The sustained growth that sexually transmitted infections (STIs) have been registering for years in Europe has set off alarm bells among the continent's health authorities.
The latest reports on these ailments prepared by the European Center for Disease Control and Prevention (ECDC), corresponding to the year 2022 and presented this morning, reveal “a worrying increase in cases of syphilis, gonorrhea and chlamydia, indicating a pressing need to improve prevention, access to testing and effective treatments to address this public health challenge,” the agency says in a statement.
All infections studied have increased significantly in the last year.
Gonorrhea has increased by 48%, syphilis by 34% and chlamydia by 16%, while the trend of lymphogranuloma venereum and congenital syphilis – caused by transmission from the mother to the fetus during pregnancy, with serious consequences for the baby — is also on the rise.
Most of the increase has occurred among men who have sex with men (MSM), but incidence has also grown among women (especially chlamydia) and heterosexual men.
“Addressing this substantial increase in STI cases requires urgent attention and concerted efforts.
Testing, treatment and prevention are at the heart 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 the consistent use of condoms and encouraging open dialogue about STIs can help reduce transmission rates,” defended ECDC director Andrea Ammon.
The ECDC, which acts as a public health agency of the EU and the European Economic Area, thus wanted to launch a serious warning about the evolution of STIs in recent years.
The concern is shared in much of the world.
In Spain, the Ministry of Health and the Carlos III Health Institute (ISCIII) recently published a report that addresses the same problem.
The following are the five reports published by the ECDC and the most notable data:
Gonorrhea
Gonorrhea is a disease caused by the bacteria
Neisseria gonorrhoeae
.
The most common symptom of the infection is a burning sensation when urinating, although it also produces a white or yellowish discharge from the penis and vaginal discharge.
Asymptomatic cases are rare among men, but very common among women, making the disease difficult to control.
It is treatable with antibiotics.
According to the ECDC, in the 28 countries that provided data on the infection, 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. “It is the highest number recorded since European surveillance of sexually transmitted diseases began in 2009,” the document highlights.
The differences between countries are very important.
Ireland, with 75.3 cases per 100,000 inhabitants, Luxembourg (73.6) and Denmark (66.9) are the three with the highest records, while Romania, Croatia and Bulgaria do not reach one.
This disparity is explained more by problems with notification and the volume of tests performed than by the real incidence in each country.
Spain is in the upper middle part of the table, with 48.3.
The most affected age group is 20 to 24 years for both men and women.
60% of cases are diagnosed in men who have sex with men (MSM).
Syphilis
Syphilis is caused by the bacteria
Treponema pallidum.
If it is not treated with antibiotics, it evolves into very serious and fatal forms.
In 2022, 35,391 confirmed cases were reported in the 29 countries that provided data, 8.5 per 100,000 inhabitants.
This represents an increase of 34% compared to 2021 and 41% compared to 2018. The rates were eight times higher in men than in women and older in the age group of 25 to 34 years.
Although 74% of the cases were diagnosed in MSM, “2022 has been the first of the last 10 with notable increases in syphilis among heterosexual men and women,” the text highlights.
Malta, with 24.4 cases per 100,000 inhabitants, Luxembourg (23.3) and Spain and Ireland (both with 16.6) are the countries with the highest notifications, while Croatia, Lithuania and Slovenia register less than two.
Congenital syphilis
Congenital syphilis is a serious disease, which leaves consequences and is potentially fatal, suffered by babies whose mothers did not receive treatment for syphilis during pregnancy.
In 2022, a total of 69 confirmed cases were reported to the ECDC in 14 countries (another 11 did not register any diagnosis), which is 14 more than the 55 registered in 2021 and a figure similar to the 69 in 2018. “This increase has "has been parallel to the increase in syphilis notification rates among heterosexual women and men," highlights the report, which points to possible under-reporting (five countries have not provided data).
Bulgaria, Cyprus and Portugal are the three countries with the highest records in relation to their population, while Spain appears at the bottom of the table with two cases in 2022.
Chlamydia
Chlamydia is an infection caused by the bacteria
Chlamydia trachomatis
(also treatable, therefore with antibiotics) that affects the genital organs, the anal area and the mouth.
It causes pain when urinating and having sexual intercourse, bleeding and discharge.
It is one of the most common STIs.
27 countries reported to the ECDC a total of 216,508 confirmed cases in 2022 - 88 cases per 100,000 inhabitants - 16% more than in 2021 and the highest number since records began, although Germany, the most populous country in Europe, Austria and the Czech Republic have not provided data.
“Notification rates were highest among women aged 20 to 24 in 2022,” the report states.
It is the disease with the greatest differences between the data reported by countries, with some, such as Denmark, exceeding 700 per 100,000 inhabitants and others, such as Romania and Greece, below one.
Spain is in the lower middle zone with 62.6.
“Differences in chlamydia testing policies, case-finding strategies and reporting” are the cause of this disparity, according to the ECDC.
Lymphogranuloma venereum
Lymphogranuloma venereum is an infection caused by some strains of the bacteria
Chlamydia trachomatis
that are different and more invasive than those that cause chlamydia.
In the initial stages, its symptoms are very similar to those of other STIs, but if the infection is not treated it can advance to the lymph nodes and cause serious complications.
In 2022, 23 countries reported 2,059 cases of the disease, 58% more than in 2021. Spain, the Netherlands, France and Belgium accounted for 84% of all reported cases, almost all of them diagnosed among MSM.
The reasons that explain these increases are several and interrelated, according to all the experts consulted.
Santiago Moreno, head of the Infectious Diseases service at the Ramón y Cajal Hospital (Madrid), points to the feeling of security offered by the pharmacological advances achieved against HIV: “Antiretroviral treatments, which maintain viral loads at undetectable levels, and pre-exposure prophylaxis [PrEP] have made it possible to avoid infections and, with this, the fear of HIV has largely disappeared.
This has led to an increase in unprotected relationships that have favored this increase in STIs, more pronounced among the group of men who have relationships with men.”
A phenomenon that already became evident two years ago with the rapid transmission of a disease such as monkeypox (now called mpox) among this group.
Jorge del Romero, director of the Sandoval Center in Madrid, specialized in this type of infections, considers that the development of “contact applications, which favor all types of interactions and practices such as
chemsex,
where the use of some drugs that can be easily found in these channels.”
The better diagnosis and the greater number of tests performed is another reason that would explain an increase in cases that has not stopped.
“The ECDC reports refer to 2022, but the trend is the same in 2023. We had never exceeded 2,000 cases of gonorrhea per year, and in 2023 we have had 2,258,” highlights Del Romero.
Beyond certain groups and practices, Jorge García, doctor at the STI Unit of the Drassanes-Vall d'Hebron Center in Barcelona—one of the reference centers in Catalonia—highlights that in the last two decades there has been “a change in sexual dynamics at a social level” that would explain these higher incidences.
“Today there are more rights.
People are freer to establish more and more diverse couples, which is a positive thing.
But this has had the unintended effect of favoring transmission,” he says.
Destigmatizing STIs is the best way to improve their control, this expert maintains.
“There are many infections that are the result of other forms of social interaction that do not have the negative social burden that STIs still have.
And this is a problem, because a great tool to deal with any infection is contact studies.
But of course, if having an STI is a reason for shame or reproach, it will be very difficult for people to freely explain their sexual contacts and thus help break the chains of contagion,” adds García.
In the pharmacological field, a new tool under investigation could help contain these infections, explains Moreno, who answers EL PAÍS by phone from Denver (United States), where the Conference on Retroviruses and Opportunistic Infections (CROI) is being held. English).
“There is a lot of talk here about the potential of so-called post-exposure prophylaxis with doxycycline.
It is a 200 milligram pill of this antibiotic that people who have had risky relationships could take.
This would be added to the use of condoms, which for now is the only effective tool to prevent these infections and we know that it is not always used,” he says.
Tests with this drug have shown high effectiveness in preventing infections of syphilis and chlamydia, and somewhat less in those of gonorrhea.