Curable STI Rates Show No Sign Of Declining – Most People Infected Don’t Know

1 in 25 people globally have at least one of the four major preventable and curable sexually transmitted infections (STIs) – chlamydia, gonorrhoea, trichomoniasis, and syphilis – but most people don’t know they are infected, leading to serious health consequences.

More than 376 million new cases of these STIs occur each year, with more than one million new cases each day. And according to a new World Health Organization study, the rates of global STI infection show no sign of declining.

If left untreated, these STIs can lead to “serious and chronic health effects that include neurological and cardiovascular disease, infertility, ectopic pregnancy, stillbirths, and increased risk of HIV,” according to a WHO press release on the new study.

“We’re seeing a concerning lack of progress in stopping the spread of sexually transmitted infections worldwide,” said Dr Peter Salama, Executive Director for Universal Health Coverage and the Life-Course at WHO, with regard to the results of the study. “This is a wake-up call for a concerted effort to ensure everyone, everywhere can access the services they need to prevent and treat these debilitating diseases.”

The study, “Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016,” shows that since the last such study in 2012, there has been no significant decline in STI rates.

It found that in 2016, for men and women aged 15–49 years, there were 127 million new cases of chlamydia, 87 million of gonorrhoea, 6.3 million of syphilis and 156 million of trichomoniasis.

However, WHO notes that more data “was available from women than men to generate these global estimates, and STI prevalence data remains sparse for men globally.”

These numbers do not represent individuals, as some people have multiple infections, Dr Melanie Taylor, study author and STI expert at WHO, noted yesterday in a press briefing.

Dr Taylor further explained that these numbers do not include the major viral STIs – herpes, HIV, hepatitis B and human papillomavirus – which also have unfortunately high global rates of transmission.

“Sexually transmitted infections are everywhere,” said Dr Teodora Wi, WHO Medical Officer for STIs, in the press briefing.

“They are more common than we think, but STIs are not given enough attention. We continue to stigmatise people living with STIs, we neglect their care, and what’s more, we fail in prevention. We need to talk openly about sexually transmitted infections,” she said. “We cannot sweep this under the carpet.”

Most People Don’t Know They Are Infected

Despite the increase in opportunities and education related to sexual health in recent years, Dr Taylor explained, there has not been a dramatic decline in infections. This, she said, is due in part to the stigma and shame associated with these infections, and also to the fact that the infections are “hidden, or silent.”

“[M]ost patients do not have symptoms when they become infected,” she said. “They don’t realise they are infected, and they transmit these infections to their partners. And unfortunately, women may transmit these infections to their children, unknowingly.”

Even while these infections are treatable and curable with antibiotics, since most infections occur without symptoms, people “don’t realise they are at risk, and so they don’t go in for testing and treatment,” Dr Taylor said.

“And thus, the opportunity to transmit the infection is quite high – the opportunity to transmit the infection to their sexual partners, but also from mothers to their unborn children, is quite high,” she said.

According to the WHO release, transmission of these diseases during pregnancy “can lead to serious consequences for babies including stillbirth, neonatal death, low birth-weight and prematurity,” among other conditions.

It further noted that syphilis alone was responsible for 200,000 stillbirths and newborn deaths in 2016, making it one of the leading infections causing baby loss globally, which Dr Taylor noted is second only to malaria.

“Timely and affordable testing and treatment are crucial for reducing the burden of STIs globally, alongside efforts to encourage people who are sexually active to get screened for STIs,” WHO underlined in the release, recommending “that pregnant women should be systematically screened for syphilis as well as HIV.”

The data from the study provides the baseline for monitoring progress against the Global Health Sector Strategy on STIs, 2016–2021, the strategy adopted by member states at the World Health Assembly in May 2016.

About the Four STIs

In the press release, WHO provided additional details on the four STIs:

  • “Trichomoniasis (or “trich”) is the most common curable STI globally. It is caused by infection by a parasite during sexual intercourse. Chlamydia, syphilis and gonorrhoea are bacterial infections.
  • Symptoms of an STI can include genital lesions, urethral or vaginal discharge, pain when urinating and, in women, bleeding between periods. However, most cases are asymptomatic, meaning people may not be aware they have an infection prior to testing.
  • Chlamydia and gonorrhoea are major causes of pelvic inflammatory disease (PID) and infertility in women. In its later stages, syphilis can cause serious cardiovascular and neurological disease. All four diseases are associated with an increased risk of acquiring and transmitting HIV.
  • Transmission of these diseases during pregnancy can lead to serious consequences for babies including stillbirth, neonatal death, low birth-weight and prematurity, sepsis, blindness, pneumonia, and congenital deformities.”

Image Credits: Jonathan Torgovnik/WHO.