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Education And Debate

Are trends in HIV, gonorrhoea, and syphilis worsening in western Europe?

BMJ 2002; 324 doi: (Published 01 June 2002) Cite this as: BMJ 2002;324:1324
  1. Angus Nicoll, director (,
  2. Françoise F Hamers, project leaderb
  1. a Public Health Laboratory Service Communicable Disease Surveillance Centre, London NW9 5EQ
  2. b European Centre for the Epidemiological Monitoring of AIDS (EuroHIV), Institut de Veille Sanitaire, 12 rue du Val d'Osne, F-94415 Saint-Maurice, France
  1. Correspondence to: A Nicoll

    The prevalence of gonorrhoea and syphilis, and that of HIV infection among heterosexuals, has been increasing in many European countries since 1995. Angus Nicoll and Françoise Hamers make a case for introducing surveillance of sexually transmitted infections other than HIV at a European level

    Summary points

    Trend data show that the numbers of new diagnoses of sexually acquired HIV infections increased by 20% in western Europe between 1995 and 2000

    Gonorrhoea reports have increased in France, the Netherlands, Sweden, Switzerland, and the United Kingdom

    The Netherlands, France, Ireland, and the United Kingdom reported outbreaks of syphilis in men having sex with men, including men already infected with HIV

    These preliminary data for several European countries imply that people may increasingly take sexual risks

    HIV remains Europe's most important sexually transmitted infection, yet complacency over HIV prevention may have set in among individuals, populations, and some governments in western Europe


    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 …

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