New report flags major global increase in sexually transmitted infections, amidst challenges in HIV, hepatitis

Global HIV, viral hepatitis epidemics and sexually transmitted infections (STIs) continue to pose significant public health challenges, causing 2.5 million deaths each year, according to a new WHO report, "Implementing the global health sector strategies on HIV, viral hepatitis and sexually transmitted infections, 2022–2030."

New data show that STIs are increasing in many regions. In 2022, WHO Member States set out an ambitious target of reducing the annual number of adult syphilis infections by 10-fold by 2030, from 7.1 million to 0.71 million. Yet, new syphilis cases among adults aged 15–49 years increased by over 1 million in 2022, reaching 8 million. The highest increases occurred in the Region for the Americas and the African Region.

Combined with insufficient decline seen in the reduction of new HIV and viral hepatitis infections, the report flags threats to the attainment of the related targets of the Sustainable Development Goals (SDGs) by 2030.

"The rising incidence of syphilis raises major concerns," said WHO Director-General Dr. Tedros Adhanom Ghebreyesus. "Fortunately, there has been important progress on a number of other fronts including in accelerating access to critical health commodities including diagnostics and treatment.

"We have the tools required to end these epidemics as public health threats by 2030, but we now need to ensure that, in the context of an increasingly complex world, countries do all they can to achieve the ambitious targets they set themselves."

Increasing incidence of sexually transmitted infections

Four curable STIs—syphilis (Treponema pallidum), gonorrhea (Neisseria gonorrhoeae), chlamydia (Chlamydia trachomatis), and trichomoniasis (Trichomonas vaginalis)—account for more than 1 million infections daily. The report notes a surge in adult and maternal syphilis (1.1 million) and associated congenital syphilis (523 cases per 100,000 live births per year) during the COVID-19 pandemic. In 2022, there were 230,000 syphilis-related deaths.

New data also show an increase in multi-resistant gonorrhea. As of 2023, out of 87 countries where enhanced gonorrhea antimicrobial resistance surveillance was conducted, nine countries reported elevated levels (from 5% to 40%) of resistance to ceftriaxone, the last line treatment for gonorrhea. WHO is monitoring the situation and has updated its recommended treatment to reduce the spread of this multi-resistant gonorrhea strain.

In 2022, about 1.2 million new hepatitis B cases and nearly 1 million new hepatitis C cases were recorded. The estimated number of deaths from viral hepatitis rose from 1.1 million in 2019 to 1.3 million in 2022 despite effective prevention, diagnosis, and treatment tools.

New HIV infections only reduced from 1.5 million in 2020 to 1.3 million in 2022. Five key population groups—men who have sex with men, people who inject drugs, sex workers, transgender individuals, and individuals in prisons and other closed settings—still experience significantly higher HIV prevalence rates than the general population.

An estimated 55% of new HIV infections occur among these populations and their partners. HIV-related deaths continue to be high. In 2022, there were 630,000 HIV related deaths, 13% of these occurring in children under the age of 15 years.

Gains in expanding service access

Efforts by countries and partners to expand STIs, HIV and hepatitis services are bringing formidable gains. WHO has validated 19 countries for eliminating mother-to-child transmission of HIV and/or syphilis, reflecting investments in testing and treatment coverage for these diseases among pregnant women.

Botswana and Namibia are on the path to eliminating HIV, with Namibia being the first country to submit a dossier to be evaluated for the triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis.

Globally, HIV treatment coverage reached 76%, with 93% of people receiving treatment achieving suppressed viral loads. Efforts to increase HPV vaccination and screening for women with HIV are ongoing. Diagnosis and treatment coverage for hepatitis B and C have seen slight improvements globally.

Sustainability planning across the three disease areas needed

The report outlines the following recommendations for countries to strengthen shared approaches towards achieving the targets:

• implement policy and financing dialogues to develop cross-cutting investment cases and national-level sustainability plans;
• further consolidate and align disease-specific guidance, plans, and implementation support within a primary health care approach;
• accelerate efforts to address ongoing criminalization, stigma, and discrimination within health settings, particularly against populations most affected by HIV, viral hepatitis, and STIs;
• expand multi-disease elimination approaches and packages, drawing from lessons learned from the triple elimination of mother-to-child transmission and
• strengthen the focus on primary prevention, diagnosis and treatment across the diseases to raise awareness, especially for hepatitis and STIs.

While the ambitious targets set by member states for 2025 and 2030 are helping to drive progress—the progress is patchy across disease areas. With many indicators remaining off-track to achieve global targets, more political will and commitment are to urgently accelerate the efforts.