Increasing trends of gonorrhoea and syphilis and the threat of drug-resistant gonorrhoea in Europe

Abstract

Sexually transmitted infections (STI) notifications have been on the rise in several European countries since the early 2000s, most likely due to multiple factors like increased screening, use of more sensitive diagnostics, improved reporting and also due to high levels of unsafe sexual behaviour among certain subpopulations. Across Europe, 32,000 cases of gonorrhoea, 18,000 cases of syphilis and over 345,000 cases of chlamydia were reported in 2010 [1]. Certain subpopulations appear to be more affected than others: Men who have sex with men (MSM) are disproportionately affected by gonorrhoea and syphilis, and young people between 15 and 24 years of age are affected mainly by chlamydia and gonorrhoea. The increases in gonorrhoea and syphilis reported in this edition of Eurosurveillance are worrying as they are identified in MSM and young adults and seem to be associated with high levels of unsafe sexual behaviour and coinfection with human immunodeficiency virus (HIV). The increases in gonorrhoea are of particular concern as they coincide with decreasing susceptibility of Neisseria gonorrhoeae to currently used antimicrobial drugs in England [2] and across Europe [3]. The increases reported in this edition can be partly explained by increased testing of risk groups. Bremer et al. [4] report that the increase in syphilis diagnoses in Germany could be linked to increased uptake of screening by HIV-negative MSM and incorporation of syphilis testing in the clinical monitoring of HIVpositive MSM. In Sweden, the increase in gonorrhoea seen over the last five years, particularly among young women (who are more often asymptomatic than men) is similarly linked to the increasing use by youth clinics of nucleic acid amplification tests which are more sensitive and test for both chlamydia and gonorrhoea in the same sample [5]. Similarly, increased testing of MSM in the United Kingdom (UK) due to the recent increases in lymphogranuloma venereum (LGV), and new testing guidance is thought to have contributed to the increase in gonorrhoea notification there [6].