The World Health Organization announced new data today on syphilis, gonorrhea, chlamydia, and trichomoniasis. All four infections are sexually transmitted, and all represent threats to global health. It feels strange to be discussing gonorrhea or trichomoniasis in 2015. They are old-fashioned infections that we associate with World War Two and posters against VD. But they remain a threat to human health, and even human life. In combination, they lead to approximately 357 million new infections every year. If you add in infections with the other two major sexually transmitted infections, human papillomavirus and herpes simplex b, there are approximately one million new infections a day.
One million infections a day of almost entirely treatable diseases indicates a major health system failure. There are easy infections to treat, for the moment. A full course of the right antibiotic will take care of syphilis, gonorrhea, chlamydia, and trichomoniasis. Herpes has an antiviral treatment that reduces symptoms and the risk of transmission. This rate of new infection means that people who are infected are not getting the care they need. If they were being promptly treated, patients would be cured or on treatment and at far less risk of infecting others.
The WHO describes the situation as an “urgent need for the public health community to ensure that well-recognized effective interventions for STI prevention, screening, diagnosis, and treatment are made more widely available.” This author prefers disappointing system failure, but the difference is semantic.
These STIs are occasionally fatal, but they are almost always debilitating. They lead to chronic pain, infertility, and disability. They also carry a strong mental health burden from the stigma and shame many people feel when infected with an STI. And, perhaps most ominously, anyone exposed to an STI has also been exposed to HIV. High STI rates can be a warning of HIV HIV rates.
The report mentions drug-resistant gonorrhea as a major threat, but it fails to mention that all four of the mentioned STIs are bacterial. The global increase in resistance to antibiotics won’t just affect syphilis. In fact, CDC has already seen cases of drug-resistant syphilis and chlamydia. Over time, all three of the infections are likely to evolve to be both more virulent and more resistant to antibiotics. There was a time when gonorrhea and syphilis routinely killed people. We could see that time again.
Taken as a whole, the report is ominous. At present, the situation looks bad. High rates of STI transmission harm patients, indicate failure in basic health systems and indicate risky sexual behavior. The future looks worse. Right now, these STIs are painful and disabling. In the future the same infections may well be antibiotic resistant – and deadly.