Background The role of primary care in STI-control has long been neglected. Although national STI surveillance often thrives on data of STI-Clinics, recent research in the Netherlands shows that approximately 70% of all STI-related consultations are in General Practice (GP). More attention for sexual health in primary care is warranted.
Methods In 2004 the Dutch College for Family Physicians (NHG) added a guideline about the “STI consultation” to their list of GP certified “standards of care”. The guideline describes care for patients with complaints of STI, for patients with questions about STI (test request), and also describes pro-active testing policies for persons visiting the health centre for a not-STI related reason. The guideline is currently being updated. Implementation of the guideline is facilitated by regional “expert” GP, united in the GP-advisory group on STD, HIV and Sexuality (the Expert group Sexual Health (SeksHAG). Such Expert Groups within the GP institutional body are relatively new and also exist, for example, diabetes and Asthma/COPD.
Results Annually approximately 1500 GP receive a continuous education session on STI facilitated by the GP expert in their region. Previous research showed moderate impact on testing habits and case detection. Qualitative interviews describe insight in personal barriers as a positive gain in training sessions. Prescribing habits of GP for Gonococcal infections are legging behind, half of GP prescribing ciprofloxacin, for which resistance is well above 40%.
Discussion A substantial but often hidden proportion of STI consultations take place in general practice. More interventions on STI-care in GP are recommended. An expert group within the national GP body can enhance attention for quality of care. The new emerging paradigm within primary care to focus not only on disease (pathogenesis) but also on health (salutogenesis) might open new avenues for sexual health counselling. New technology also has potential: continuous education sessions have limited impact on prescribing habits for infrequent conditions with fast changing resistance patterns like gonoccocal infections; learning GP to use more and better their electronic prescription expert-system based on patient ICPC code (Prescriptor) is a better option and now available in most GP operating systems in the Netherlands.
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