Wellness centres: an important but overlooked source of Legionnaires disease. Eight years of source investigation in the Netherlands, 1 August 2002 to 1 August 2010.

Visiting wellness centres is considered safe and relaxing and might provide health benefits for visitors with certain cardiovascular, dermatological or respiratory diseases. On the other hand, wellness centres could pose health risks, especially with respect to Legionnaires' disease. We investigated the role of wellness centres in the occurrence of Legionnaires' disease by analysing the data of eight years (2002­2010) of source investigation in the Netherlands. There were 15 wellness centres identified as potential sources of infection for a total of 35 Legionnaires' disease patients. Twelve of these centres were positive for Legionella spp.: six for Legionella pneumophila, six for non-pneumophila Legionella spp.. Of the 65 positive environmental samples found during the wellness centre investigations, 41 were derived from shower heads. For two centres, the Legionella pneumophila strains in the collected samples had a genotype that was indistinguishable from the patient isolates. These results show that wellness centres are potential sources of Legionnaires' disease.

Different demographic and sexual correlates for chlamydial infection and gonorrhoea in Rotterdam.

BACKGROUND: The objective of the study was to estimate the prevalence of gonorrhoea and chlamydial infections and to determine sexual and demographic correlates for these sexually transmitted diseases (STD) among visitors of an STD clinic. METHODS: In 1994, a cross-sectional study was carried out among 2984 consecutive visitors of the STD clinic of the University Hospital Rotterdam. RESULTS: The prevalence of chlamydial infection was 12.1% for women and 12.3% for men. For gonorrhoea, prevalence was 3.2% and 6.0%, respectively. For men, gonorrhoea was independently associated with multiple partners in the last month, homosexual activities, a history of gonorrhoea, last sexual contact in the past 4-14 days and casual partners. In contrast, chlamydial infection was less likely to be found in homosexual men and male intravenous drug users. Additionally, chlamydial infection was independently associated with young age, multiple partners in the last 6 months and with last sexual contact in the past 2 months. For women, intravenous drug use (associated with commercial sex work) and a history of trichomoniasis were independent risk factors for gonorrhoea. Independent risk factors for chlamydial infection in women were: young age, two or three sexual partners during life and last sexual contact within 2 months. Chlamydial infection was uncommon in commercial sex workers. CONCLUSIONS: The differences in the epidemiological correlates suggest that chlamydial infection is more diffusely spread into the general population than gonorrhoea. Additionally, it is hypothesized that men acquire their chlamydial infection through less stable relationships and subsequently infect their regular female partner.

[Increase of early syphilis in Rotterdam (1995-1997): more (addicted) prostitutes and their clients]. / Toename van vroege syfilis in Rotterdam (1995-1997): meer (verslaafde) prostituees en hun bezoekers.

OBJECTIVE: To detect risk groups in an increase of early (infectious) syphilis. DESIGN: Retrospective study of patient records. METHOD: Data from visitors with an early syphilis were collected from their respective medical records in the outpatient clinic for sexually transmitted diseases (STD) of the Academic Hospital Rotterdam-Dijkzigt, the Netherlands, over the years 1993-1997. In particular, data on risk behaviour and risk groups were collected. To obtain an indication of the (possible) causes of the increase in the number of visitors with early syphilis, (shifts in) characteristics of this population over the years were compared. RESULTS: 195 patients with early syphilis had visited the outpatient clinic, 130 males and 65 females, mean ages ranging from 30.9 (1993) to 38.1 years (1997). Most infected persons (68%) came to the outpatient clinic because of symptoms. The number of women who came to the outpatient clinic through partner notification increased considerably, from an average of 5% in 1993-1995 to 36% in 1996. Over the years a relative increase of (drug addicted) prostitutes and their clients was observed (1993-1995: 39%; 1996: 56%). CONCLUSION: The cause of the increase, or failure to decrease, of the number of syphilis-infected visitors in the STD outpatient clinic of the Academic Hospital Rotterdam-Dijkzigt should probably be sought among (drug addicted) prostitutes and their visitors.

[Increase of early syphilis in a red light district in Rotterdam (1995-1997) and preventive treatment]. / Toename van vroege syfilis in een tippelzone in Rotterdam (1995-1997) en profylactische behandeling.

The number of cases of syphilis in Rotterdam has increased dramatically since 1995. The prevalence of early syphilis in 1997 was highest among street prostitutes (16%). Some prostitutes could not be reached for further evaluation and treatment, probably due to their addiction to hard drugs. Prophylactic treatment for syphilis was given to most street prostitutes in a cruising zone during a screening programme for sexually transmitted diseases (STD) in January 1997. Since then, STD checkups were performed regularly in the cruising zone. The prevalence of early syphilis in the cruising zone dropped to 1.3% in 1998. The total number of reported cases of syphilis in Rotterdam also decreased sharply in 1998.

Patient referral outcome in gonorrhoea and chlamydial infections.

OBJECTIVE: To describe the outcome of patient referral at the STD clinic of the University Hospital Rotterdam. To study characteristics of heterosexual index patients and partnerships related to referral outcome. METHODS: In 1994, patients with gonorrhoea and chlamydia were referred to public health nurses for interview and patient referral. Referral outcome was classified as "verified" if partners attended the STD clinic and as "believed" if partners were said to have attended elsewhere. RESULTS: Of 454 patients, 250 (55%) participated in the study. The outcome of patient referral for the 502 eligible partners was 103 (20.5%) verified referrals, 102 (20%) believed referrals, and 297 (59%) with unknown follow up. Of the 103 partners examined, 43 had an STD of which 63% reported no symptoms. The contact finding ratio was higher for chlamydia patients and heterosexual men. Also, referral was more effective for index patients with recent sexual contact, with follow up visits to the public health nurse, for men who were not commercial sex worker (CSW) clients, and, to a lesser degree, for Dutch patients and patients who sometimes used condoms. For steady partners, referral was improved if the last sexual contact was more recent. Casual partners visited the clinic more often if sexual contact occurred more than once, if the last contact was more recent, if they were older, and if they were Dutch. CONCLUSIONS: Patient referral was more effective for certain groups, such as chlamydia patients and steady partners, but was inadequate for others, including CSW and their clients, other "one night stands", young partners, and ethnic minorities.

Prevalence and risk factors for hepatitis B virus infections among visitors to an STD clinic.

OBJECTIVE: To determine the prevalence and risk factors for hepatitis B virus (HBV) infections among individuals attending an STD clinic in a low endemic region. STUDY DESIGN: A total of 1228 women and 1648 men attending the STD clinic at the University Hospital Rotterdam, Netherlands, were examined for HBV infection by determination of hepatitis B surface antigen (HBsAg) and antibodies to hepatitis B core antigen (anti-HBc). Demographic characteristics, information on sexual behaviour, and intravenous drug use were recorded. RESULTS: The seroprevalence of HBsAg was 1.4% in women and 2.1% in men (0% in homosexual men). The seroprevalence of anti-HBc was 13% in women and 20% in men (36% in homosexual men). Native country, intravenous drug use, a history of STD, and the number of partners in the past half year (inversely) were independent risk factors for HBsAg positivity in women and heterosexual men. For anti-HBc independent associations were observed for native country, age, intravenous drug use, commercial sex, number of lifetime partners, homosexual contacts, orogenital contact (inverse), and a history of STD. CONCLUSION: The HBV prevalence in the STD clinic attendants was high, exceeding the national estimate, and indicates that the STD clinic population may be considered a high risk group. Our data confirmed an increased risk for HBV infections among established risk groups. Therefore, these risk groups should be routinely screened to identify HBV cases for counselling and contact tracing.