Increased STI notifications in Ireland: Trends to the end of 2023
The Health Protection Surveillance Centre (HPSC) has published the annual data on STI for 2023, today March 26th, 2024. There have been significant increases in 2023 compared with 2022 and pre COVID-19 pandemic, this is similar to other European countries who are also experiencing an increase in STIs.
Background
STIs present a significant Public Health challenge with over 1 million STIs being acquired globally every day. With the introduction of World Health Organization (WHO) targets for STIs in July 2022, there is renewed focus on STIs. The 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.
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.
There are steps that everyone can take to look after their sexual health, reducing the risk of contracting STIs, via condom use, and reducing further spread by testing promptly, getting appropriate treatment and informing partners so they can be tested too.
Key Points
Overall rates
- STI notification rates in Ireland for 2023 have increased when compared to previous years.
- The STI notification rate in 2023 increased by 31% compared to 2022 (from 346 to 452 per 100,000 population). The largest increases were seen in gonorrhoea (+68%) and chlamydia (+25%)
- The most common STIs reported in 2023 were chlamydia (n=13,711) and gonorrhoea (n=6,824).
- 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
- 45% of all STIs notified in 2023 were in people aged less than 25 years of age.
Since 2022 in females:
- 15-19 year olds:
STI notification rate increased by 61%: chlamydia notification rate increased by 53%; gonorrhoea notification rate increased by 175%.
18 and 19-year-olds account for 85% of chlamydia notifications and 88% of gonorrhoea notifications.
- 20-24 year olds:
STI notification rate increased by 30%; chlamydia notification rate increased by 22%; gonorrhoea notification rate increased by 143%.
Since 2022 in males:
- 15-19 year olds:
STI notification rate increased by 60%; chlamydia notification rate increased by 63%; gonorrhoea notification rate increased by 65%.18 and 19-year-olds account for 91% of chlamydia notifications and 90% of gonorrhoea
- 20-24 year olds:
STI notification rate increased by 36%; chlamydia notification rate increased by 33%; gonorrhoea notification rate increased by 57%.
STIs in gbMSM
- Some STIs disproportionately affect gbMSM. In 2023 (where mode of transmission was known in males), they accounted for: 100% of LGV; 100% of mpox; 91% of early infectious syphilis (EIS); and 84% of gonorrhoea.
- Gonorrhoea notification rates in gbMSM over 18 years of age, where mode of transmission was known increased by 36% in 2023 compared to 2022.
- Mpox: there were 13 confirmed cases in 2023. The notification rate decreased by 93% compared to 2022. Where known, all cases were among gbMSM.
Behaviour change, and immunity due to vaccination or infection have contributed to the decline in mpox cases. According to the WHO latest mpox risk assessment, the overall global risk for gbMSM and sex workers is assessed as moderate.
An overview of the latest global mpox situation can be found here
ECDC/WHO regional office of Europe mpox surveillance bulletin can be found here
European trends
On March 7th 2024, the European Centre for Disease Prevention and Control (ECDC) published the 2022 surveillance reports for, chlamydia, gonorrhoea , syphilis, congenital syphilis and lymphogranuloma venereum.
In 2022, the number of cases reported to ECDC increased significantly compared to the previous year, gonorrhoea cases by 48%, syphilis cases by 34%, and chlamydia cases by 16%. Increases were also reported in cases of LGV and congenital syphilis (caused by transmission from mother to foetus).
Also published on March 7th was a rapid communications article, describing how gonorrhoea cases had increased steeply in women aged 20 to 24 years across 15 EU/EEA countries (including Ireland) in July-December 2022 and January-June 2023 with 73% and 89% more cases reported than expected, respectively, based on historical data from 2015-2019.
ECDC suggested several actions, including raising awareness among young heterosexual populations about the increasing risk of STIs, emphasising the importance of condom use, as well as testing before or after engaging in unprotected sex; employing innovative ways (e.g. through social media) to effectively reach young populations, and partner notification.
Public health implications and actions
Many of the ECDC recommendations are already underway in Ireland, through the Sexual Wellbeing campaign aimed at 17 to 30-year-olds. The campaign, developed by HSE Sexual Health and Crisis Pregnancy Programme (SHCPP) emphasises the importance of condom use and raises awareness of the free home STI testing service, among a variety of sexual wellbeing messages. In early 2023, the campaign identified the younger 17 to 24 year old audience as a primary audience, with a secondary audience of 25 to 30 year olds. Campaign messages were increased towards the younger age group. TikTok, Snapchat and Instagram channels were prioritised to reach younger audiences.
The HSE has a range of free supports, promoted through the Sexual Wellbeing and Man2Man campaigns, such as:
- Free condoms: Condoms are the most effective method of preventing most STIs. Condoms and lubricant are available free and can be accessed by anyone from the age of 17 years through postal services or community venues. Further information on how to access free condoms is available here.
- National HSE free home STI testing services: The HSE free home STI testing service is available to anyone aged 17 or older. To use the service, order a test kit at sexualwellbeing.ie/hometesting, return your samples to the laboratory by post, and you will receive your test results by text message or phone call.
- Public STI clinics: All STI testing and treatment in public sexual health or GUM clinics is provided free of charge. A list of public STI clinics is available here.
- Learn about prevention: Information on how to prevent STIs can be found here. This includes advice on condom use, testing and vaccinations.
- Resources for gay, bisexual, and other men who have sex with men (gbMSM) are available at man2man.ie