Sexually transmitted infections: what's new?

Since the beginning of the third millennium the incidence of Sexually Transmitted Infections (STIs) is rising in Europe and in Belgium, and this after a steady decline in the second half of last century. It concerns new or lesser known diseases such as Hepatitis C and Lymphogranuloma venereum (LGV) and 'old' diseases such as gonorrhoea and syphilis, occurring in specific risk groups. In this article we give an update of the diagnostic means and therapeutic challenges that are of interest for the clinician. Besides these (re)-emerging diseases we touch on Human Papillomavirus (HPV) and Herpes Simplex (HSV). This selection of diseases is based on the daily experience of the clinicians working in the STI clinic of the Institute of Tropical Medicine in Antwerp. Data and clinical guidelines are derived from the Scientific Institute of Public Health in Brussels, the European and American Centers for Disease Control and Prevention, and the Guidelines of the Flemish Agency for Care and Health. New evolutions in diagnostics, prevention and treatment options make it necessary to regularly update the knowledge of this group of diseases, especially when they are complicated by HIV co-infection. As the incidence of neither HIV nor STIs seem to decrease in Belgium and Europe, it remains necessary to stay aware of the state-of-the-art management.     

Risk behaviour and sexually transmitted diseases are on the rise in gay men, but what is happening with HIV?

Increases in sexually transmitted diseases and sexual risk behaviour among men who have sex with men in the Western world have raised concern with regard to the HIV/AIDS epidemic in this group. The aim of this review is to give an overview of possible explanations for these alarming increases and to indicate what impact they might have on this epidemic.     

Sexually transmitted infections in Estonia--syndromic management of urethritis in a European country?

Sexually transmitted infections (STIs) are considered a major public health problem, globally. In particular, increasing STI rates have been documented throughout eastern Europe and central Asia. The Russian Federation and adjacent countries have, traditionally, managed STIs on an aetiological basis. This approach is expensive in terms of laboratory costs and it may lead to delayed diagnosis and treatment. To overcome the limitations of the aetiological management of STIs, the World Health Organization (WHO) has placed an increased emphasis on integrated care using syndromic management at the primary care level, especially in developing countries. This article reviews the current aetiology of STIs in Estonia, an eastern European country bordering the Baltic Sea and formerly a part of the Soviet Union, with the aim of defining whether infection with Trichomonas vaginalis is common enough to include its management in a syndromic management protocol. The use of syndromic management, in general, is also discussed.     

A care pathway for chlamydia, what's happening in primary care 12 months on?

Primary care is seen as central to the future provision of sexual health services, including chlamydia screening. The aim of this study was to establish levels of awareness and application of a chlamydia care pathway among practice nurses in primary care 12 months after its launch and present knowledge and practice of testing. Questionnaires were sent to 46 practice nurses at 22 general practitioner practices within the care pathway pilot site. Response rate was 33/46 (72%), with 30 (94%) practice nurses aware of the care pathway and 19 (62%) routinely using it. Endocervical swabbing was performed by 29 (90%) respondents, no endourethral swabs were taken from men and 85% nurses did not perceive partner notification as being part of their role. Practice nurses identified the need for training in using the care pathway and in identification of infection to optimize the provision of effective sexual health care in primary care.     

Low-density lipoprotein in the setting of congestive heart failure: Is lower really better?

Hypercholesterolemia is a risk factor for coronary artery disease (CAD), CAD mortality, and incident heart failure (HF). Lipid-lowering therapy with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) has been shown to reduce the risk of developing HF in patients with CAD. However, in patients with chronic established HF, hypercholesterolemia has not been associated with an increased risk of mortality. Several studies have demonstrated that higher lipid and lipoprotein levels, including total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides, are associated with significantly improved outcomes in HF of both ischemic and nonischemic etiologies. In light of the association between high cholesterol levels and improved survival in HF, statin or other lipid-lowering therapy in HF remains controversial. To date, large outcome trials of statin therapy in HF of multiple etiologies have not demonstrated mortality benefit.