Prevention of sexually transmitted infections fails in Catalonia: they increase by 32% each year

BarcelonaSexually transmitted infections are a public health problem throughout Europe. In our country, these diseases are increasingly numerous: since 2010 they have increased by an average of 32.4% each year, and in 2023 37,571 cases were diagnosed. In fact, Catalonia exceeds the European and Spanish average for all sexual infections. Behind this increase in casesHowever, there are many factors. On the one hand, many diagnostic tests are carried out, extensive screenings are carried out in which people who do not show symptoms of the disease are detected, and there is a surveillance network that allows more people to be diagnosed than in neighbouring countries. On the other hand, there is an increase in risky sexual behaviour, a drop in condom use and an increase in the number of sexual partners that a person has. All of this has created a breeding ground for these infections to rise steadily in recent years.

However, experts warn that there are more factors that come into play. One of them is the lack of prevention, the great challenge pending to break this upward trend. Now more and better infections are detected, they are diagnosed early and many people are treated, but after 10 years of sustained growth in cases we still do not anticipate the appearance of the disease. The Department of Health recognises in a document to which the ARA has had access that these diseases entail a significant economic burden and that "efforts in education and prevention must be intensified".

There are specific groups, such as teenagers and immigrants, in which it is especially urgent to deploy new and better prevention policies, because "the current ones do not reach", warns Susana Muñoz, an assistant doctor in the Sexually Transmitted Infections Unit of the Germans Trias i Pujol Hospital. For the expert, it is necessary to increase the work in the institutes with a "much broader view" that also incorporates psychologists, educators and even sociologists. One in three sexual infections in Catalonia is diagnosed in people under 25 years of age and Health admits that it is necessary to put more preventive efforts in this group.

Regarding immigrants, Muñoz warns that there are "very large language and cultural barriers" that make prevention work difficult. For this reason, it argues that the important thing is to guarantee access to the health system to all people born outside Spain, regardless of their situation, and to work alongside the network of entities that provide direct care to these groups. Sexual infections occur mainly in people born in the country (60% of the total cases) but the incidence rates among foreigners have quadrupled in the last decade, warns the department.

Most prevalent infections

As has been the case in recent years, the most prevalent infections are chlamydia and gonorrhoea, with 15,512 cases and 13,154, respectively. The Department of Health warns that there has been an 18.8% increase in gonorrhoea infections compared to the previous year and also warns of the rise in lymphogranuloma venere, an STI that has shot up by 66.8% in one year. For Muñoz, it is also worth highlighting the increase in cases of syphilis, with 2,516 diagnoses, which can have serious consequences if, for example, a pregnant woman contracts it. In these cases it can cause malformations in the baby and even a spontaneous abortion. Even so, he highlights the good work carried out by the sexual and reproductive health care units (ASSIR) to detect and act on pregnant women in time.

Muñoz also focuses on chlamydia infection in young girls. Almost half of these diseases were detected in women, but the expert points out that the problem is mainly in adolescence: "These are girls who have started having sex at an earlier age than a few years ago and many are unaware of certain prevention mechanisms." For example, they know what the morning-after pill is, to avoid pregnancy, but they do not know how to prevent certain sexual infections. In addition, in the consultation she has found girls who, due to pressure from their partner, have had sex without a condom. "The concept of consent must be broadened. It is not only accepting that you want to have sex, but how you want to have these relationships," she argues.

To anticipate these diseases, Ángel Rivero, medical director of BCN Checkpoint, the community center for the detection and control of HIV and other infections, explains that, beyond detection and treatment, there are methods to prevent their spread, such as DoxyPEP. It is an antibiotic that has shown good results in studies by breaking the chains of transmission after sexual intercourse. Rivero believes that it could be implemented as a preventive tool, although it has not yet been incorporated into clinical guidelines.

The expert believes that more efforts should be put into sexual education to prevent these infections, but believes that the continued increase in cases is not a reason to be alarmed. "A lot of detection work is being done, cases are skyrocketing because we are treating more and more asymptomatic people through screening," he clarifies. In this regard, Rivero questions whether it is necessary to continue putting efforts into detection, and states that there are countries such as Belgium or Holland that are studying whether to stop carrying out mass testing and treat only people with symptoms: "If you stop doing tests, the incidence will go down."

Men who have sex with men

Most infections occur among men and the predominant transmission continues to be in the group that has sex with other men. According to Muñoz, these are people who are within the STI detection circuit, routine controls are carried out and this favours the detection of more cases. At the BCN Checkpoint there are 4,000 people on the waiting list, equivalent to a year to receive an appointment. "We are now seeing those who signed up last February," Rivero explains. Many come to take the pill that prevents HIV infection, pre-exposure prophylaxis (PrEP), and there they are tested for other STIs. HIV co-infection for all infections in Catalonia is 5.9%, a percentage that rises to 14.7% in the case of syphilis and up to 19.9% in the case of lymphogranuloma venere.

However, not all of these men are within the circuit. Muñoz explains that there is a small percentage of men who have a stable relationship with a woman but who occasionally have sporadic sex with other men. These cases often present more serious infections because it takes longer to detect them. For the expert, there is a "lack of sexual education" that makes these diseases proliferate, since "they have no perception of risk" and are outside the circuit of infection detection. In addition, she believes that health professionals also have "prejudices", because it takes longer to think about doing an HIV test on someone who has been married to a woman for 20 years, she concludes.