MANILA — The World Health Organization is calling for more attention and investment in the development of point-of-care diagnostics for sexually transmitted infections as new data reveals there was no “substantial decline” since 2012.
In 2016, the latest data available published by WHO, research showed there were 376 million new cases, including 127 million new cases of chlamydia, 87 million for gonorrhea, 6.3 million for syphilis, and 156 million for trichomoniasis. These show an increase in the number of cases for all four curable STIs compared to 2012, when new cases of chlamydia were estimated at 131 million, gonorrhea 78 million, syphilis 5.6 million, and trichomoniasis 143 million for both men and women aged 15-49 years old.
“We need point-of-care tests that are cheap, affordable, and available. Additionally, we need more data to make a case for STIs.”— Teodora Wi, medical officer for STIs, WHO
Cases vary among WHO regions and between men and women. Chlamydia is highest in the Western Pacific region for both men and women, but slightly higher among men (21 million) than women (18.1 million). Gonorrhea is highest among women in the African region (9.8 million), and highest among men in Western Pacific (13.7 million). Syphilis meanwhile is highest for both men and women in the Americas, with over 1 million cases each.
Women often have more persistent infections than men due to the physiology of the female genital tract, said Dr. Melanie Taylor, study author and sexually transmitted infections expert at WHO during a virtual press briefing Thursday.
“The vaginal canal can serve as a reservoir for ... persistent infection, whereas in the male physiology, it’s not a hospitable environment for these organisms to live,” she said.
When categorized according to SDG regions, the research highlights the high incidence and prevalence rates of all four infections among men and women in Oceania, excluding Australia and New Zealand.
This shows the significant need for infection control in small island states alone. In the WHO region categories, the incidence rate for small island states are lumped with China under Western Pacific.
WHO experts attribute the large number of cases to complacency, lack of awareness, tools for testing, and access to services.
Most STIs are asymptomatic — most of those who have them aren’t aware and don’t go for testing and treatment. This creates the opportunity for transmission to sexual partners, or from infected mothers to their unborn infants, leading to stillbirth or neonatal deaths. Syphilis alone causes over 200,000 neonatal deaths and stillbirths annually, making it the second leading cause of infectious stillbirth globally, after malaria, WHO’s Taylor said.
“Most patients do not have symptoms when they become infected. They don’t realize they are infected and they transmit the infections to their partners and unfortunately, women may transmit these to their infants unknowingly. So we do consider it a hidden epidemic, a silent epidemic, a dangerous epidemic, that is persistent globally,” she said.
Access to screening is also not widely available in low-income countries, with point-of-care tests “still unavailable” in these countries, according to Taylor.
“We need more services for sexual and reproductive health services, and I think a cutback on some of these support [mechanisms] … not only in the U.S. but also all over the world, is already affecting some of the issues regarding STI services,” said Teodora Wi, WHO medical officer for sexually transmitted infections, responding to a question on the “global gag rule,” or Mexico City Policy.
In addition, more adolescents might be engaged in unprotected sex.
In the 1980s, at the height of the HIV epidemic, sex education was “very intense,” said Wi. But with the availability of treatment for HIV, people seem to become more complacent about protection.
Antimicrobial resistance is also a problem. WHO has been seeing “very high rates” of resistance to quinolone in treating gonorrhea, as well as emerging resistance to azithromycin. The U.N. agency is also seeing resistance emerging to ceftriaxone, Wi said.
The WHO expert called on different stakeholders to play their part in addressing the problem of STIs. She urged policymakers not to cut budgets for STI services, and researchers and experts to find “better ways” to prevent, diagnose, screen, and treat STIs.
“We need point-of-care tests that are cheap, affordable, and available. Additionally, we need more data to make a case for STIs. We still have very limited data at the moment,” she said.
WHO is currently developing a product profile and on public consultation with manufacturers to look into point-of-care diagnostics for STIs, similar to a dip test or pregnancy test that costs $1 or $2, she said.
Health care providers, meanwhile, should treat STIs like any infection and not be a source of stigma for patients seeking help.
“Sex is part of our lives. Sadly, so are sexually transmitted infections,” she said. “We cannot sweep them under the carpet and pretend that they do not exist.”