#18,623
Although most STIs (sexually transmitted infections) remain treatable by modern antibiotics, a little over 2 years ago in 2023's Massachusetts DPH: First Detection Of Gonorrhea Strain With Resistance To 5 Classes of Antibiotics we looked at growing concerns over antibiotic resistant gonorrhea in the United States.
Also in 2023 we saw a report from the UKHSA: Gonorrhoea and Syphilis at Record Levels in 2022, which found that the levels of Syphilis in the UK was at its highest since 1948, and that gonorrhoea diagnoses had increased 50.3% compared to 2021.
This past week the ECDC released a series of 5 reports on STIs (sexually transmitted infections), for the year 2023:
On Friday the ECDC's Weekly Communicable Disease Threats Report carried the following summary and risk assessment. I'll have a bit more after the break.
Overview:
Considerable increases were seen in reported cases of syphilis and gonorrhoea in 2023, relative to 2022, continuing the increasing trend seen in 2022. The trends for all STIs that ECDC provides surveillance data on underscore the need for immediate action to prevent further transmission and mitigate the impact of STIs on public health.
In 2023, nearly 100 000 confirmed cases of gonorrhoea were reported in EU/EEA countries, showing a 31% increase compared to 2022 and a striking increase of more than 300% compared to 2014. This surge was observed across different age groups and demographics, including men who have sex with men and heterosexual men and women.
The highest rates among women were within the age group 20 to 24 and this is also the group with the steepest increase in 2023 (46%). For men, the highest rates were seen in the 25 to 34-year-old age group. If left untreated, gonorrhoea can lead to significant health problems, such as pelvic inflammatory disease, and infertility in both men and women.
Syphilis cases also continue to rise. In 2023, 41 051 confirmed cases were reported in 29 EU/EEA countries, representing a 13% increase compared to 2022, and a doubling compared to 2014. Syphilis is more common among men, with seven men diagnosed for every one woman. The highest rates were seen among men aged 25 to 34. The majority of syphilis cases (72%) were reported in men who have sex with men. Still, compared to 2022, rates of syphilis increased among women of all age groups. Untreated syphilis can cause long-term complications in the heart and nervous system and if a pregnant woman has untreated syphilis, the baby may suffer severe complications.
Despite a slowdown in the increase of chlamydia notifications in 2023, it remains the most frequently reported bacterial STI in Europe. In 2023, more than 230 000 cases were reported across EU/EEA countries, representing an increase of 13% since 2014. The infection continues to disproportionately affect young people, with the highest rates among women aged 20 to 24.
Aside from the rise in the number of reported cases of STIs, a particular concern is the increasing threat of antimicrobial resistance (AMR) in gonorrhoea. The emergence of drug-resistant strains threatens the effectiveness of current treatments, making it crucial to emphasise prevention and promote responsible antibiotic use. ECDC actively monitors AMR trends in Neisseria gonorrhoea and works with countries to strengthen surveillance and implement strategies to combat resistance.
ECDC assessment:
There are several hypotheses as to why cases of STIs have increased. More testing for STIs in some populations likely accounts for some of the increase. Other possible explanations that need further study include changes in sexual risk behaviours, such as less condom use, and higher numbers of sexual partners.
ECDC emphasises the importance of proactive measures to address the rising STI rates. Using condoms consistently for vaginal, anal and oral sex is crucial for prevention. Open and honest communication about sexual health with partners can also help reduce the risk of STI transmission.
People who experience symptoms of sexually transmitted infections, including pain when urinating, discharge from the penis, vagina, or anus, or pain in the lower stomach are strongly advised to seek testing. Other symptoms include an ulcer or rash around the genital area, mouth or anus. As it is possible to have an STI and not have any symptoms, sexually active people are encouraged to get tested for STIs, especially those with new, casual or multiple sexual partners. Early detection and treatment are essential to prevent further transmission and potential complications. If you suspect you may have contracted an STI, seek medical advice immediately
Actions:
ECDC published a news item on 10 February 2025 where the five Annual Epidemiological Reports can be found. Information has also been disseminated through social media (e.g., on Linkedin, Facebook, Bluesky, Threads).
Meanwhile, here in the United States the number of STIs reported in 2023 remains high - but is slightly lower than in 2022 (see CDC chart below). Whether this represents an actual decrease, or a decrease in screenings, is unknown.
Last November the CDC reported:
National Overview of STIs in 2023
About
Sexually Transmitted Infections Surveillance, 2023 provides the latest data on trends for three nationally notifiable sexually transmitted infections (STIs): chlamydia, gonorrhea, and syphilis, including congenital syphilis. This overview summarizes the national STI surveillance data presented in this report.
Findings
In 2023, over 2.4 million cases of syphilis, gonorrhea, and chlamydia were diagnosed and reported. This includes over 209,000 cases of syphilis, over 600,000 cases of gonorrhea, and over 1.6 million cases of chlamydia. Importantly, the combined count includes 3,882 cases of congenital syphilis, including 279 congenital syphilis stillbirths and neonatal/infant deaths.
The number of STIs decreased 1.8% from 2022 to 2023, reflecting decreases in gonorrhea (7.2% decrease),stable trends in chlamydia (<1.0% change), and an increase in total syphilis (all stages and congenital syphilis combined) (1.0% increase).
While we spend much of our time focused on viral illnesses like novel flu and COVID, they are far from the only global public health threats on the horizon. The world faces a growing array of multidrug resistant organisms (MDROs) - both bacterial and fungal - that already claim thousands of lives each year.
Some recent blogs on other AMR (antimicrobial resistant) disease threats include:
ECDC Rapid risk assessment - Carbapenem-resistant Enterobacterales – 3rd update
ECDC: Antimicrobial resistance in the EU/EEA (EARS-Net) - Annual Epidemiological Report 2023
WHO DON & Risk Assessment: Hypervirulent Klebsiella pneumoniae (hvKp) ST23
China's Growing Antibiotic Resistance Problem
While I cover AMR topics occasionally in this blog, I can heartily recommend CIDRAP's Antimicrobial Stewardship Project as the best place to learn about the growing global threat of AMR.
You'll also want to check out the CIDRAP-ASP Youtube Channel, which has more than 24 hours of lectures and webinars on Antimicrobial stewardship.
