds that were certified ADV-free showed the same spectacular increase as in the sow population: from approximately 14% in the last quarter of 1996 to 90% in the first quarter of 1999. It is anticipated that the last stage of the ADV eradication campaign, stopping vaccination, will be achieved very soon. Monitoring wild boars for ADV between 1994 and 1999 indicated that ADV is uncommon within the wild boar population. Therefore, it seems that ADV infection in the wild boar population is not an important reservoir in The Netherlands.

Animals↗
PubMed2000

Transmission of classical swine fever virus by artificial insemination during the 1997-1998 epidemic in The Netherlands: a descriptive epidemiological study.

In the course of the 1997-1998 CSF epidemic in the Netherlands, two semen collection centres (SCC) became infected. As an eradication strategy for an acute crisis situation, it was concluded that all semen of the boars at the SCCs collected and distributed in the risk period of 28 January to 7 March 1997 was potentially contaminated (suspect semen). As a consequence, a total of 1,680 pig herds, mainly located in the southern part of the Netherlands, were officially declared CSF suspect. The purpose of this study was to investigate whether infection of farms through contaminated semen played a significant role in the CSF epidemic. A total of 123 CSFV infected herds were identified, that had received suspect semen from one or both of the infected SCCs. In 87 out of these 123 infected herds, infection by way of artificial insemination (AI) could be excluded either according to the insemination information or the infection pattern observed. In only 21 herds, infection by way of AI was regarded as possible according to the insemination information and infection pattern. Owing to missing information, no conclusion could be drawn about the possibility of infection of 15 farms by way of AI. Thus, we conclude that at most 36 farms may have been infected through AI during the CSF epidemic in the Netherlands.

Animals↗
PubMed2006

Stable incidence of childhood and adult glioma in The Netherlands, 1989-2003.

Time trends in the incidence of glioma may reflect changes in the prevalence of environmental risk factors for glioma. We therefore investigated trends in the incidence of childhood and adult glioma in The Netherlands from 1989 to 2003. We used population-based incidence data from the Netherlands Cancer Registry. We calculated European standardised incidence rates for glioma, and stratified for age, gender and glioma subgroups. Changes in the incidence were estimated by calculating the Estimated Annual Percentage Change. Similar to other countries, the overall incidence of glioma was fairly stable in The Netherlands during the period 1989 to 2003, for both children and adults. In adult astrocytic glioma, a significantly increasing incidence of high-grade astrocytoma was balanced by simultaneous decreases of low-grade astrocytoma, astrocytoma with unknown malignancy grade and glioma of uncertain histology. Most of these time trends can be explained by improving detection and diagnostic precision. Stable incidence rates of adult and childhood glioma suggest that no major changes in environmental risk factors have occurred, which influenced the incidence of glioma in the studied period.

Adolescent↗
PubMedDate not supplied

STEPPS group treatment for borderline personality disorder in The Netherlands.

BACKGROUND: Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a new cognitive group treatment for outpatients with borderline personality disorder. METHODS: The English and Dutch language literature was reviewed on the STEPPS program. RESULTS: STEPPS was introduced in The Netherlands in 1998 under the acronym VERS. Reasons for its rapid dissemination throughout Holland include a user-friendly manual, its 20-week duration, ability to maintain the patient's current treatment team, and ease of therapist training. Two pilot studies, one in the US and one in The Netherlands, suggest its efficacy. Randomized controlled trials are now underway. CONCLUSIONS: STEPPS has become widespread in The Netherlands, and is now being modified for other settings, such as programs for adolescents.

Affect↗
PubMedDate not supplied

Approach to setting occupational exposure limits for sensory irritants in The Netherlands.

This article describes how scientists in the Netherlands set occupational exposure limits (OELs) for sensory irritants. When they tackle this issue, a number of key questions need to be answered. For example, did the studies indeed measure sensory irritation and not cytotoxicity? When the irritant is an odorant, can interference of olfactory stimulation be excluded? In the case of subjective measurements, can psychological irritation be excluded? When adaptation is an issue, did the studies indeed measure adaptation and not habituation? When OELs are established in the Netherlands, each of these issues is carefully addressed before a value is suggested. When setting an OEL in the Netherlands, human data carry more weight than animal data of comparable quality. As in the United States, documentation for the recommended OEL is written and a discussion of all available relevant and reliable data culminating in the selection of the key study for deriving the health-based recommended occupational exposure limit is provided. Special effort is dedicated to reconciling differences between the animal and human data. If the toxicological database is considered to be inadequate, the committee acknowledges this limitation and will not recommend a limit value due to insufficient data.

Air Pollutants, Occupational↗
PubMed2004

Resurgence of lymphogranuloma venereum in Western Europe: an outbreak of Chlamydia trachomatis serovar l2 proctitis in The Netherlands among men who have sex with men.

BACKGROUND: Lymphogranuloma venereum (LGV) is a sexually transmitted disease (STD) and is rare in the Western world. Recently, 3 men who have sex with men presented with LGV proctitis at the Erasmus Medical Center, Rotterdam, The Netherlands. We investigated a possible outbreak in a sexual network of men who have sex with men (MSM). METHODS: After active case finding, a total of 15 men presented and were investigated. Serum antibody titers to Chlamydia trachomatis were determined. Urine and rectum specimens were analyzed by polymerase chain reaction (PCR) for the presence of C. trachomatis. C. trachomatis-positive specimens were genotyped to detect the specific C. trachomatis serovars. All subjects underwent routine STD screening. Sociodemographic, clinical, and endoscopic characteristics were evaluated. RESULTS: Thirteen subjects had high immunoglobulin (Ig) G and IgA titers to C. trachomatis, suggesting an invasive infection. Rectal specimens of 12 subjects were PCR-positive for C. trachomatis. All urine specimens were negative. Genotyping revealed serovars L(2) (n=8) and L(1) (n=1). An ulcerative proctitis was found in all subjects obtaining sigmoidoscopy (n=9). Eleven of 13 subjects with an LGV diagnosis were seropositive for human immunodeficiency virus (HIV), 6 had another concomitant STD, and 1 had recently acquired a hepatitis C virus infection. Further sexual contacts were reported from The Netherlands, Germany, Belgium, the United Kingdom, and France. CONCLUSIONS: We revealed an outbreak of LGV proctitis among MSM in The Netherlands. The ulcerous character favors transmission of HIV, other STDs, and blood-borne diseases. From a public health perspective, it seems important to increase the awareness of possible LGV in MSM with symptomatic proctitis.

Adult↗