This article first appeared at ntv.de
The numbers from the USA are alarming: more than two million people were infected with chlamydia, gonorrhea (also known as gonorrhea) or syphilis in 2022. The US health authority CDC speaks of a real epidemic that is “getting out of control”. Experts are particularly concerned about syphilis. In the last five years alone, cases have increased by 80 percent. A similar trend is also emerging in Germany.
The infection rate in this country is not comparable to the situation in the USA, says Norbert H. Brockmeyer, specialist in skin and sexually transmitted diseases and president of the German STI Society, in an interview with ntv.de. Nevertheless, there has been a significant increase in syphilis cases since the turn of the millennium. “In 2000 we had around 800 infections, today there are more than 8,300,” says the doctor. The number has increased tenfold - and the trend is rising.
Syphilis is caused by the spiral-shaped bacterium Treponema pallidum. In most cases, transmission occurs via sexual contact. During unprotected sexual intercourse, the pathogen can enter the body through small injuries to the mucous membrane/skin, blood or wound fluid. Transmission is also possible via unclean needles or from an infected mother to her unborn child.
Mother-child infections are a major problem, especially in the USA. The CDC recorded more than 3,700 such cases in 2022 - an increase of around 930 percent within a decade. The consequences are fatal: “Tragically, 282 infants died as a result of the infections,” says the current report from the US health authority.
Numbers that fortunately do not exist in Germany. “Our prenatal care is significantly better than that in the USA,” says Brockmeyer. In addition, syphilis in Germany is currently spreading much more strongly in the so-called MSM community, i.e. among men who have sex with men. "However, we are also seeing infections in the heterosexual community."
According to Brockmeyer, the reasons for the increasing number of syphilis cases, but also other sexually transmitted diseases, are varied. On the one hand, the Internet enables quick and varied sexual contacts thanks to dating apps. On the other hand, the increasing use of drugs for sex also plays a role. Whether it's alcohol or synthetic drugs, "they make you looser, your sense of pain and your awareness of risk decreases," says Brockmeyer. Another positive reason for the increase in the number of cases is the increase in testing. “If more people get tested, this leads to more positive results.”
Sexual practice could also be decisive. Anal sex, whether for a man or a woman, carries a higher risk of infection. “The anal mucosa is more vulnerable and small tears occur more easily,” explains the expert. Pathogens could penetrate more easily through these small injuries.
STDs are also tricky because in many cases they cause no or only minor symptoms. According to Brockmeyer, only about every second infection with syphilis causes symptoms. After three to four weeks, an ulcer usually appears at the pathogen's entry point, for example on the penis, anus, vagina or throat. “But these are also often misunderstood,” says the expert. "If the small ulcer disappears after a few weeks, those affected often think everything is fine again and don't get tested."
Sexually transmitted diseases are still a source of shame and taboo in society. According to Brockmeyer, education is particularly important in the fight against syphilis, chlamydia and the like. “We need to talk more about sexuality and sexual health again.” This has already been successful with HIV in Germany. “That’s why we always had the lowest HIV infection rates,” said the doctor. The same effect would have to be achieved for other sexually transmitted diseases. "Absurdly, syphilis or gonorrhea are now perceived as having a greater stigma than HIV." If diagnosed early, the diseases can be treated quickly and effectively with antibiotics.
According to Brockmeyer, schools are particularly in demand for prevention. However, you should under no circumstances rely on deterrence. It is much more important to clarify misunderstandings and myths and to remove taboos from the diseases. "Studies have shown that if young people are well informed, they generally have sexual contacts later and become infected significantly less often."
Condoms offer good protection, although not 100 percent. There are also vaccinations against certain pathogens such as HPV. According to Brockmeyer, these would have to be expanded significantly. The vaccination rates for girls (60 percent) and boys (25 percent) are too low to effectively protect the population.
In addition to condoms and vaccinations, there are specific medications such as Doxy-PrEP. This antibiotic is used to prevent chlamydia or syphilis and can be taken by people at high risk of syphilis or chlamydia infection. Anonymous testing offers such as home tests for HIV or self-collection kits also help - although if you suspect syphilis, you need some blood for diagnosis.
“However, it is crucial that people are made aware,” says Brockmeyer. "We have to break down the taboos and, above all, the discrimination surrounding the topic." This is the only way to ensure that people who suspect they have an STI get tested and treated immediately in order to prevent the pathogen from spreading further.