2 Jun 2020

Sexually transmitted infections (STIs) are on the increase: NEJM review

A/Prof Marcus Chen
Prof Deborah Williams
Professor Deborah Williamson (Doherty Institute) and Adjunct Associate Professor Marcus Chen (Melbourne Sexual Health Centre) are authors on a New England Journal of Medicine review article providing an overview of how both established and emerging sexually transmitted infections (STIs) are on the increase, and their recommendations for controlling the spread of STIs.

Quoting from their conclusion, "Rates of established STIs in many countries are approaching levels not seen since the 1970s, with concerns about public health priorities such as increasing antimicrobial resistance in N. gonorrhoeae and the rising incidence of congenital syphilis. New or reemerging sexually transmissible pathogens with potentially serious morbidity present additional challenges to public health control, health services, and community responses.

'The incidence of these STIs will probably continue to increase as a result of enhanced human interconnectedness due to growth in international travel, in online social networking, and in numbers of people taking preexposure prophylaxis. Timely testing and treatment have been critical for the control of STIs, and this applies equally to newer sexually transmissible pathogens."

They recommend:
  • Access to health care and clinical services for at-risk individuals and groups, particularly for mobile, vulnerable, and marginalized populations. These services will require adequate resources and funding. 
  • dedicated, multimodal public health responses that include health promotion and biomedical prevention (e.g., development and use of effective vaccines). 
  • Robust surveillance systems that include laboratory culture of pathogens to identify new outbreaks and evaluate the effectiveness of interventions.
They believe that "The incorporation of genomic technologies into STI surveillance offers great promise in defining transmission networks, including those caused by antimicrobial-resistant pathogens, and may allow improved targeting of public health interventions. Experience from the global response to HIV infection suggests that adequate control of STIs can be achieved only through genuine partnerships among governments, nongovernmental organizations, and the private sector, together with community participation and engagement."

Williamson DA, Chen MY. Emerging and Reemerging Sexually Transmitted Infections. N Engl J Med. 2020 May 21;382(21):2023-2032. doi: 10.1056/NEJMra1907194. Review.  PMID: 32433838

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