Seksueel overdraagbare aandoeningen; een advies van de Gezondheidsraad

– This report (240 pg) on sexually transmitted diseases (STD) consists of two parts. The first deals with general aspects such as incidence and risk factors, PID, and minimal requirements for diagnosis. New developments in the study of the separate diseases, with emphasis on laboratory diagnosis and treatment, are dealt with in the second part. After some critical comments on recent changes in the organization of prevention of STD, a plea is made for closer cooperation between treating physicians and those responsible for contact tracing. However, it appears doubtful that this will improve the tracing. Failure to calculate cost-effectiveness precludes an answer to the question whether to screen for STD in high-risk groups. The use of condoms is advised for promiscuous contacts, but, wisely, antibiotic treatment without culture is discouraged in these situations because of the risk of bacterial resistance. Individual instruction on risk factors is recommended but details on how to attain this, are lacking. Some detailed but pragmatic rules are given for the use of laboratory diagnostic methods. Culture for Chlamydia should not be included in routine tests, but it is recommended to expand these in pregnant women and prostitutes. Also a plea is made to increase facilities for laboratory diagnosis. Some recommendations for therapy include cefotaximdoxycycline (with or without metronidazole) for PID without known cause, and primary treatment of gonorrhoea with cefotaxim (or amoxycillinclavulanic acid) if the proportion of penicillinase-producing N. gonorrhoeae is over 10.

It is postulated that the risk group of male homosexuals should be vaccinated against hepatitis B, just like persons at risk in hospitals. This is cost-effective but the question who should pay for vaccination, is not answered.