Gonorrhoea and syphilis infections reach their highest levels in Europe in more than a decade

Indeed, over the last decade or so, STIs such as gonorrhoea, syphilis and, to a lesser extent, chlamydia have seen a clear rise across Europe. The main reasons lie in changes in people’s behaviour. Condom use is becoming increasingly rare; they are used less frequently. Secondly, there has been an increase in the number of sexual partners—not in the frequency of sexual intercourse, which would be the least of our concerns—and this is particularly true amongst the younger population, starting from puberty, amongst teenagers and those in their twenties. This is truly worrying, as these STIs can cause serious problems such as infertility, chronic pain, and so on.

One important aspect highlighted in this report is the rise in congenital syphilis. This is a very serious complication that can even lead to the death of the newborn or cause lifelong sequelae.

In Spain, the management of STIs is relatively well regulated. Primary healthcare centres have the authority and capacity to carry out screening and treatment, including prevention campaigns, but the most important thing would be to raise awareness among the general public that this problem exists and that the condom is the most effective and cheapest way to prevent the transmission of these diseases.

STIs such as gonorrhoea and syphilis are on the rise in Europe. What is your assessment of this trend? (also highlighting the increase in congenital syphilis cases)

“Indeed, STI diagnoses have been steadily increasing since the early 2000s, although in the last five years the rise has been much more pronounced.

The increase in congenital syphilis cases is particularly concerning, and is partly correlated with the rise in syphilis among women of reproductive age.

The causes behind these increases are not entirely clear and are likely to be multiple: changes in sexual behaviour that facilitate transmission, increased efforts to improve diagnosis of these infections, and strengthened surveillance systems.”

What behavioural changes may be behind this, especially considering the sharper increase in cases since the pandemic?

“These increases could be linked to changes in sexual behaviour, such as a higher number of condomless sexual encounters, an increase in the number of sexual partners, and the use of dating and hook-up apps.

The COVID-19 pandemic led to a drop in diagnoses, both due to lockdowns and restrictions on mobility, as well as reduced access to healthcare services, which made testing more difficult.”

What role may HIV pre-exposure prophylaxis (PrEP) have in the increase in other STIs?

“In HIV PrEP programmes, routine STI screening every three months is already included for users, so part of the observed increase may also be due to improved detection.

It should be noted that some STIs are asymptomatic or present with mild symptoms, meaning individuals may not seek medical attention. If they are enrolled in a screening programme, these cases are detected.

However, we are also seeing increases in STIs among heterosexual men and women, among whom PrEP use is not as widespread.”

How up to date or advanced is Spain in its approach to STIs (screening, treatment, prevention campaigns, etc.)?

“The Strategic Plan for the Prevention and Control of HIV and other STIs of the Ministry of Health for the 2021–2030 period specifically addresses a range of STI-related actions.

Among them, from a primary prevention perspective, regular awareness campaigns are carried out promoting condom use and vaccination against STIs for which vaccines are available (mpox, hepatitis A, hepatitis B and HPV). In terms of secondary prevention, work has been done on improving diagnostic recommendations in collaboration with various scientific societies. Activities are also being carried out to raise awareness among healthcare professionals through training programmes across different settings.”