Australia joins rest of world in dramatic spike in STIs

There have been dramatic spikes in gonorrhoea and syphilis cases in Australia in the past decade, according to research from a leading STI surveillance group.

In reports released today, the Kirby Institute at UNSW Sydney reports a two-fold increase in gonorrhoea cases and a tripling in syphilis numbers since 2013.

Chlamydia has also risen by 12% at the same time, though Kirby researchers say the disease – which is often symptomless – is likely underreported.

In total, 93,777 Australians were diagnosed with chlamydia last year; 32,877 with gonorrhoea; and 6,036 with syphilis. Among the concerning data published by the Kirby Institute were findings that:

• STIs remain most prevalent in men, accounting for 71% of gonorrhoea and 82% of syphilis diagnoses in 2022, led primarily by increasing positive cases among gay and bisexual men.
• Women are not exempt, with 6 times as many syphilis cases recorded among women in 2022 than in 2013. 
• Aboriginal and Torres Strait Islander peoples are diagnosed with chlamydia twice as frequently as the non-Indigenous population, and five times higher for gonorrhoea and syphilis.

The increasing rate of STIs in Australia isn’t isolated to the last 10 years and has been a consistent trend stretching back many years.

But one COVID trend appears to have continued post-pandemic – the low testing rate. While lockdowns and social restrictions reduced screening for STIs at the time, the end of restrictions hasn’t seen testing uptake for particular diseases return to pre-2020 levels.

For instance, chlamydia testing for people aged 15-24 is at lows similar to a decade ago, rather than its 2019 high point.

The proportion of gay men having comprehensive STI testing has also declined – from more than half of men having an annual test in 2019, to just 42% last year.

Gonorrhoea testing, on the other hand, reached a new high – particularly among men – last year.

Overall however, the Kirby Institute is calling for greater vigilance among sexually active groups.

“There’s genuine concern,” says Dr Skye McGregor, an epidemiologist at the Kirby Institute.

“Australia is not the only place that’s experiencing this, particularly amongst syphilis, we’ve seen dramatic increases across the world.

“Because we’ve seen that persistent reduction in testing on the back of the increases to all of them, we’re concerned, really, about the level of infections, plus what the impacts are.”

McGregor points to healthcare inequities and access as causes of the persistent rise in STI cases, as well as the more recent low rate of testing.

“People in remote settings: it’s hard to get tested and treated in a timely fashion, which has been exacerbated by COVID. It’s hard enough to get an appointment with a healthcare provider that you want in an urban setting, let alone in regional and remote settings.

“It’s important to consider the social determinants of health – so the non-medical factors that impact on health – particularly among Aboriginal and Torres Strait Islander people: income, education, employment, all those sorts of things that potentially a higher priority for people than getting tested for STIs.”

There are some positives in the Kirby Institute’s data.

The human papillomavirus (HPV) vaccine has slashed diagnoses of genital warts in the 15 years since the program was introduced in 2007. Where 10.6% of non-Indigenous women under 21 were testing positive for HPV at the beginning of the program, just 0.2% did in 2022.

And the Kirby Institute says genital ulcer-causing Donovanosis, a once-common infection among Aboriginal and Torres Strait Islander communities caused by the bacterium Klebsiella granulomatis, has likely been eradicated.