Public health officials are observing an increase in sexually transmitted infections (STIs) globally, with a concerning rise in cases of syphilis, gonorrhea, and chlamydia. While increased screening is contributing to the detection of more infections, the underlying trend indicates a genuine increase in transmission rates. This situation poses a significant challenge to public health goals, particularly in the context of ongoing efforts to combat HIV and viral hepatitis.
Rising STI Rates: A Global Concern
A recent report from the World Health Organization (WHO) highlights the continuing public health challenges posed by HIV, viral hepatitis, and STIs, collectively causing 2.5 million deaths annually. The report specifically notes a surge in STI cases, despite ambitious targets set in 2022 to reduce syphilis infections by tenfold by 2030. Instead of declining, adult syphilis cases increased by over one million in 2022, reaching 8 million globally. The most substantial increases were observed in the Americas and the African Region.
Four curable STIs – syphilis, gonorrhea, chlamydia, and trichomoniasis – account for over one million infections daily. The WHO report points to a significant increase in adult and maternal syphilis, along with a corresponding rise in congenital syphilis cases, particularly during the COVID-19 pandemic.
Regional Trends: La Réunion as a Case Study
Data from Santé Publique France reveals a similar trend in La Réunion, a French island in the Indian Ocean. Since 2022, there has been an increase in both HIV and STI screening, alongside a rise in detected cases of HIV, and STIs. This suggests that increased testing is not solely responsible for the observed increase in infections. transmission rates are also climbing.
In La Réunion, the rate of HIV serology testing has reached 192 per 1,000 inhabitants, continuing an upward trend since 2022. This rate is higher than that of mainland France but lower than other French overseas regions (excluding Mayotte). The increase in testing is observed across all age groups and both sexes, with particularly high rates among women aged 25-49 (302.5/1,000 inhabitants) and 15-24 (279.4/1,000 inhabitants).
The number of HIV tests performed in La Réunion increased in 2024 compared to 2023, across all age groups, with the largest increase observed in the 25-49 age bracket. This indicates a growing awareness and engagement with HIV testing services.
Increased STI Screening in La Réunion
Alongside HIV, screening for other STIs is also on the rise in La Réunion. The rate of Chlamydia trachomatis testing has increased to 98 per 1,000 inhabitants in 2024, up from 80 per 1,000 in 2023. This increase is particularly pronounced among women, who are screened at significantly higher rates than men.
Gonorrhea testing rates have also been increasing since 2022. Among women aged 15-25 and 25-49, testing rates are nearly three times higher than the regional average and 2.5 to 3.5 times higher than those of men in the same age groups.
Syphilis testing rates have also been climbing since 2022, with the highest rates observed among women aged 15-25 and 25-49 – more than twice the regional average. However, the increase is seen across all age groups and both sexes.
Challenges in Data Reporting
Despite the increased screening efforts, there is a concerning trend of declining completeness in mandatory reporting of STI cases in La Réunion. Accurate and comprehensive data are crucial for effective public health interventions. Santé Publique France emphasizes the need to restore the quality of surveillance data to inform policy decisions and ensure appropriate responses.
Biologists and clinicians are required to report all diagnosed STI cases through the www.e-DO.fr application. This includes initial diagnoses, recent discoveries of seropositivity, deaths related to HIV, and diagnoses of AIDS, regardless of prior knowledge of HIV status. Both clinicians and biologists are responsible for submitting independent reports.
The Importance of Early Detection and Prevention
The observed increases in STI rates underscore the importance of strengthening collective efforts to promote regular STI screening and facilitate access to pre-exposure prophylaxis (PrEP) for individuals at risk. Early detection and treatment are critical for preventing complications and controlling the spread of infection. The increased screening rates in La Réunion, while accompanied by rising case numbers, represent an opportunity for early intervention and improved understanding of local transmission dynamics.
The WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, acknowledged the progress made in accessing essential health commodities, including diagnostics and treatment. However, he stressed the need for countries to maximize their efforts to achieve the ambitious targets set for STI control by 2030, particularly in an increasingly complex global landscape.
The rise in STIs is a complex issue with multiple contributing factors, including asymptomatic infections, limited access to healthcare, and the stigma surrounding sexual health. Addressing these challenges requires a comprehensive approach that prioritizes prevention, early detection, and equitable access to care.
