[Prevention of sexually transmitted diseases. The norwegian experience]

A significant decrease in the incidence of most STDs has been reported in Norway during the last decade, especially the last 5 years. Today, syphilis, hepatitis B and gonorrhoea are almost non-existent with incidence rates (IR) of 1.1, 0.9 and 4.4 per 100,000 respectively. The frequency of genital herpes, however, has remained unchanged (IR = 45), while chlamydial infection has shown a decrease of 13% during the last year (IR women = 240). The Chlamydia epidemic became evident in the early 1980-ies and since then has represented the major threat to the reproductive condition in young women resulting in PID, tubal occlusions and ectopic pregnancies. In Norway a preoperative screening program in connection with the performance of abortions was introduced 8-9 years ago. Since then a gradual decrease in the frequency of chlamydial positivity has been notified. At our hospital a reduction of 75% (from 11.7% to 3.1%) in the prevalence of C. trachomatis has been observed in women seeking abortion. The decrease is evident is all age groups, but predominantly in those below 25 years. At the same time the frequency of PID has decreased by 80%, while so far only a slight reduction in the frequency of ectopic pregnancies has been observed. Public and professional awareness, together with an increased prescription of anti-chlamydial drugs to women with genital infections may have contributed to this decrease. Partner tracing is not satisfactory, being performed in only one out of 5 cases. A new act for the prevention of communicable diseases will be introduced next year. This act will make partner notification mandatory and STD treatment free of charge. In Norway, 350,000 chlamydial tests (8 per 100 inhabitants) are performed per year, 39% in women < 25 years. Even today the age-specific prevalence of these women are so high that Chlamydia screening is cost-effective.