Introduction

As a consequence of AIDS prevention campaigns in the late 1980s and the early 1990s, the numbers of new reported diagnoses of gonorrhoea, infectious syphilis, and other sexually transmitted infections fell in several countries in western Europe.1 The downward trends in gonorrhoea seen in England and Wales, France, the Netherlands, and Sweden (fig 1) were typical and paralleled reports of declining levels of sexual behaviours with a high risk of transmitting infection.2 Available data indicate that the campaigns seem to have been successful in either reducing transmission of HIV or preventing it from rising as much as it did in countries that did not have early interventions.3

In Europe at the start of the 21st century, HIV remains the most serious sexually transmitted infection. An estimated 540 000 west Europeans have an infection that remains incurable and the cost of treating a single adult once discounting for time is undertaken …