International epidemiological studies on HIV, HCV and STI

This thesis comprises international epidemiological studies on HIV, Hepatitis C (HCV) and sexually transmitted infections (STI) and the evaluation of STI diagnostic tests with the ultimate goal to decrease spread and disease burden of these infections.
The main conclusions are:
1. Without the use of HIV-therapy, long term progression-free survival of HIV is a rare but real phenomenon.
2. HCV incidence had already increased among HIV positive men who have sex with men (MSM) in the period before 2000 but from 2002 onwards it increased substantially.
3. In the era of combination antiretroviral therapy availability, HIV/HCV co-infected individuals have higher risk of death from hepatitis/liver disease and also a higher HIV/AIDS-related mortality is higher than those with only HIV infection.
4. In Suriname, chlamydia is more frequent among youngsters and among individuals of Creole and Javanese ethnicity. Sexual mixing with partners of another ethnicity was not associated with chlamydia.
5. Surinamese migrants in the Netherlands are not an effective bridge population for chlamydia transmission between Suriname and the Netherlands.
6. The chlamydia epidemic in MSM is an isolated phenomenon, distinct from the heterosexual network.
7. Although claimed differently by the manufacturer, the chlamydia rapid test performs far below expectations. Especially low chlamydia load infections are missed.
8. The performance of a self-collected rectal swab for diagnosis of chlamydia and gonorrhoea is comparable to a provider-collected rectal swab.
9. The syphilis real-time PCR is a fast, efficient and reliable test to diagnose primary syphilis, both in an STI patient clinic and a general practitioner setting.