Common STIs surge among young people

Over the past three years, cases of gonorrhoea have risen by 45% and chlamydia by 24%.
 
These figures, based on comparable data, are pulled from the latest National Notifiable Diseases Surveillance System (NNDSS) report, which analyses the various diseases of public health concern in Australia, including sexually transmitted infections (STIs).
 
When comparing the first three quarters of each year across 2021–23, there were 82,559 chlamydia cases reported in 2023, compared to 66,814 cases in 2021, translating to a 24% increase.
 
Gonorrhoea cases also spiked by 45% across the three-year period – in 2023, there were 30,112 confirmed cases, compared to 20,699 in 2021.
 
Notably, these rates of infection are highest among young people aged 15–29.
 
So far in 2023, people in this age cohort account for 67% of all chlamydia infections and 50% of all gonorrhoea infections.
 
Dr Sara Whitburn, Chair of RACGP Specific Interests Sexual Health Medicine, believes there are many reasons behind these increases, reduced screening during the pandemic played a major role.
 
‘Numbers appeared lower during COVID-19 as people were socially distancing but also were not able to access testing,’ she told newsGP.
 
‘Now, both sexual encounters but also tests are increasing leading to increased numbers of STIs, [and] asymptomatic transmission is likely to be a factor for the increased numbers.’
 
However, Dr Whitburn says asymptomatic testing is ‘still not high enough’ due to people not getting back into regular screening post-pandemic, as well as known barriers to testing including cost, availability, and embarrassment of getting a test.
 
Condom use is also declining among young people. A recent La Trobe University national sexual health survey of Australian secondary students found condom use in young people has decreased from 59% in 1992 to 49% in 2021, while across that same time period, the number of year 12 students who reported being sexually active increased from 49% to 69%.
 
Dr Whitburn notes that condom use has also decreased among people who are using pre-exposure prophylaxis (PrEP) to decrease their risk of HIV.
 
Meanwhile, the latest NNDSS data also reveals that for the entirety of 2023 to date, there have been 93,122 chlamydia cases reported, compared to a total of 87,368 cases across all four quarters of 2021. Confirmed gonorrhoea cases are 34,079 for the entirety of this year to date, compared to 26,599 across all four quarters of 2021.
 
Associate Professor Caitlin Keighley is a microbiologist, infectious diseases physician and Pathology Awareness Australia ambassador. Adding to Dr Whitburn’s interpretation, she told newsGP the recent increase in these STIs is a result of the pandemic’s widespread impact.
 
‘The primary reasons for the recent rise in chlamydia and gonorrhoea infections are likely due to less people visiting their GP during the pandemic, along with the challenges that sexual health education faced when being delivered in an online setting, as opposed to face-to-face, when young people were schooled remotely,’ she said.
 
Given both of the highly transmissible STIs can have long-term adverse outcomes if left undiagnosed, Associate Professor Keighley highlights their rise in cases as an important public health issue, and one that GPs play a central role in addressing through encouraging regular STI testing and practising safe sex.
 
‘A rise in STIs in the general population, in this case gonorrhoea and chlamydia, places greater importance on the role of GPs in providing diagnosis, treatment, prevention, and education to all patients,’ she said.
 
‘GPs can help by being proactive in addressing STIs, promoting safe practices, and collaborating with other healthcare professionals to stop the spread of these infections.’
 
Dr Whitburn also points out GPs should be alert to the rising rates of syphilis in parts of Australia, and that asymptomatic screening should include chlamydia, gonorrhoea, HIV and syphilis testing.
 
‘GPs need to ask about common STI symptoms regularly and to consider it a differential when people attend for dysuria or any genital symptoms, but also to discuss and offer asymptomatic screening opportunistically,’ she said.
 
‘Offering asymptomatic STI screening when we see young people can be as simple as requesting a urine sample or offering self-taken swabs.
 
‘Another option is to offer STI screening when discussing contraception, cervical screening or during general check-ups.’
 
The Australian STI guidelines are a useful resource for GPs when testing and treating different populations and conditions.
 
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chlamydia gonorrhoea post-pandemic sexual health STIs young people