Sexually transmitted infections on the rise since 2020

Public Health France has just made public a survey on the monitoring of STIs in mainland France, and its results may seem worrying. Since 2020, the number of cases of the three STIs studied (chlamydia, gonorrhea and syphilis) has skyrocketed across the entire territory, according to this survey coordinated by the Sentinelles network of general practitioners. And these figures most certainly underestimate the real incidence, underlines Douada Niaré, main author of the survey. “The analyzes focused on cases declared voluntarily by doctors in the Sentinel network between 2020 and 2022, which excludes all those not declared and of course people who have never been tested.” Nevertheless, experts want to be reassuring: the increase in incidence most likely reflects an intensification of screening activity in recent years.

In France, the number of chlamydia infections jumped by 16% between 2020 and 2022. Representing a little more than half of cases, women are the most affected. However, regardless of sex, the infection mainly concerns young people aged 15 to 25: 21% of cases among men were declared in this age group, 33% for women.

The upward trend was even more marked for the two other STIs which exploded between 2020 and 2022: 91% for gonorrhea and 110% for syphilis. For these two infections, men were on the front line. They represented 77.7% of gonorrhea cases; 22% of patients were between 15 and 25 years old and 20% between 30 and 39 years old. Regarding syphilis, men account for 90% of cases, including 22.5% among those aged 50 and over.

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Experts explain these resurgences primarily by the Covid-19 pandemic. If successive confinements have limited the possibility of meeting unknown partners, it seems that they have also slowed down screening activity. “Certain centers having closed during this period, this could have caused delays in diagnosis, a greater circulation of STIs and therefore an increase in their incidence,” explains Pascal Pugliese, president of the French Society for the Fight against AIDS (SFLS) .

The largest increase, according to this survey, was observed among men who have sex with men (MSM). The proportion of chlamydia infections involving MSM doubled between 2020 and 2022, going from 6.9% to 18.4% of total cases. The same goes for gonococcal infections: 28% affected MSM in 2020, compared to 54% in 2022. Syphilis is a little different: three quarters of cases were declared following relationships between men, regardless of the year of monitoring.

However, specialists point out, the surge in STIs is nothing new. It has been observed in France for several years, according to surveillance data from the National Health Data System (SNDS), and could be partly explained by an increase in screening activity. Excluding the Covid-19 bracket, surveys show that this activity doubled between 2014 and 2022 for the search for chlamydia and gonococci. “The dynamic is therefore not necessarily worrying because the increase in screening and diagnostics allows early treatment and control of their spread, which is good news,” reassures Dr. Pugliese.

This would also be explained by the recommendations of the health authorities which have allowed, since 2021, general practitioners to initiate and monitor Prep users in community medicine. “Prep, which is preventive HIV treatment intended for HIV-negative people at high risk, is accompanied by quarterly screening for other STIs. The increase in diagnoses can therefore also be linked to greater monitoring of Prep users,” explains Pascal Pugliese.

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On the other hand, experts are concerned about the insufficient use of condoms. “I too often see young people in relationships for 2 or 3 months who have already had unprotected sex without being screened,” says Professor Nicolas Dupin, dermatologist in charge of the sexual health center at Hôtel-Dieu ( AP-HP) in Paris.

Consequently, deplores the doctor, it is the symptomatology which leads to consultation. And although most STIs are curable with appropriate treatment, they can have serious consequences in people at risk. “I've seen patients who start, for example, syphilis with a stroke. This infection can also lead to fetal death in utero or other sometimes severe sequelae when it occurs in pregnant women,” warns Dr Dupin.

Specialists remind us of the importance of not trivializing “basic” actions: wearing a condom, repeated screening for STIs before committing to a new partner, implementing preventive treatment of Prep for people exposed to HIV, vaccination prevention for papillomavirus (HPV) infections and hepatitis B. “When possible, it is imperative to inform one's partner(s) in the event of diagnosis to break the chains of transmission on the one hand, and not to not be reinfected with the same partner who has not been screened or possibly treated,” adds Dr. Pugliese.