How to stop the rise of sexually transmitted infections?

The incidence of sexually transmitted infections (STIs) has risen sharply over the past two decades, due, among other things, to changes in the way people interact with each other and a decline in condom use. With such a panorama, how can these pathologies be stopped?

Experts from the National Epidemiological Center (CNE) of the Carlos III Institute of Public Health (ISCIII) and the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), consulted by EFE, analyze the results of the latest report on the epidemiological surveillance of STIs in Spain and provide possible solutions.

The report includes data regarding gonococcal infection (gonorrhea), syphilis, congenital syphilis, chlamydia and lymphogranuloma venereum (LGV). The latest available data shows that chlamydia cases have increased 245% since 2016, and gonorrhea cases have increased 25-fold in two decades.

As for syphilis, the number of cases is 8,141, and at the beginning of the series there were 1,010.

There were two cases of early congenital syphilis in 2022 in children under 2 years of age diagnosed in the first months of life, and PLV – 912 cases compared to 654 in 2021.

Reasons for the increase

Asuncion Díaz, head of HIV and sexually transmitted infections surveillance at CNE ISCIII and one of the paper’s authors, believes that part of this increase in cases may be due to improved data collection systems. in essence, he attributes it to changes in relationships between people. “There are now more partners than before, and the age of first sex has been lowered,” says Diaz, who also emphasizes that condom use has decreased.

SEIMC spokesman and director of the Center for Epidemiological Research on STIs in Catalonia, Jordi Casabona, speaks in a similar vein, saying that the number of infections has increased because people are putting themselves more at risk. “I always say that historically, STIs better reflect the social changes of countries and societies. Currently, we are seeing a very important change in the type of sexual relations, and they are no longer so moralized,” the SEIMC representative emphasizes.

In addition, there are not many monogamous couples, especially among young people, and social networks play a very important role: “It is very easy to start relationships with new contacts, and also to have more than one at the same time, so this makes it epidemiologically much easier and increases the efficiency of transmission.” , he adds. In short: “If there are more relationships, they are more frequent and less protected, then there is more transmission of the virus,” he says.

These are not trivial infections; they have serious consequences.

And these infections, although easily treated with antibiotics because they are caused by bacteria, can have serious consequences.

The ISCIII researcher emphasizes that, for example, syphilis can occur in different stages and, if not treated correctly, can cause side effects that can be both cardiovascular and neurological.

“This is a set of pathologies that are characterized by each other, since sex is important as a transmission mechanism, and each of them has its own characteristics; that’s why it’s important to track them,” Diaz says. If a woman becomes infected during pregnancy and is not treated, it can cause congenital syphilis.

The same thing applies to gonococcal infections; If left untreated, it can also cause infertility problems like other STIs.

“These are infections that have possible serious consequences, and if a person is infected, they can infect someone else and should be aware of this responsibility,” adds the SEIMC spokesperson.

Sometimes these infections can cause few symptoms or nonspecific discomfort that may go unnoticed; In these cases, the person must be warned if they have had unprotected sex, in which case they should consult a doctor.

According to SEIMC, screening is part of the solution, but it is aimed at populations that are initially at greater risk of contracting the underlying infection.

Diaz, for his part, emphasizes that there are established protocols and effective diagnostic methods that exist for both primary and specialty care. And this explains that there is a strategic government plan, agreed with the Autonomous Communities, until 2030 with a series of goals and actions aimed at the prevention and control of HIV and STIs in Spain.

Awareness, condoms and sex education

The SEIMC spokesperson insists there is no single measure that can stop the rise of STIs, but one would involve looking at the reasons for the decline in condom use.

“There are things like emergency contraception, PrEP (pre-exposure prophylaxis for HIV) that have caused some subgroups of people to think, ‘Well, if I no longer have to protect myself from these other things, then I won’t use condoms anymore.’ – Casabona reflects.

In this sense, it is clear that we are better at controlling the risk of some things, such as pregnancy or HIV infection, than others, such as these infections. And this is not about instilling fear, but about giving citizens elements that allow them to assess the risk of contracting an STI.

“If a person is infected, he can infect another, and he must be aware of this responsibility; so I think that this concept of risk needs to be communicated and that they have the information, especially young people,” he says.

Casabona also reminds us that there is a network of NGOs that offer free and confidential tests for various STIs. SEIMC is exploring other patient-centered approaches, such as collecting a sample at home and mailing it for testing.

In his opinion, there is a need for “more relevant fundamental actions”, such as the existence of sexuality education, allowing young people to know about the risks of STIs, but not only about this, but also about everything related to sexual and reproductive health.