In 1999 the incidence of syphilis in Spain was 1.73 cases per 100,000 inhabitants, according to data from the Ministry of Health and the Ministry of Science. 18 years later, in 2017, the incidence was more than 6 times higher.
With gonorrhea (or gonococcal infection) the increase has been even greater: it went from an incidence of 2.04 in 2001 to a value of 18.74 in 2017. Numerous causes are behind this increase in sexually transmitted infections in Spain and other countries, which mainly affect men between the ages of 20 and 35. We explain it to you.
The attenuation of AIDS and other causes that cause the increase in STIs
The different experts consulted by Maldita Ciencia point out that this increase in sexually transmitted infections (STIs) has a series of interrelated causes behind it. The vice president of the Spanish Federation of Sexology Societies (FESS), Guillermo Gonzalez Anton, explains to Maldita Ciencia that the main cause is a decrease in prevention measures “after a supposed victory against HIV as an exponent of the most serious STI and potential mortality. For Gonzalez Anton, “a generation is partially unaware of what this HIV pandemic was and those who remember it have learned how the treatments have removed it from the casuistry of mortality to turn it into a chronic disease.”
Beyond this cause, Alvaro Vives, head of the Men’s Health Unit at the Dexeus Mujer center in Barcelona, clarifies that this increase has occurred “in all developed countries for the last 20 years” for multiple reasons: the increase in the number of sexual partners, the importation of STIs because “every time people travel more” and the increasingly widespread use of more sensitive diagnostic tests that allow more STIs to be detected.
The andrologist also denounces the lack of a health response by the authorities and the lack of specialized centers “with easy access for the population where not only patients with symptoms are treated, but also offer complete check-ups in asymptomatic people with risk behaviors, because it is precisely this group that is the most difficult to address” to cut the chain of infections.
For her part, the sexologist and sociologist Norma Ageitos of the State Association of Sexology Professionals (AEPS) highlights that there is no commitment to the prevention of STIs and for this she recommends promoting comprehensive sexual education, both “in formal educational spaces and informal, that has all the groups involved, that begins as soon as possible and extends over time and of quality”. Alvaro Vives also points it out: “There is a lack of correct sexual education in schools. It cannot be that sex education classes are based on how to put on a condom and instead nothing about STIs is explained to them”. The sexologist points out that it is not taught that oral sex is today one of the fundamental routes of transmission of numerous STIs and partly because of this “nobody puts on a condom for oral sex.”
Men between the ages of 20 and 35 are those who have more STIs
But this growing incidence of STIs is not distributed equally among all age and sex groups: it is men between 20 and 35 years of age who have the highest incidence of syphilis and gonorrhea in Spain in 2017. Behind these data there are also several factors that explain it.
“There is a greater tendency to take risks, especially on the part of men and this is even read socially as a manifestation of their courage, which is equated to one’s own manhood” and “it is more common to have more erotic partners in youth“, highlights Ageitos. Guillermo Gonzalez Anton agrees that there is a “secular tradition of ‘risky men’” and adds that men tend to have a greater number of sexual partners and that “the number of men who have relationships with men (MSM) who belittle the potential to transmit and/or acquire an STI”.
Alvaro Vives has an impact on this, who indicates that STIs are increasing in all groups but especially in the group of men who have relationships with men because they are a group that is “generally sexually very active and have more risky sexual practices such as anal sex . and anonymous oral sex. The appearance of pre-exposure prophylaxis (PreP) against HIV/AIDS, highly effective drugs to prevent HIV infection in people at risk of becoming infected, which “is especially indicated in this group and especially in this age group, means that at be protected against HIV, relax and stop using condoms, so they are more exposed to other STIs”, added Vives.
Norma Ageitos clarifies that “the more we move away both temporally and generationally from what the appearance of HIV/AIDS meant, the more we move away from the later attitude of caution.” The sexologist warns that the latest data is from 2017 and in four years, with a pandemic involved, the trend may have changed.
Vaccines and condoms against STIs
STIs are a serious public health problem, points out Guillermo Gonzalez, and for this he calls for using vaccines against those viral STIs susceptible to immunization such as hepatitis A and B and the human papilloma virus. The expert also points out that, except for hepatitis, passing a sexually transmitted infection “does not leave permanent immunity, so reinfection is possible.” The vice-president of the FESS stresses that “the detection of contacts is important to prevent spread and reinfection” and calls for STI diagnostic tests to be improved and facilitated to prevent them.
Alvaro Vives denounces the serious error that supposes that “many heterosexual couples do not use condoms because the woman uses contraceptives” and advises double contraception: condoms to prevent STIs and other contraceptives to prevent pregnancy.
The consequences of becoming infected with syphilis or gonorrhea
Although HIV/AIDS is the most serious STI and the one that causes the most mortality, other STIs such as syphilis and gonococcal infection must also be taken seriously, which can also cause significant health problems and their lack of symptoms usually facilitates their transmission. . In addition to using a condom during sexual intercourse, it is important to get tested for these STIs and notify recent sexual partners if you test positive.
Syphilis is caused by the Treponema pallidum bacterium and usually does not cause symptoms, but the ulcer that it produces at the site of the infection can go unnoticed and, if not treated correctly, causes serious long-term health problems many years after the infection, such as paralysis, blindness and dementia. It is prevented with a condom and can be transmitted from mother to child during pregnancy, explains the National Plan on AIDS of the Ministry of Health.
The gonococcal infection is caused by the bacterium Neisseria gonorrhoeae and, like syphilis, does not usually cause symptoms but if not treated correctly can lead to long-term health problems such as infertility and pelvic and testicular pain. It is prevented with a condom. The infection can be passed from mother to child during childbirth and cause a serious eye infection in the newborn, clarifies a document from the National AIDS Plan of the Ministry of Health.