New report flags major increase in STIs around the world

Global HIV, viral hepatitis epidemics and sexually transmitted infections (STIs) lead to 2.5 million deaths a year, according to a new report from the World Health Organization (WHO). The data in the report shows STIs are increasing in many regions across the world.

In 2022, WHO Member States set out an ambitious target of reducing the annual number of adult syphilis infections by tenfold by 2030, from 7.1 million to 0.71 million. Yet, new syphilis cases among adults aged 15–49 years increased by over 1 million in 2022, reaching 8 million.

“The rising incidence of syphilis raises major concerns,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.

“Fortunately, there has been important progress on a number of other fronts including in accelerating access to critical health commodities including diagnostics and treatment.

“We have the tools required to end these epidemics as public health threats by 2030, but we now need to ensure that, in the context of an increasingly complex world, countries do all they can to achieve the ambitious targets they set themselves.”

Increasing incidence rate

Four curable STIs — syphilis (Treponema pallidum), gonorrhoea (Neisseria gonorrhoeae), chlamydia (Chlamydia trachomatis) and trichomoniasis (Trichomonas vaginalis) — account for over 1 million infections daily. The report notes a surge in adult and maternal syphilis (1.1 million) and associated congenital syphilis (523 cases per 100,000 live births per year) during the COVID-19 pandemic. In 2022, there were 230,000 syphilis-related deaths.

New data also shows an increase in multi-resistant gonorrhoea. As of 2023, out of 87 countries where enhanced gonorrhoea antimicrobial resistance surveillance was conducted, no countries reported elevated levels (from 5% to 40%) of resistance to ceftriaxone, the last line treatment for gonorrhoea.

WHO is monitoring the situation and has updated its recommended treatment to reduce the spread of this multi-resistant gonorrhoea strain.

In 2022, around 1.2 million new hepatitis B cases and nearly 1 million new hepatitis C cases were recorded. The estimated number of deaths from viral hepatitis rose from 1.1 million in 2019 to 1.3 million in 2022 despite effective prevention, diagnosis and treatment tools.

New HIV infections only reduced from 1.5 million in 2020 to 1.3 million in 2022. Five key population groups — men who have sex with men, people who inject drugs, sex workers, transgender individuals and individuals in prisons and other closed settings — still experience significantly higher HIV prevalence rates than the general population.

Recommendations

Globally, HIV treatment coverage reached 76%, with 93% of people receiving treatment achieving suppressed viral loads. Efforts to increase HPV vaccination and screening for women with HIV are ongoing. Diagnosis and treatment coverage for hepatitis B and C have seen slight improvements globally.

Efforts by countries and partners to expand STIs, HIV and hepatitis services are bringing gains. WHO has validated 19 countries for eliminating mother-to-child transmission of HIV and/or syphilis, reflecting investments in testing and treatment coverage for these diseases among pregnant women.

The report outlines the following recommendations for countries to strengthen shared approaches towards achieving the targets:

• Implement policy and financing dialogues to develop cross-cutting investment cases and national-level sustainability plans.
• Further consolidate and align disease-specific guidance, plans and implementation support within a primary healthcare approach.
• Accelerate efforts to address ongoing criminalisation, stigma and discrimination within health settings, particularly against populations most affected by HIV, viral hepatitis and STIs.
• Expand multi-disease elimination approaches and packages, drawing from lessons learned from the triple elimination of mother-to-child transmission.
• Strengthen the focus on primary prevention, diagnosis and treatment across the diseases to raise awareness, especially for hepatitis and STIs.
   

While the ambitious targets set by member states for 2025 and 2030 are helping to drive progress, the progress is patchy across disease areas. With many indicators remaining off-track to achieve global targets, more political will and commitment are needed to urgently accelerate the efforts.

Image credit: iStock.com/Pornpak Khunatorn