The World Health Organization has called for more honest discussion of sexually transmitted infections after reporting that more than 1m STIs are contracted around the world each day. WHO data shows there are 376m infections annually of four diseases: chlamydia, gonorrhoea, syphilis and trichomoniasis. Sometimes people have recurring or multiple infections.
The infections can result in stillbirths, the deaths of newborns and infertility. Syphilis alone causes more than 200,000 newborn deaths and stillbirths each year. The WHO says too little attention is paid to STIs, the data is inadequate and there is a risk that some will spiral out of control as the bacteria become resistant to antibiotics.
“These figures demonstrate an incredibly high global burden of these sexually transmitted infections,” said Dr Melanie Taylor, the lead author of a study published in the WHO Bulletin. “These infections are treatable and curable with antibiotics but unfortunately most of these infections occur without symptoms and thus people don’t realise they have the infection, they don’t realise they are at risk and they don’t go in for testing and treatment. The opportunity to transmit the infection to their sexual partners but also from mothers to their unborn infants is very, very high.”
Dr Teodora Wi, the WHO’s medical officer for sexually transmitted infections, said STIs were more common than generally believed and did not get enough attention, and people who got infections were stigmatised and neglected. “We need to talk openly and honestly about sexually transmitted infections. STIs should not be treated differently from any other infection,” Wi said. “Most importantly, we cannot sweep them under the carpet and pretend that they don’t exist.”
Sexual health budgets have been cut in many countries, including the UK, as the cost of healthcare soars. Wi pleaded for governments to think again: “We are all in this together. For policymakers: make sex safer and support STI services. Please do not cut the budget on STI control and STI services. Even increase it.”
Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016
Jane Rowley, Stephen Vander Hoorn, Eline Korenromp, Nicola Low, Magnus Unemo, Laith J Abu-Raddad, R Matthew Chico, Alex Smolak, Lori Newman, Sami Gottlieb, Soe Thwin, Nathalie Broutet & Melanie M Taylor
(Submitted: 10 December 2018 – Revised version received: 8 April 2019 – Accepted: 3 May 2019 – Published online: 6 June 2019)
Objective To generate estimates of the prevalence and incidence of urogenital infection with chlamydia, gonorrhoea, trichomoniasis and syphilis in women and men, aged 15–49 years, in 2016.
Methods For chlamydia, gonorrhoea and trichomoniasis, we systematically searched for studies conducted between 2009 and 2016 reporting on prevalence. We also consulted regional experts. To generate estimates, we used Bayesian meta-analysis. For syphilis, we aggregated the national estimates generated by using Spectrum-STI.
Findings For chlamydia, gonorrhoea and/or trichomoniasis, 130 studies were eligible. For syphilis, the Spectrum-STI database contained 978 data points for the same period. The 2016 global prevalence estimates in women were: chlamydia 3.8% (95% uncertainty interval, UI: 3.3–4.5); gonorrhoea 0.9% (95% UI: 0.7–1.1); trichomoniasis 5.3% (95% UI:4.0–7.2); and syphilis 0.5% (95% UI: 0.4–0.6). In men prevalence estimates were: chlamydia 2.7% (95% UI: 1.9–3.7); gonorrhoea 0.7% (95% UI: 0.5–1.1); trichomoniasis 0.6% (95% UI: 0.4–0.9); and syphilis 0.5% (95% UI: 0.4–0.6). Total estimated incident cases were 376.4 million: 127.2 million (95% UI: 95.1–165.9 million) chlamydia cases; 86.9 million (95% UI: 58.6–123.4 million) gonorrhoea cases; 156.0 million (95% UI: 103.4–231.2 million) trichomoniasis cases; and 6.3 million (95% UI: 5.5–7.1 million) syphilis cases.
Conclusion Global estimates of prevalence and incidence of these four curable sexually transmitted infections remain high. The study highlights the need to expand data collection efforts at country level and provides an initial baseline for monitoring progress of the World Health Organization Global Health Sector Strategy on STIs 2016–2021.