The increasing prevalence of gonorrhoea and syphilis in the European Union (EU) and the European Economic Area (EEA) from 2022 to 2023 presents a significant public health challenge, necessitating urgent and comprehensive prevention measures.
According to the European Centre for Disease Prevention and Control (ECDC), gonorrhoea cases surged by 321%, syphilis by 100%, and chlamydia by 13% between 2014 and 2023. Notably, 58% of gonorrhoea and 72% of syphilis cases in 2023 were reported among men who have sex with men (MSM). This may be attributed to the increased frequency of unprotected sex and the widespread use of pre-exposure prophylaxis (PrEP). Researcher Ottilia Mord from the ECDC highlights that “[MSM are overrepresented in all three bacterial STIs, with an increase in cases reported among HIV-negative MSM—potentially HIV PrEP users who are being tested more frequently, but also reflecting increased transmission].”
Beyond MSM, other high-risk groups include transgender individuals, migrants, and young heterosexual women. The highest incidence of gonorrhoea and chlamydia was observed in individuals aged 20-24, while syphilis was most frequently diagnosed in men aged 25-34. Although men continue to account for the majority of syphilis cases, there was a 20% rise in infections among women in 2023, raising concerns about potential reproductive health complications.
Several factors have contributed to the resurgence of bacterial sexually transmitted infections (STIs). Maria Wessman, Head of Sexually Transmitted Infections at Denmark’s Statens Serum Institute, links this trend to changing perceptions of HIV/AIDS. She states that “[in the late 1990s and early 2000s, there was almost no gonorrhoea and syphilis because people were afraid of HIV and AIDS],” suggesting that advancements in HIV treatment may have led to reduced condom use and increased STI transmission.
The consequences of bacterial STIs are particularly severe for women, as untreated infections can cause pelvic inflammatory disease, infertility, and ectopic pregnancies. Syphilis poses additional risks, including miscarriages, stillbirths, and congenital abnormalities, underscoring the need for timely diagnosis and intervention.
Experts advocate for comprehensive prevention strategies that combine education, condom promotion, and expanded access to STI testing and treatment. Wessman stresses that “[the fact that condoms are an effective way to protect against STIs is widely known, but not practiced],” calling for innovative approaches to encourage safe sexual behavior, particularly among young people.
Early detection, partner notification, and antibiotic resistance management are critical components of STI control efforts. Mord emphasises that effective treatment strategies must accompany prevention efforts to reduce infection rates. A multifaceted public health response integrating education, medical intervention, and social support is essential to curbing the STI epidemic in Europe.
