- Sexually transmitted infections: unravelling transmission & impact
M.F. Schim van der Loeff
- Award date
- 6 November 2015
- Number of pages
- Document type
- PhD thesis
- Faculty of Medicine (AMC-UvA)
The aim of the thesis was to gain insight into sexual mixing patterns, the effect of these patterns on the spread of sexually transmitted infections (STIs), pathogen interactions, and infectious disease progression and outcome.
The main findings are:
1. Among heterosexuals in Amsterdam, partnership factors (e.g. age difference) are more important determinants of unprotected sexual contact than characteristics of the individual. STI prevalence differences between ethnic populations are not always caused by differences in sexual behaviour.
2. Demographic characteristics (e.g. age) are less important for partner selection among men who have sex with men (MSM); the key determinant of unprotected anal intercourse among MSM is perceived concordant HIV status. Molecular epidemiology of Chlamydia trachomatis and N. gonorrhoeae did not reveal subpopulations among MSM, suggesting a homogeneously mixed population, but the risk to acquire N. gonorrhoeae differed between meeting venues. Furthermore, the pharynx is more important for the spread of N. gonorrhoeae than the rectum, even though the prevalence of rectal infections is higher.
3. The disease burden of hepatitis C virus infection will increase in the upcoming years among people who inject drugs. HCV treatment will reduce the burden, but postponing implementation of treatment reduces its effect, because the population becomes older and the average duration of infection is increasing.
4. Finally, no evidence for a reduction in mortality from HIV-1 in individuals dually infected with HIV-1 and HIV-2 in West Africa was found.
We are entering a new era in which biomedical prevention strategies become important. In response, pathogen dynamics are likely to change.
- Research conducted at: GGD Amsterdam
Thesis (complete) (Embargo until 06 November 2017)
2.1 The importance of partnership factors and individual factors in association with absent or inconsistent condom use in heterosexuals - a cross-sectional study (Embargo until 06 November 2017)
3.1 Perceived HIV status is a key determinant of unprotected anal intercourse within partnerships of men who have sex with men in Amsterdam (Embargo until 06 November 2017)
3.2 Determining the most likely source of infection: an application to Neisseria gonorrhoeae infection among men who have sex with men (Embargo until 06 November 2017)
3.3 The contribution of rectal, urethral, and pharyngeal Neisseria gonorrhoeae infections to spread among men who have sex with men (Embargo until 06 November 2017)
4.1 Distinct Neisseria gonorrhoeae transmission networks among men who have sex with men in Amsterdam, the Netherlands (Embargo until 06 November 2017)
4.2 Multilocus sequence typing of Chlamydia trachomatis among men who have sex with men reveals cocirculating strains not associated with specific subpopulations (Embargo until 06 November 2017)
5.1 The effect of hepatitis C treatment and human immunodeficiency virus (HIV) co-infection on the disease burden of hepatitis C among injecting drug users in Amsterdam (Embargo until 06 November 2017)
5.2 Mortality rates in people dually infected with HIV-1/2 and those infected with either HIV-1 or HIV-2: a systematic review and meta-analysis (Embargo until 06 November 2017)
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