Surveillance of STIs in Ireland 2022

HPSC has published the latest data on STI notifications to the end of 2022 on the HPSC website. Given reductions in STIs notified during 2020 and 2021 as a result of disruption of services and the COVID-19 pandemic, when reviewing trends, we have compared figures in 2022 with those in 2019.

STIs present a significant Public Health challenge with over 1 million STIs being acquired globally every day. With the introduction of WHO targets for STIs in July 2022, there is renewed focus on STIs. The World Health Organization (WHO) has published Global Health Sector Strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030 (GHSS). Agreed by the World Health Assembly in May 2022, the new strategies propose a common vision to end AIDS and the epidemics of STIs and viral hepatitis by 2030.

Key Points

Overall rates

STI notification rates in Ireland for 2022 have increased when compared to 2021, 2020 and the pre-pandemic year 2019.
The increase in the total number of STIs in 2022, compared to 2019, is mainly due to an increase in gonorrhoea (45%) and chlamydia (20%) while notifications of early infectious syphilis (EIS), herpes simplex (genital) (HSV) and trichomoniasis have remained relatively stable.
The commonest STIs reported in 2022 were chlamydia (n=10,955), gonorrhoea (n=4,075) and HSV (n=1,619)
The groups most affected by STIs were young people aged (15 to 24 years), and gay bisexual and other men who have sex with men (gbMSM).

STIs in Young People

Two fifths of all STIs notified in 2022 were in people aged less than 25 years of age.
Since 2019

The STI notification rate in females aged 15-19 years decreased by 6%: chlamydia notification rate decreased by 8%; gonorrhoea notification rate increased by 23%
The STI notification rate in females aged 20-24 years increased by 34%; chlamydia notification rate increased by 35%; gonorrhoea notification rate increased by 75%
The STI notification rate in males aged 15-19 years increased by 8%; chlamydia notification rate decreased by 11%; gonorrhoea notification rate increased by 44%
The STI notification rate in males aged 20-24 years increased by 17%; chlamydia notification rate increased by 6%; gonorrhoea notification rate increased by 56%

STIs in gbMSM

Some STIs have disproportionately affected gbMSM. In 2022 (where mode of transmission was known), they accounted for: 100% of lymphogranuloma venereum (LVG); 99% of mpox; 84% of early infectious syphilis (EIS); and 71% of gonorrhoea
Gonorrhoea notifications in gbMSM where mode of transmission was known increased by 50% in 2022 compared to 2019.
Early Infectious Syphilis cases increased by 14% since 2019.
Mpox first emerged in May 2022 as a sexually transmissible infection when a cluster of cases without travel history to an endemic area was detected, and then rapidly spread mainly among the gbMSM population internationally, including Ireland.

Why have STIs increased significantly in 2022 when compared to 2019?
We cannot definitively say why this has happened, but it is likely to be due to a combination of factors that are all contributing to the increases seen:

Prior to the pandemic, many STIs were increasing and the figures in 2022 reflect ongoing increasing trends evident in advance of the COVID-19 pandemic.
In 2022, socialising resumed, along with behaviours that increase the risk of acquiring an STI. These include not using condoms consistently, particularly when changing partners.

Additional resources containing the latest behavioural surveillance data available or planned include:

The Irish national general population sexual health survey, coordinated by the Sexual Health and Crisis Pregnancy Programme (SHCPP); preparatory work commenced in April 2023.
The European men who have sex with men Internet Survey (EMIS), 2017. This survey commenced in late 2023.
The 2021 EMERGE study, conducted on the effect of COVID-19 and government restriction on the sexual health and well-being of gay and bisexual men available at EMERGE Report - MPOWER (ie).

The introduction of a STI home testing service, integrated with public STI clinics, initially on a pilot basis in 2021, but progressively expanding over time to cover all counties by October 2022, has provided more testing capacity, and so the figures may represent in some part, better ascertainment of infection, which for STIs can often be asymptomatic.

Eighty three percent of the people availing of home testing were asymptomatic at the time of testing. (SHCPP personal communication).
In 2022, with nearly 57,000 tests completed, 4,121 cases of chlamydia and 933 cases of gonorrhoea were detected. We estimate that this would account for approximately 38% and 23% of notifications for these diseases in 2022.

Public health implications and actions needed
Though STIs are usually easily treatable, some STIs can cause serious health issues such as infertility and pelvic inflammatory disease. Many people are unaware that they have an STI as they are often asymptomatic.

The key prevention messages are to use condoms for vaginal, oral and anal sex, and to get tested for STIs if people have symptoms of an STI, change their sexual partner, have multiple or overlapping partners or their partner has an STI.

Most notable in 2022, is the increase in chlamydia and gonorrhoea in women aged 20-24 years. An ongoing nationwide Sexual Wellbeing campaign, developed by SHCPP for the 18-30 year age group, promotes condom use, free home STI testing and raises awareness of Sexualwellbeing.ie as a source of information. The campaign reaches the target audience across a variety of channels and also delivers messages on the ground to students in colleges around the country.

The Man2Man campaign for gbMSM aged 18+ promotes safer sex (including condoms) and STI testing among gbMSM and promotes Man2Man.ie as a source of information on safe sex. Messages are promoted on an ongoing basis across the platforms.

HSE SHCPP and partners continue to work on implementation of the Sexual Health Strategy and are working with the Department of Health on development of a new Sexual Health Strategy.

Further information

The 2022 ECDC annual STI reports are available at: https://www.ecdc.europa.eu/en/news-events/sti-cases-rise-across-europe

You can find information about STI testing and condoms at https://www.sexualwellbeing.ie/

Social media messages can be found on Sexual Wellbeing’s social media platforms.

Twitter: @_respectprotect

Facebook: @Sexual Wellbeing

Instagram: @hserespectprotect

Tiktok: @sexualwellbeing.ie

gbMSM, additional resources are available at http://www.man2man.ie/. gbMSM targeted social media messages can be found on Man2man social media platforms:

Twitter: @man2manireland

Facebook: @man2manireland

Instagram: @man2manireland