Australians are being urged to get regular tests for sexually transmitted infections (STIs) after a significant rise in cases across the country, including an almost 20% increase in New South Wales gonorrhoea cases between 2022 and 2023.
The Royal College of Pathologists (RCPA) issued a warning on Wednesday of a concerning rise in cases of gonorrhoea, syphilis and HIV nationally. The RCPA is the lead body for pathologists who are specialist doctors trained in laboratory techniques used to test for disease.
Dr Christine Selvey, NSW Health’s director of its communicable diseases branch, sent a letter in June warning general practitioners that gonorrhoea cases in the state had increased by almost 20% from 2022 to 2023, and were rising even further this year.
Selvey said a particular concern was that cases resistant to first-line antibiotic treatments azithromycin or ceftriaxone were “increasing rapidly”.
Gonorrhoea cases were diagnosed in heterosexual males and females, sex workers, and men who have sex with men, across a broad age range, Selvey wrote.
The RCPA said the increasing number of gonorrhoea cases with antibiotic-resistant infections “complicates treatment protocols and highlights the urgent the need for regular STI testing”.
Alongside gonorrhoea, RCPA warned that “syphilis rates have also surged, particularly congenital syphilis, where the infection is transmitted to unborn children”.
Associate Prof Caitlin Keighley, a spokesperson for RCPA and medical director of Southern IML Pathology, said: “In 2014 there were two cases of congenital syphilis – last year there were 20.”
The college said the rise in cases could be attributed to changing sexual practices, including reduced use of condoms across a range of demographics.
That reduced use could be due to a range of factors, including a decreased concern about infection, Keighley said.
The perception that HIV was no longer as common was true but there were ongoing cases, and while people taking the prophylaxis tablet prep were protected against HIV, Keighley stressed: “It doesn’t protect against other infections.”
Keighley also raised the issue of students who missed out on sexual education during the pandemic, as well as some people having an aversion to condoms because of a perceived difference in comfort.
The Kirby Institute’s latest annual surveillance report of sexually transmissible infections in Australia shows diagnoses of gonorrhoea have doubled from 2013 to 2022, while cases of syphilis have tripled.
Keighley said: “Despite a concerning rise in cases, we are not seeing a corresponding increase in testing rates.
“This includes older adults who may not be forthcoming about changes in their sexual practices.
“Low testing levels mean that infections can go undiagnosed and untreated, leading to severe health complications and further transmission,” Keighley said.
“This leaves many individuals unknowingly at risk and is particularly concerning for pregnant women, where untreated STIs can result in congenital infections with devastating outcomes.
“Regular testing is crucial to early detection, effective treatment and preventing the spread of these infections.”
RCPA highlighted that Aboriginal people and Torres Strait Islanders faced substantially higher rates of STIs compared with non-Indigenous Australians. For example, chlamydia diagnoses among Aboriginal people and Torres Strait Islanders were twice as common as in non-Indigenous individuals, while for gonorrhoea and syphilis, the prevalence was more than five times higher, the college said.
It said these figures highlighted the critical need for culturally sensitive health promotion, testing and treatment initiatives.
The latest Kirby report found there had been a decline in the number of Medicare-rebated tests for chlamydia and gonorrhoea among both men and women between 2019 and 2022, likely due to the ongoing impacts of the Covid-19 pandemic.
Dr Skye McGregor, an epidemiologist who leads the report at the Kirby Institute, told Guardian Australia: “During the height of the Covid-19 pandemic, STI notifications decreased due to reductions in testing and sexual activity, as a consequence of restrictions on the movement of people, and the capacity of the health system.
“As these restrictions were relaxed, we’ve seen an increase in STIs, likely related to a resumption in sexual activity and accessing health services for STI testing.”
McGregor added that most STIs occured via transmission from people with no symptoms so timely and regular testing for any sexually active people was crucial for treating and preventing transmission.
