New health guidance to stop explosive growth of sexually transmitted infections: increased screening, special focus on teenagers | Society

The Ministry of Health and the main scientific and medical societies have developed a new strategy to detect and treat sexually transmitted infections (STIs), which continue to rise in Spain (and the rest of the world). They have just produced new guidance that, among many other actions, proposes expanding screening to identify them and devotes a separate chapter to adolescents and children, something that has not existed until now.

Consensus document for Diagnosis and treatment of STIs in adults, children and adolescents “which will be published in the coming days and to which EL PAÍS has access” is an update that allows all health professionals to have the tools to identify this type of disease and know how to act against them.

Since the beginning of the century, especially in the last decade, there has been an increase in the incidence of STIs. The Carlos III Institute of Health released data on Monday for 2023 that showed an increase of gonorrhea by 42.6%, syphilis by 24.1%, chlamydia by 27.6% and lymphogranuloma venereum by 80%. Men aged 20 to 34 years are most affected.

The report does not mention HIV, the incidence of which has been trending downward in recent years. This can be partly explained by the introduction of Prep, a pharmacological drug that is used before sexual intercourse and prevents infection. Quarterly STI testing is also recommended among the population to which it is prescribed, which may also be the reason for the increase in cases: it is not only that there are more of them, but that detection is better.

The guidance expands screening, which has so far focused on vulnerable populations such as men who have sex with men, people with HIV, sex workers and young people under 25 years of age. It now also includes any sexually active person in a closed relationship at the start of a new relationship or after a change of partner. It also includes people who have multiple partners or are in open relationships.

The document suggests that health care providers routinely include in health records an assessment of sexual habits and behaviors that may put people at risk for contracting or transmitting STIs. “To achieve this, it is vital to ask clear, respectful and non-judgmental questions that include the sexual practices involved, as well as social and environmental assessments,” the text says.

The idea is not to focus so much on so-called “at-risk groups” (a term banned to avoid stigma), but to focus on behavior that increases the likelihood of infection: unprotected sex. According to Mar Vera, a member of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), who participated in the preparation of the guidelines, it is very important to detect these infections even if they do not show signs, since “they are usually transmitted asymptomatically.”

In a chapter on adolescents and children, the document suggests conducting sexual behavior surveys and physical examinations from age 12 onwards, in the absence of their parents or guardians, to promote intimacy. “Sexuality should be included in health surveys for every adolescent,” the guidelines say. The greater risk of this population depends on both biological and behavioral factors. Data shows that condom use has dropped sharply, especially among young people and teenagers.

As for children, if an STI is suspected in prepubertal minors, the document recommends a detailed investigation, “with the first priority being to rule out childhood sexual abuse,” although other forms of transmission, such as perinatal or accidental, should also be considered.

New diagnostic methods

The guidance, which is largely technical, includes the use of new diagnostic techniques that were not widely available or available in 2017, the publication date of the previous guidance. Cesar Sotomayor, a physician in the infectious diseases service of the Virgen del Rocío hospital and coordinator of the consensus document, explains that one of the great innovations is to prioritize the detection of a specific disease, rather than simply focusing on symptoms: “Before, when a patient arrived with discomfort, e.g. discharge or pain, sometimes we could not make a diagnosis. Cultures were not always possible and the diagnosis was not testable. We know that there is a significant percentage of rare infections, and now with the help of molecular diagnostics we can be sure of the microorganism that causes them.”

This will allow for more precise targeting of therapy and avoid inappropriate use of antibiotics. These medications, which are very effective against most common STIs (bacterial rather than viral ones such as HIV), are at risk of losing their usefulness due to microbial resistance, which is becoming more common and can cause complications in infections such as syphilis and gonorrhea.

Both Sotomayor and Vera believe that in order to stop the explosive growth of STIs, it is necessary to recognize the specialty of infectious diseases, which is not currently among those offered in the training of Interior Medical Resident Physicians (IMRs). It is the only country in the European Union that does not have one, and SEIMC has required it for years to improve training and treatment of infectious diseases. Shortly after Monica Garcia was appointed health secretary a year ago, she announced that her department had begun work on its creation, but at the moment there are no specifics as to when this will happen.