In a press release published on May 21 this year, the Director General of the World Health Organization, Tedros Adhanom Ghebreyesus wrote: “We have the tools necessary to end these epidemics as public health threats by 2030, but we must now ensure that, in the context of an increasingly complex world, countries do everything they can to achieve the ambitious goals they have set themselves.” Reading it, hardly the word “epidemics” would at first glance be associated with what the Ethiopian Ghebreyesus is referring to. Because it is a term that we immediately connect to the pandemic that began as an epidemic in 2020, because for a few months there has been an emergency dengue, which in Brazil has exceeded four million infections, because we have returned to talking about avian flu or swine fever, and all this seems perfectly consistent with the definition. Instead, what the World Health Organization is warning us about are sexually transmitted diseasesincreasing worldwide. And let’s talk about two and a half million deaths per year and one million and three hundred cases of cancer. A new report entitled tells us this Implementing the global health sector strategies on HIV, viral hepatitis and sexually transmitted infections, 2022–2030which shows that after two years of global efforts to tackle the problem, sexually transmitted infections (STIs) have not decreased, in fact, the exact opposite.
In detail, the four treatable sexually transmitted diseases – syphilis (Treponema pallidum), gonorrhea (Neisseria gonorrhoeae), chlamydia (Chlamydia trachomatis) and trichomoniasis (Trichomonas vaginalis), cause more than 1 million infections every day. In particular, cases of adult and maternal syphilis and associated congenital syphilis have increased in the wake of the COVID-19 pandemic. And multidrug-resistant gonorrhea is on the rise. These pathologies, which from the 1970s to 2000 had shown such a decrease in cases as to be on the verge of disappearing in the West, show in Europe and partly also in Italy, a sudden increase in incidence, especially in large metropolitan cities. These current new emergencies have been attributed to sudden changes in sexual behavior in populations, such as an increasing use of risky sexual practices and an ever decreasing use of condoms, even among individuals with known HIV infection. In recent years there has been a gradual and constant increase in the spread of genital infections Human papillomavirus (HPV)in sexually active girls of age under 25 years the prevalence of HPV is approximately 20%. Genital HPV infections are characterized by clinical manifestations ranging from benign lesions, which in most cases the immune system eliminates within 6/24 months, up to malignant forms such as carcinoma of the uterine cervix, to whose development it contributes significantly. the infection is significant. WHO also emphasized the fact that new HIV and viral hepatitis infections are not declining as fast as would be necessary to achieve the related goals of the 2030 Agenda for Sustainable Development. The report, in fact, is the first in a series of semi-annual updates on progress in the implementation of global health sector strategies on HIV, viral hepatitis and sexually transmitted diseases for the period 2022-2030 collected in a document that outlined a vision, objectives and strategic direction to end AIDS and viral hepatitis and sexually transmitted disease epidemics by 2030. But it is not going that way, and the idea that by 2030 we can define ourselves as beyond the emergency is losing faith.
The report shows, however, some positive data. For example, over 75% of people living with HIV receive antiretroviral therapy, while as many as 93% of those on treatment have suppressed their viral load. Additionally, 19 countries have been officially validated to eliminate mother-to-child transmission of HIV and/or syphilis. Yet the fact remains that new HIV infections declined by only 200,000 (from 1.5 million to 1.3 million) from 2020 to 2022 and remain well above the 2025 target of 370,000 newly infected people. And of the 630,000 HIV-related deaths in 2022, many were due to late treatment and structural barriers to care. In fact, timely treatment is essential. L’Aidsa disease that attacks and debilitates the immune system, is caused by HIV virus: to prevent it from developing as soon as HIV positivity is detected through a specific test, it is necessary to take antiretroviral drugs as soon as possible, which are capable of keeping the HIV infection under control. It would be a mistake to believe that these numbers mostly concern the countries of the sub-Saharan region, by far the most affected by the HIV virus, with 67% of all people affected by HIV and 75% of deaths in the world from AIDS. Here too, on 1 December 2023, World AIDS Day, the picture that emerged from the update of the national surveillance of new diagnoses of HIV infection and AIDS cases, managed by the Istituto Superiore di Sanità, is that these they started to rise again. In 2022 there were 1,888, equal to 2% more than in 2021 and 34% more than in 2020. It is the second consecutive increase after more than a decade of decline. But this trend should not be taken as the only spurious data, but inserted in the context of the last, very troubled, years inhabited half by the pandemic emergency. An emergency that caused a general decrease in diagnoses: simply, with hospitals collapsing and the risk of contagion, we monitored ourselves less, we skipped visits dedicated to prevention, and screening for a disease that carries with it a stigma that he never really left. Yet the quality of life of those living with HIV is a fundamental issue to be addressed at 360° which must be framed within a broader path, from the diagnosis of HIV to awareness, from the actions necessary to combat the virus to the reactions that include awareness to better deal with relationships with others, with the doctor and even with oneself. The issues of early diagnosis, adherence to therapy and the fight against stigma then become priorities, which today appear weakened again, perhaps due to the mistaken belief that it is a disease somehow “from the past”, limited to a specific historical period, that of the boom between the 80s and 90s.
New data also indicates an increase in multidrug-resistant gonorrhea. In 2023, WHO reported that of 87 countries with enhanced antimicrobial resistance surveillance of gonorrhea, nine showed high levels of resistance to ceftriaxone, the last line of treatment. Furthermore, among the concerns highlighted in the report is the increasing mortality due to viral hepatitis. Hepatitis B and C combined caused 1.3 million deaths in 2022, a number close to the number of deaths caused by tuberculosis (the world’s second deadliest infectious disease) and up from 1.1 million in 2021. Hepatitis B can be transmitted through sexual activity, while hepatitis C It is spread mainly through needle sharing for drug use. WHO also highlighted the global increase in syphilis cases, led by increases in the African region and the Americas region. There syphiliscaused by a bacterium (Treponema pallidum), is a very serious disease: it develops at different times and for this reason it is necessary to intervene promptly. In fact, if left untreated, it can lead to serious complications (heart disease, dementia, blindness, paralysis and even death). The number of new cases in adults aged 15 to 49 increased from 7.1 million in 2020 to 8 million in 2022, while cases of congenital syphilis (mother-to-child transmission) increased from 425 per 100,000 births live per year in 2020 to 523 in 2022. The gonorrhea or the syphilis, have short incubation times so, if recognized early, they can be treated promptly. This is a very important factor, because it reduces the patient’s infectivity and limits infections. However, many of these infections are recurrent and tend to reappear in the same subject or, especially those that are asymptomatic or manifest with unclear symptoms, often fail to be diagnosed or are mistaken for other diseases, resulting in easy spread. The goals set by WHO for 2025 are 5.7 million new cases of syphilis and fewer than 200 cases of congenital syphilis per 100,000 live births. Overall, there were 374 million new cases of the four treatable STDs in 2022. A 20% reduction in all four infections will be needed to meet the 2025 targets, the WHO said. Meeting the 2030 targets would require reductions of 60%. No mean feat.
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