Sexually Transmitted Infections (STIs) do not stop growing.
At the same time that the circulation of HIV has fallen, others such as gonorrhea, syphilis or chlamydiosis have been increasing each year for more than a decade without the health authorities knowing how to stop them.
Easier to have relationships and less fear of AIDS are some of the explanations behind this explosion.
The phenomenon is global.
The outdated Health statistics only go to 2019 for most infections (except for HIV which are updated until 2021).
Although the majority (65%) occur in men, the increase in women has been spectacular: more than 1,000% in a decade, according to the Bloom Women's Health Observatory.
In the last 10 years with records, HIV transmission has dropped by 22.6%, to 2,786 infections per year.
Meanwhile, those of gonorrhea have multiplied by six (12,359 cases) and those of syphilis have more than doubled (5,822).
In the only four years for which the Ministry of Health has data, lymphogranuloma venereum has risen by 82% (453 infections) and chlamydia, the only female majority, has grown by 144% (17,718 diagnoses).
Not counting the latter
The unpublished data that some researchers track in the communities indicate that after a breather in the first year of the pandemic, the result of less social contact, "2021 surpassed 2019, and 2022 will probably continue on that path," explains Irene María Sempere Fernández. , specialized in Family Medicine and a Preventive resident, in whose master's thesis she has studied STIs in Andalusia.
The statistics still do not include Pablo's HIV positive or Silvia's gonorrhea.
They are two names invented to safeguard the privacy of two adults aged 42 and 40 who contracted STIs just a few months ago.
Both consider themselves well informed about the risks of these diseases and both, either through a slip or a lack of habit, became infected during intercourse without a condom.
Since
Put it on, put it on,
there have been many campaigns for condom use.
But none has achieved the impact that this one achieved at the end of the eighties, in the face of a society terrified by AIDS, which then meant an almost certain death sentence.
The last one from the Ministry of Health came out in September, under the slogan
Go out as you want, but don't go out without condoms
, aimed at the young population.
Data such as the ProyectoScopio barometer show that 45% of young people between the ages of 15 and 29 have practiced unprotected sex, despite the fact that most of them are aware of the risks.
25% say they do it on a regular basis and 15% confess that it pays off, even though there is a possibility of contracting sexual infections.
Mar Vera, a doctor at the Sandoval Health Center in Madrid, a public clinic specializing in sexually transmitted infections that often serves as a thermometer to predict their growth, says that the use of condoms has been greatly relaxed.
In part, she puts it down to losing her fear of HIV, which is now treated as a chronic disease.
She has also contributed, in her opinion, to the generalization of the Prep.
It is a pill that public health has dispensed since 2019 and prevents the transmission of HIV.
In addition, who receives this treatment has to undergo routine check-ups, which also brings up infections that would otherwise remain hidden.
But experts agree that the increase in STIs is not only due to the fact that more are being diagnosed, since the rise is prior to Prep.
It is clear that more infections occur.
“Dating apps make it much easier to have sexual encounters anytime, anywhere with strangers.
Chemsex
(sex under the stimulus of drugs) is also growing,
which is accompanied by risky practices,” says Vera.
Drugs and alcohol are often behind the relaxation in condom use.
It was the case of Silvia: “I slept with an acquaintance at a festival.
He had been drinking and I don't remember exactly what happened, but we didn't use it.
I also confided in myself because I was someone with whom I had previously had sexual relations, ”she admits.
A few weeks later she noticed enormous pain in her belly and foul-smelling discharge.
She ended up hospitalized for four days.
Diagnosis: gonorrhea.
Although she overcame the infection thanks to antibiotics, doctors warn that they are becoming less effective due to microbial resistance, one of the great public health concerns, which will foreseeably worsen in the coming decades.
What is normally cured with simple treatment can lead to serious complications, even death.
Juan Carlos Galán, head of Virology at the Ramón y Cajal Hospital in Madrid, warns that even asymptomatic infections can have consequences.
It occurs, for example, with the human papilloma virus, which can lead to cervical cancer or, less frequently, anal, penile or oral cancer.
Or with candidiasis, which can cause reproductive problems in women who are infected: difficulty getting pregnant, ectopic pregnancies, pelvic inflammatory disease.
“There is also the problem of transmitting it to other people in whom it can give symptoms and complications from the start,” he says.
Faced with these realities, a forum of experts in the field, in which public health technicians from the regional administrations also participate, have come together to study what to do, find the best practices and implement them.
Under the acronym Fexits, they have presented a document of recommendations this fall, which includes population screenings in both high-risk and low- and moderate-risk individuals.
It would be the way to stop the chains of transmission of infections when they are asymptomatic, something that happens very often.
It occurs, for example, with chlamydiasis, which does not present signs in approximately 70% of men and 50% of women with infection, according to data from the Ministry of Health.
Along with the use of condoms, routine checkups are the best measure to stop STIs, in the opinion of Jorge Garrido, a member of Fexits and director of Apoyo Positivo.
“Condoms are used less and that contributes to the increase in infections.
But it's not magic either.
Both condoms [France has announced this week that they will be free for people between the ages of 18 and 25] and STI tests should be more accessible, bring them closer to health centers and remove the stigma ”, he argues.
Pablo received an HIV diagnosis this September and has experienced the difficulties of access firsthand.
He acknowledges that he has had "practically all STIs" and the experiences have not always been good.
“At the health center sometimes they did not want to do tests on me, they sent me to Sandoval.
In another I had to take the samples myself because I saw that the nurse couldn't because of disgust, ”he narrates.
He belongs to the highest risk group: men who have sex with men.
“I move in an environment in which HIV is relatively present, I have had two HIV-positive partners.
Despite that, it amazes me that there is still so much stigma.
People who have HIV nearby do not have information, nor do they know anyone who speaks openly about it ”, she points out.
In his case, as frequently happens, he has been "normalizing" risk relationships.
“I am from the generation of
put it on, put it on
and I had it very marked years ago.
But in the end you see people who have it, you catch other STIs and you relax.
Sometimes I have thought that I have trusted myself too much, but it is not different from what happens with smoking, with not exercising, with eating fat, ”she justifies.
What to do to stop STIs?
"It is the big question," acknowledges Mar Vera.
The Ministry of Health approved in December 2021 a
Plan for the prevention and control of HIV infection and STIs
.
Its objective: "To promote and coordinate actions for the elimination of HIV and STIs as a public health problem in 2030, through prevention, early diagnosis and treatment of infections, attention to chronicity and improvement of quality of life, as well as the approach to stigma and discrimination associated with HIV and other STIs in Spain”.
The documents prior to this plan admit that to date the plans of the autonomies suffer from a "high degree of heterogeneity", do not have tools to measure their impact and have "big areas for improvement", especially in the previous situation study to the implementation and specific actions related to the assistance to STIs and in terms of stigma and discrimination.
Galán focuses on monkey smallpox (now, officially, mpox), which despite the debate as to whether it is actually an STI is contracted in the vast majority of cases during sexual intercourse.
"We have been able to limit its progress, something that we have not achieved with other infections such as syphilis," he reflects.
The doctor believes that lessons can be drawn from there.
“He generated a sensation of alarm, of fear, with a quick appeal from the World Health Organization and a perception of the severity of the disease greater than he really had, surely due to association with smallpox.
With this alert, all the health centers began to identify it very quickly and there was a great diagnostic work, ”she points out.
There are many differences between mpox and the most common STIs.
Most do not have a vaccine, they have a much higher percentage of asymptomatic patients and the social alarm is not the same.
"But we can learn from early diagnosis, it is the first tool that, if we compare the two models, we can extrapolate," he argues.
To the screenings, the experts add a greater awareness that must come long before young people start having sexual relations.
“They have to know that they are the ones who can set limits, that the risk increases the more sexual partners they have, the importance of condoms.
And that STIs are not a problem of a group, but a social problem that affects us all”, concludes Galán.