‘Significant increase’ in sexually transmitted infections alarms European health authorities | Society

The steady rise in sexually transmitted infections (STIs) reported in Europe for years has raised alarm among the continent’s health authorities. The latest reports on these diseases from the European Center for Disease Control and Prevention (ECDC), covering 2022 and presented this morning, show “an alarming increase in cases of syphilis, gonorrhea and chlamydia, indicating an urgent need to improve the situation.” prevention, access to testing and effective treatment to address this public health problem,” the agency said in a statement.

Over the past year, the number of all studied infections has increased significantly. Gonorrhea increased by 48%, syphilis by 34% and chlamydia by 16%, and there is also a trend in the development of lymphogranuloma venereum and congenital syphilis, caused by transmission of infection from mother to fetus during pregnancy, with serious consequences for the child. height. The largest increase has occurred among men who have sex with men (MSM), but incidence has also increased among women (especially chlamydia) and heterosexual men.

“Combating this significant increase in STI cases requires urgent attention and concerted efforts. Testing, treatment and prevention are at the core of any long-term strategy. We must prioritize sexual health education, expand access to testing and treatment, and combat the stigma associated with STIs. Promoting consistent condom use and encouraging open dialogue about STIs can help reduce transmission,” said ECDC Director Andrea Ammon.

The ECDC, which acts as the public health agency of the EU and the European Economic Area, thus wanted to issue a serious warning about the evolution of STIs in recent years. This concern is shared in many countries around the world. In Spain, the Ministry of Health and the Carlos III Institute of Health (ISCIII) recently published a report addressing the same issue.

Below are five reports published by ECDC and their most notable findings:

Gonorrhea

Gonorrhea is a disease caused by bacteria Neisseria gonorrhea. The most common symptom of infection is a burning sensation when urinating, although white or yellowish penile discharge and vaginal discharge are also observed. Asymptomatic cases are rare among men but very common among women, making the disease difficult to control. This is treated with antibiotics. Across the 28 countries that reported infection data, a total of 70,881 cases were confirmed in 2022 – 17.9 per 100,000 inhabitants – an increase of 48% compared to 2021 and 59% compared to 2018, according to the ECDC. this is the highest number recorded since European surveillance of sexually transmitted diseases began in 2009,” the document emphasizes.

Differences between countries are important. Ireland, with 75.3 cases per 100,000 inhabitants, Luxembourg (73.6) and Denmark (66.9) are the three with the highest rates, while Romania, Croatia and Bulgaria achieve none. This discrepancy is due more to problems with notification and the volume of tests carried out than to the actual incidence in each country. Spain is in the upper middle of the table with a score of 48.3. The most affected age group is 20 to 24 years for both men and women. In 60% of cases it is diagnosed in men who have sex with men (MSM).

Syphilis

Syphilis is caused by bacteria Treponema pallidum. If it is not treated with antibiotics, it develops into very serious and fatal forms. In 2022, there were 35,391 confirmed cases among the 29 countries reporting data, a rate of 8.5 per 100,000 inhabitants. This represents an increase of 34% over 2021 and 41% over 2018. In the 25 to 34 age group, the rate was eight times higher in men than in women and older. Although 74% of cases were diagnosed among MSM, “2022 was the first year in the last 10 with a marked increase in the incidence of syphilis among heterosexual men and women,” the text emphasizes. Malta, with 24.4 cases per 100,000 inhabitants, Luxembourg (23.3), Spain and Ireland (both with 16.6) are the countries with the most notifications, while Croatia, Lithuania and Slovenia have less than two cases.

Congenital syphilis

Congenital syphilis is a serious, permanent and potentially fatal disease that affects children whose mothers were not treated for syphilis during pregnancy. In 2022, a total of 69 confirmed cases were reported to the ECDC in 14 countries (a further 11 reported no diagnosis), which is 14 more than the 55 reported in 2021 and similar to the figure of 69 in 2018. “occurs in parallel with an increase in the incidence of syphilis among heterosexual women and men,” the report emphasizes, which points to possible underreporting (five countries did not provide data). Bulgaria, Cyprus and Portugal are the three countries with the highest populations, while Spain is at the bottom of the table with two cases in 2022.

Chlamydia

Chlamydia is an infection caused by bacteria Chlamydia trachomatis (also treatable, therefore, with antibiotics), affecting the genitals, anal area and mouth. This causes pain during urination and sexual intercourse, bleeding and discharge. This is one of the most common STDs. 27 countries reported a total of 216,508 confirmed cases to the ECDC in 2022 – 88 cases per 100,000 inhabitants – 16% more than in 2021 and the highest since records began, although Germany, the most populous country in Europe, Austria and the Czech Republic did not provide data. “In 2022, notification rates were highest among women aged 20 to 24,” the report said. It is the disease with the greatest variation between countries’ data, with some, such as Denmark, having rates above 700 per 100,000 inhabitants, and others, such as Romania and Greece, below one. Spain is in the lower middle zone with a score of 62.6. According to the ECDC, the reason for this disparity is “differences in chlamydia testing policies, case-finding and reporting strategies.”

Lymphogranuloma venereum

Lymphogranuloma venereum is an infection caused by certain strains of bacteria. Chlamydia trachomatis which are different and more invasive than those that cause chlamydia. In the initial stages, its symptoms are very similar to those of other STDs, but if the infection is not treated, it can spread to the lymph nodes and cause serious complications. In 2022, 23 countries reported 2,059 cases, an increase of 58% from 2021. Spain, the Netherlands, France and Belgium accounted for 84% of all reported cases, almost all of them diagnosed among MSM.

According to all the experts interviewed, there are several reasons explaining this growth and they are interrelated. Santiago Moreno, head of the infectious diseases service at the Ramón y Cajal Hospital (Madrid), points to the sense of security that pharmacological advances in the fight against HIV provide: “Antiretroviral treatment, which keeps the viral load at undetectable levels, and prophylaxis (PrEP) have made it possible to avoid infections, and thanks to this, the fear of HIV has largely disappeared. This has led to an increase in unprotected relationships, which has contributed to an increase in the incidence of STIs, more pronounced among the group of men who have relationships with men.” A phenomenon that had already become evident two years ago when a disease called monkeypox (now called smallpox) quickly spread among this group.

Jorge del Romero, director of the Sandoval Center in Madrid, which specializes in this type of infection, believes that the development of “contact applications that favor all types of interactions and practices, such as chemsex, where the use of certain drugs that can be easily found in these channels plays an important role.” Better diagnostics and more tests carried out are another reason why the number of cases has continued to rise. “The ECDC reports are for 2022, but the trend is the same in 2023. We have never exceeded 2,000 cases of gonorrhea per year, and in 2023 there were 2,258,” Del Romero emphasizes.

Beyond specific groups and practices, Jorge García, a doctor at the STI department of the Drassanes Val d’Hebron Center in Barcelona, ​​one of the referral centers in Catalonia, emphasizes that over the past two decades there has been a “change in sexual dynamics.” at the social level,” which could explain such a high incidence rate. “Today there are more rights. People are freer to create more and more diverse pairings, which is a positive thing. But this had the unintended effect of favoring transmission,” he says.

Destigmatizing STIs is the best way to improve control, says this expert. “There are many infections that result from other forms of social interaction that do not carry the negative social burden that STIs still carry. And this is a problem, because contact testing is an excellent tool for combating any infection. But of course, if having an STI is a source of shame or blame, it will be very difficult for people to freely explain their sexual encounters and thereby help break the chains of infection,” Garcia adds.

In the field of pharmacology, a new research tool could help contain these infections, explains Moreno, who answers EL PAÍS by phone from Denver (USA), where the Conference on Retroviruses and Opportunistic Infections (CROI) is taking place. “There is a lot of talk here about the possibility of so-called post-exposure prophylaxis with doxycycline. This is a 200-milligram tablet of this antibiotic that can be taken by people who have been in risky relationships. Added to this is the use of condoms, which is currently the only effective way to prevent these infections, and we know that they are not always used,” he says. The use of this drug would be similar to the use of PrEP, which is already used to prevent the spread of HIV and has been shown to be highly effective against syphilis and chlamydia, and to a lesser extent against gonorrhea.