Surge in Sexually Transmitted Infections Across Europe

Key Takeaways

 

• Europe is experiencing a significant rise in sexually transmitted infections (STIs) like gonorrhea, syphilis, and chlamydia, posing a major public health challenge.
• Young heterosexual individuals, especially young women, are notably affected by this surge, with changing sexual behaviors and antimicrobial resistance exacerbating the situation.
• Untreated STIs can lead to severe health complications, including infertility, chronic pain, and risks to pregnancy, highlighting the need for prompt diagnosis and treatment.
• A multi-faceted approach involving enhanced public awareness, targeted interventions, and the promotion of safer sex practices is essential to combat the rise in STIs.
• Individual responsibility, including regular STI testing and open communication about sexual health, plays a crucial role in reversing the increasing trend of STIs.

 

In recent years, Europe has witnessed an alarming surge in sexually transmitted infections (STIs), with significant increases in gonorrhea, syphilis, and chlamydia cases reported by the European Centre for Disease Prevention and Control (ECDC). While sexually transmitted infections such as chlamydia, gonorrhoea and syphilis, are treatable, they can still lead to serious health complications if left untreated.

These include, amongst others, pelvic inflammatory disease or chronic pain. Additionally, chlamydia and gonorrhoea can lead to infertility while syphilis can cause neurological and cardiovascular issues. Untreated syphilis infection during pregnancy can lead to serious adverse outcomes in children. This article will delve into the alarming data, the factors contributing to the surge, the impact on public health, and potential strategies to address the rise in STIs.

Surge in Sexually Transmitted Infections Across Europe: Alarming Data

 

Overview of the Surge

The European Centre for Disease Prevention and Control (ECDC) has reported a dramatic surge in sexually transmitted infections (STIs) across Europe, with significant increases in gonorrhea, syphilis, and chlamydia cases. The CDC’s annual report echoes this concern, revealing over 2.5 million cases of syphilis, gonorrhea, and chlamydia in the US in 2022, with a particular focus on the syphilis and congenital syphilis epidemics, which demand urgent innovation and collaboration in prevention efforts.The latest ECDC reports on lymphogranuloma venereum (LGV) highlight a sharp increase in reported cases across 27 European Union/European Economic Area (EU/EEA) countries, indicating a dynamic and challenging landscape. Recent reports on syphilis and congenital syphilis show a steadily increasing trend despite a temporary dip in 2020.^[1]

 

Key Trends and Demographics

A notable rise in STI infections among young heterosexual people, particularly young women, has been observed, indicating a shift in sexual behavior post-pandemic. Chlamydia rates have fluctuated, showing increases from 2012 to 2019, a decline in 2020 due to the pandemic, and another increase in 2021, with testing disparities leading to potential underdiagnosis among men despite higher rates among young adult heterosexual women.The surge in gonorrhea cases among men who have sex with men (MSM) has surpassed increased pre-pandemic levels in 2021, underscoring a concerning trend. The data also highlights the expanding impact of STIs across various demographic groups in the EU/EEA.^[2]

Understanding the surge in STIs requires exploring the various reasons behind this sustained rise, including better surveillance, the rise in home-testing, and increases in riskier sexual behavior. The COVID-19 pandemic’s temporary stalling of STI cases due to social isolation measures and the subsequent rebound effect as restrictions lifted is also a significant factor to consider.Concerns around antimicrobial resistance, particularly in relation to gonorrhea, must be addressed, with ongoing monitoring by health authorities to ensure appropriate treatment and prevention strategies.

 

Understanding the Surge

 

Factors Contributing to the Rise

Several factors have been identified as contributors to the sustained rise in STI cases across Europe. One significant aspect is the improvement in surveillance methods, which has led to more accurate and comprehensive reporting of cases. Additionally, the increasing availability and utilization of home-testing kits have made it easier for individuals to screen themselves for STIs, potentially detecting more cases that may have otherwise gone unnoticed.^[3] Moreover, shifts in sexual behavior, including an increase in risky sexual practices, have been observed, further exacerbating the spread of STIs.

The role of the COVID-19 pandemic in influencing the trajectory of STI rates cannot be overlooked. During the pandemic, social isolation measures and restrictions on social interactions temporarily stalled the rise of STIs by limiting opportunities for transmission.^[4] However, as these restrictions were lifted and social activities resumed, a rebound effect was observed, leading to a resurgence in STI cases. The disruption caused by the pandemic also resulted in interruptions to STI testing and treatment services, exacerbating the situation further.

The European Union/European Economic Area (EU/EEA) has witnessed a sharp increase in gonorrhea cases, particularly among young women, across 15 countries in 2022 and 2023, marking it as the second most commonly reported bacterial STI, while cases among young men have risen to a lesser extent during this period.^[5] One of the most concerning aspects of the surge in gonorrhea, is the emergence of antimicrobial resistance (AMR). Gonorrhea has become increasingly resistant to common antibiotics, posing a significant public health threat. Health authorities are closely monitoring the situation and implementing strategies to address AMR, including promoting judicious use of antibiotics, enhancing surveillance of resistant strains, and researching alternative treatment options such as combination therapies.Understanding these factors is crucial for developing effective prevention strategies and mitigating the surge in STI cases.

 

Health Complications and Concerns

Untreated sexually transmitted infections (STIs) can lead to severe health complications, highlighting the critical importance of timely diagnosis and treatment.

STIs such as syphilis, gonorrhea, and chlamydia, if left untreated, can result in a range of health issues. For instance, untreated syphilis can progress through several stages, leading to serious complications such as neurological damage, cardiovascular problems, and even death in severe cases.^[6] Gonorrhea and chlamydia, if untreated, can cause pelvic inflammatory disease (PID) in women, which may result in chronic pelvic pain, ectopic pregnancy, and infertility.^[7]

One particularly concerning aspect is the rise in congenital syphilis cases, which has significant implications for maternal and child health. Congenital syphilis occurs when a pregnant woman with syphilis passes the infection to her unborn child. If left untreated, the severe phase of syphilis may lead to complications decades after infection, affecting multiple organs and systems, including the brain, nerves, eyes, liver, heart, blood vessels, bones, and joints.^[8] Severe syphilis can also cause death.Congenital syphilis can cause premature delivery, and it is essential to perform serological tests during the third trimester, particularly for women who have immigrated from regions with high syphilis prevalence. The CDC reported over 3700 cases of newborn syphilis in the United States in 2022, a more than ten-fold increase since 2012, highlighting the urgency of addressing this issue.^[9]

 

Addressing the Surge

Data from the European Centre for Disease Prevention and Control (ECDC) indicates a pressing need for comprehensive public health interventions aimed at tackling the surge in STIs. In 2022, there were over 500,000 reported cases of gonorrhea alone in the European Union/European Economic Area (EU/EEA), underscoring the urgency for increased testing, treatment, and prevention efforts.^[10]

Scaling up accessibility to STI testing services, particularly in high-risk populations and underserved communities, is crucial for early detection and prompt treatment.

Moreover, promoting safer sex practices, such as consistent and correct condom use, remains vital. According to the World Health Organization (WHO), condoms can reduce the risk of acquiring STIs, including HIV, by up to 80% when used consistently and correctly . Additionally, while Pre-exposure prophylaxis (PrEP) has been successful in HIV prevention.Pre-exposure prophylaxis (PrEP) is highly effective, reducing the risk of HIV transmission by about 99% during sex and at least 74% during injection drug use when taken as prescribed.^[11] Also it is important to acknowledge its limitations in preventing other STIs.