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Original article
Incidence of repeat testing and diagnoses of Chlamydia trachomatis and Neisseria gonorrhoea in swingers, homosexual and heterosexual men and women at two large Dutch STI clinics, 2006–2013
  1. Nicole H T M Dukers-Muijrers1,2,
  2. Martijn S van Rooijen3,
  3. Arjan Hogewoning3,
  4. Genevieve A F S van Liere1,2,
  5. Mieke Steenbakkers1,
  6. Christian J P A Hoebe1,2
  1. 1Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen, The Netherlands
  2. 2Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
  3. 3STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
  1. Correspondence to Dr Nicole H T M Dukers-Muijrers, Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, P.O. Box 2022, Geleen 6160 HA, The Netherlands; Nicole.dukers{at}


Objective Swingers, that is, heterosexuals who as a couple have sex with others, including group sex and bisexual behaviour, are an older-aged risk group for STIs. Here, we report on their repeat testing (reattendance) and STI yield compared with other heterosexuals and men who have sex with men (MSM, homosexual men) at two Dutch STI clinics.

Methods Swingers are routinely (since 2006, South Limburg, registration-completeness: 99%) or partially (since 2010, Amsterdam, registration-completeness: 20%) included in the clinic patient registries. Data (retrospective cohort) are analysed to assess incidence (per 100 person-years (PY)) of reattendance and STI (Chlamydia trachomatis (CT) and/or Neisseria gonorrhoeae (NG)) and associated factors calculating HRs.

Results In South Limburg 7714 and in Amsterdam 2070 swinger consultations were identified. Since 2010, swingers' incidence of reattendance was 48–57/100 PY. Incidence was lower in MSM (30–39/100 PY, HR 0.56; 95% CI 0.51 to 0.61, South Limburg; HR 0.88; 95% CI 0.80 to 0.96, Amsterdam), heterosexual men (8–14/100 PY, HR 0.16; 95% CI 0.15 to 0.17, South Limburg; HR 0.33; 95% CI 0.30 to 0.36, Amsterdam) and women (13–20/100 PY, HR 0.56; 95% CI 0.51 to 0.61, South Limburg; HR 0.46; 95% CI 0.42 to 0.51, Amsterdam). Swingers' STI incidence at reattendance was 11–12/100 PY. Incidence was similar in heterosexual men (14–15/100 PY; HR 1.19; 95% CI 0.90 to 1.57, South Limburg; HR 1.20; 95% CI 0.91 to 1.59, Amsterdam) and women (12–14/100 PY; HR 1.14; 95% CI 0.88 to 1.49, South Limburg; HR 0.98; 95% CI 0.74 to 1.29, Amsterdam) and higher in MSM (18–22/100 PY; HR 1.59; 95% CI 1.19 to 2.12, South Limburg; HR 1.80; 95% CI 1.36 to 2.37, Amsterdam). Risk factors for STI incidence were partner-notified (contact-tracing), symptoms and previous STI. Swingers' positivity at any clinic attendance was 3–4% for NG (ie, higher than other heterosexuals) and 6–8% for CT (ie, lower than heterosexuals overall but higher than older heterosexuals).

Conclusions Systematic identification reveals that swingers are part of the normal STI clinic populations. They frequently repeat test yet are likely under-recognised in clinics which not routinely ask about swinging. Given swingers' notable STI rates, usage of services is warranted, although use may be restricted, that is, to those with an STI risk factor (as did Dutch clinics). As swingers have dense sexual networks, enhancing contact-tracing may have high impact.


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  • Handling editor Jackie A Cassell

  • Contributors NHTMD-M analysed the data and wrote the manuscript; MSvR and GAFSvL contributed to the data collection; all authors contributed to the interpretation of the results and the final draft of the manuscript.

  • Competing interests None.

  • Ethics approval Medical Ethical Committee of the University of Maastricht (METC 11-4-108).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are included in the paper. Coded data can be retrieved from the authors.

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