A million a day: STIs are a worldwide epidemic, declares WHO

By Dr. Liji Thomas, MDJun 6 2019

STIs continue to rise globally, with more than 1 million new STIs of just four types being reported every day, according to a new report from the World Health Organization (WHO). This comes to over 376 million new STIs a year among people between 15 and 49 years.

Image Credit: Shubin Vitaliy / Shutterstock

Estimates are that 1 in 25 people the world over have one or more STIs. But many of them may not even know it because of the lack of symptoms, which means they don’t seek treatment but spread it to others.

This includes 87 million cases of gonorrhea, 6.3 million of syphilis, 127 million cases of chlamydia and 156 million of trichomoniasis. Strikingly, these high figures do not even touch upon STIs like herpes, HIV and HPV infection, which will be published in a few months. Both high- and low-income regions of the world are equally affected though STI patterns vary.

The estimated incidence figures are represented as a table below.

In the overwhelming majority of cases, STIs are not only curable but highly preventable. Proper sex education and consistent correct condom use with every act of sex between new or casual partners, including oral, anal and vaginal intercourse, is known to prevent the spread of STIs.

All the same, STIs continue to rise, with no change in existing or new infection rates from 2012.

Peter Salama, WHO executive director for universal health coverage, called this “a concerning lack of progress” and “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.”

Why bother about STIs?

Untreated, these STIs can devastate the body, causing problems ranging from chronic neurological and cardiovascular disease, infertility and tubal pregnancies, to stillbirths and an increased risk of acquiring HIV infection. For instance, one of the biggest baby killers in 2016 was syphilis, which caused 200,000 babies to be born lifeless or to die soon after birth. They also disrupt homes, causing domestic violence and social ostracism.

Study author Melanie Taylor says: “"We consider this a hidden epidemic, a silent epidemic, a dangerous epidemic." Its impact is bitter, she says, labeling it “persistent within populations, families and relationships and quite damaging to all.”

STIs spread primarily via sexual activity. Other routes include vertical spread (from mother to child, during pregnancy or delivery), through infected blood/blood products (as with syphilis), and hypodermic sharing for injected drug abuse.

People don’t bother to make sure they are protected from STIs, say WHO experts like Teodora Wi, who warns: “Sexually transmitted infections are everywhere. They are far more common than we think.”

With the fear of HIV lessening, due to effective preventive pills and treatments, people have become “complacent about protection”, says Wi, despite the universal availability of sex with unknown partners today – a truly dangerous trend.

Incurable STIs?

Treatment of STIs is relatively simple and the drugs are typically easily available, except for benzathine penicillin, a long-acting form of the drug used to treat syphilis. However, the high number of gonorrhea cases is frightening, because “super-gonorrhea” has cropped up in some places, showing resistance to multiple antibiotics. Experts fear that this may become increasingly common, making the disease incurable.

Drug resistance is also being found with other STIs, like Mycoplasma genitalium and syphilis. Tim Jinks, drug-resistance expert at Wellcome, warned, “Untreatable cases of gonorrhoea are harbingers of a wider crisis where common infections are harder and harder to treat. We urgently need to reduce the spread of these infections and invest in new antibiotics and treatments to replace those that no longer work.”

Urgent action against STI spread

To reduce this alarming figure, WHO recommends making STI testing affordable and accessible, promoting STI screening among those who are sexually active, and setting up screening programs for syphilis and HIV in all pregnant women.

Wi opposes recent budget cuts that affect STI testing and control in many countries, calling on policymakers to increase the spending on sexual health instead.

WHO research on STIs is based mostly on figures from women, and prevalence data is limited. It is trying to improve global and national data collection and surveillance. Prevention efforts, better health care for those with STIs, point-of-care diagnostic kits, improved treatment strategies, and vaccine development are among the target areas.

The report was published on June 6, 2019, in the Bulletin of the World Health Organization.