A new monitoring report from the European Centre for Disease Prevention and Control (ECDC) has found that most EU and European Economic Area (EEA) countries are ill-prepared to respond effectively to rising sexually transmitted infections (STIs), with major gaps in prevention, testing, treatment, and surveillance. It added that many national strategies are outdated, key data are missing, and progress toward 2025 STI targets is being undermined by uneven access to services and inconsistent policies across Europe.

Drawing on responses from 29 of 30 EU/EEA countries to the first ECDC online STI monitoring questionnaire conducted in 2024, the report found that although most countries do have national STI strategies, many are no longer fit-for-purpose and cannot adequately address rapidly changing behavioral and epidemiologic trends.

The report revealed that notification rates for gonorrhea rose nearly 300% between 2014 and 2023 among gay, bisexual, and other men who have sex with men (MSM), with recent surges also seen among young women. Syphilis notifications also increased by 90% and chlamydia by 180%.

The ECDC noted that while increased testing may partly explain these trends, reduced condom use and higher numbers of sexual partners are also likely contributing factors. A World Health Organization (WHO) report released last year found that condom use was declining among younger age groups: among 15-year-olds who reported being sexually active, 30% did not use contraception.

The ECDC report also raised concerns about antimicrobial resistance in Neisseria gonorrhoeae and noted the spread of extensively drug-resistant Shigella among MSM, prompting the organization to urge immediate action to contain drug-resistant strains.

Lina Nerlander, MBBS, PhD, ECDC principal expert on sexually transmitted infections, told Medscape News Europe that it is essential for clinicians to follow local guidelines for offering vaccination, testing, and treatment. Clinicians are a key source of accurate information on sexual health and should ask questions in ways that signal openness to discussion, while providing information and counseling when STIs are suspected or prevention measures are needed.

She also urged clinicians to report detected cases promptly to public health authorities, providing as complete information as possible. Reporting data on factors such as the likely route of transmission gives public health authorities critical insight for planning and targeting interventions.

Clinicians can further contribute by working together to highlight gaps in prevention and care for specific populations and by collaborating with public health authorities to address those gaps, Nerlander said.

Gaps in National Responses and Data

The WHO European Regional Action Plan 2022-2030 had set interim STI targets for 2025. But the ECDC said that “critical gaps in testing and prevention policies” remain.

STIs continue to be a major public health challenge. Left untreated, they can lead to “long-term irreversible and potentially fatal outcomes,” including chronic pelvic pain, cancers, ectopic pregnancy, infertility, adverse pregnancy outcomes, neonatal death, and congenital abnormalities. Some STIs also increase the risk for HIV infection. Because many STIs remain asymptomatic for long periods, silent transmission can occur both sexually and during pregnancy.

The ECDC said interpretation of national notification data is complicated by wide variation in testing policies, access to services, populations screened, approaches to asymptomatic testing, and diagnostic technologies. These limitations are compounded by scarce data on symptoms at the time of diagnosis.

Although the current STI monitoring system was developed last year to align with the WHO Global Health Sector Strategy, only 10 countries have updated their national STI plans in the past 5 years. As a result, many national strategies are lagging behind prevention needs, while access to treatment remains uneven.

Nerlander said “the monitoring system itself works to measure the presence of different policies and the extent of implementation of various public health interventions in EU/EEA counties.” However, “gaps in data availability for many measures” make it difficult to assess how effectively interventions are being implemented.

Only four countries, for example, were able to report data on the proportion of pregnant women tested for syphilis. This represents “a critical knowledge gap,” Nerlander said, while “rates of congenital syphilis are rising.”

Call for Broader Collaboration

Beyond improving surveillance and prevention programs, the ECDC recommends stronger collaboration among public health authorities, laboratories, clinical bodies, and civil society and community-based organizations.

Nerlander said the level of collaboration varies widely across countries. Some, such as Ireland, have standing working groups that bring together public health authorities and civil society organizations on an ongoing basis, supporting both prevention efforts and coordinated outbreak responses.

She added that the ECDC’s experience with HIV has shown that simply convening representatives from public health authorities and clinical societies at the national level to share data and coordinate efforts “can be highly productive and mutually beneficial.”