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Cases of gonorrhea and syphilis skyrocketed between 2022 and 2023 in European Union/European Economic Association countries, reported the European Centre for Disease Prevention and Control (ECDC) in its latest Annual Epidemiological Reports on sexually transmitted infections (STIs).

Between 2014 and 2023, the ECDC reported a 321% increase in cases of gonorrhea, a 100% increase in syphilis, and a 13% increase in chlamydia.

The organization also noted that men who have sex with men (MSM) accounted for 58% and 72% reported cases of gonorrhea and syphilis, respectively, in 2023, as well as 20% of chlamydia cases.

“MSM are overrepresented in all three bacterial STIs, with an upsurge in cases reported among MSM with negative HIV status — potentially HIV PrEP users who undergo more frequent testing, but also reflecting increased transmission,” Ottilia Mårdh, ECDC scientific officer for STIs told Medscape Medical News.

“ECDC has very limited data; however, there are indications that transgender people and migrant MSM are at increased risk,” she added.

Heterosexual men and women also saw increased rates of STIs, with women aged between 20 and 24 years having particularly high rates of gonorrhea and chlamydia. The highest rates of syphilis were seen in men aged 25-34 years. Men were seven times more likely to be diagnosed with the infection than women.

Although more men were affected by syphilis than women, women saw a higher increase in rates of syphilis: 20% between 2022 and 2023, compared with 12% during the same period for men. The ECDC further reported an increase in congenital syphilis, with 78 confirmed cases in 2023.

Why the Increase?

Mårdh noted that reasons behind the sharp increase in STIs may vary across countries and population groups. Factors such as unprotected intercourse, a higher number of intimate partners, use of dating apps, and changes in “networks of intimacy” may contribute to the higher rates, she said.

Changes in testing practice with enhanced case detection may also play a role, alongside the emergence of more transmissible and less symptomatic strains of gonorrhea. But such a hypothesis “needs further confirmation through genome sequencing,” noted Mårdh.

Medscape Medical News also spoke with Maria Wessman, MD, PhD, head of bloodborne and infections and STIs at Statens Serum Institute in Copenhagen, Denmark. She said that people “no longer being afraid of HIV/AIDS” may further contribute to Europe’s rising rate of STIs.

“Gonorrhea and syphilis were almost nonexistent during the late 1990s and early 2000s, as people were afraid of HIV and AIDS. Since then, we have seen a steady increase in gonorrhea and syphilis, especially during recent years, most likely because people are no longer afraid of HIV/AIDS and therefore [no longer take protective measures],” she said.

Recent medical advances ensure that patients with HIV/AIDS who are well treated do not transmit the virus and experience few side effects. These advances have diminished fear of HIV/AIDS, Wessman added.

“People living with HIV now live lives that are comparable to those of the background population, including in length,” she said.

Women

“The largest increases [of STIs] have been seen among young heterosexual individuals, especially young women,” noted Wessman. 

When asked why this may be, she said that young women are more likely to visit general practitioners and get tested than male counterparts and that bacteria may be better at “getting stuck” in women’s mucosal genital tissues. 

In a 2024 report, the European Commission described increasing rates of bacterial STIs among women as “particularly concerning.” The organization noted that untreated gonorrhea and chlamydia infections can increase risk for pelvic inflammatory disease and thus ectopic pregnancy, chronic pelvic pain, and tubal factor infertility.

It further noted that syphilis is linked to adverse fetal and neonatal outcomes such as miscarriage, fetal death, and abnormalities in newborns. 

What to Do

Mårdh recommended that countries develop national strategies for STI prevention based on high-quality STI epidemiology data. The strategies should address the main drivers of transmission and target vulnerable populations, she said.

She also recommended national interventions such as sexual health education, safe sex campaigns, condom promotion, and ensuring accessible testing, treatment, and sexual health care.

“The fact that condoms are an efficient way of protecting oneself against STIs is widely known but not practiced. By trying to be innovative in campaigning, by addressing young people directly instead of patronizing them, it's possible to reintroduce [condoms] as a protective choice,” said Wessman.

Mårdh added that more should be done to promote services that are stigma- and discrimination-free. A goal should be to ensure a comprehensive approach that includes risk reduction counseling, recommended vaccinations, integrated testing, and linkage to other care services (like HIV care and viral hepatitis C treatment) if needed.

“Clinicians should follow evidence-based treatment guidelines and employ effective partner notification strategies. Also, ensure people return for test-of-cure for gonorrhea and that antibiotic susceptibility testing is carried out,” she concluded. 

Annie Lennon is a medical journalist. Her writing appears on Medscape Medical News, Medical News Today, and Psych Central, among other outlets.