STIs on the rise across Australia as resistance to antibiotic treatments ‘rapidly increasing’

Australians are being urged to get regularly tested for sexually transmitted infections (STIs) after a significant rise in cases across the country, including an almost 20% increase in gonorrhoea cases in New South Wales between 2022 and 2023.

The Royal College of Pathologists (RCPA) warned on Wednesday of a worrying rise in the number of 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 diseases.

Dr Christine Selvey, director of NSW Health’s infectious diseases department, sent a letter in June warning GPs that gonorrhoea cases in the state had increased by almost 20% from 2022 to 2023, with the increase expected to accelerate further this year.

Selvey said a particular concern was that cases resistant to first-line antibiotic treatments such as azithromycin or ceftriaxone were “increasing rapidly”.

Cases of gonorrhea have been identified among heterosexual men and women, sex workers and men who have sex with men, across a wide age range, Selvey wrote.

The RCPA said the increasing number of gonorrhea cases with antibiotic-resistant infections “complicates treatment protocols and highlights the urgency of regular STI testing”.

In addition to gonorrhea, the RCPA warned that “syphilis rates have also increased, particularly congenital syphilis, in which the infection is transmitted to unborn children.”

According to the college, the increase in the number of cases can be attributed to changing sexual practices, including decreased condom use across various demographic groups.

The Kirby Institute’s Final Annual Review reporting of sexually transmitted infections Research in Australia shows that the number of diagnoses of gonorrhea has doubled between 2013 and 2022, while the number of cases of syphilis has tripled.

Associate Prof Caitlin Keighley, a spokesperson for RCPA and medical director of Southern IML Pathology, said: “Despite a worrying rise in cases, we are not seeing a corresponding increase in testing rates.”

“This also applies to older people who do not respond openly to changes in their sexual habits.

“Low testing levels mean infections can go undiagnosed and untreated, leading to serious health complications and onward transmission,” Keighley said.

“This puts many people at risk without realizing it, and this is particularly worrying for pregnant women, for whom untreated STDs can lead to congenital infections with devastating consequences.

“Regular testing is crucial for early detection, effective treatment and preventing the spread of these infections.”

RCPA highlighted that Aboriginal and Torres Strait Islander people had significantly higher rates of STIs compared to non-Indigenous Australians. For example, chlamydia diagnoses were twice as common among Aboriginal and Torres Strait Islander people than non-Indigenous individuals, while the prevalence of gonorrhoea and syphilis was more than five times higher, the college said.

According to the report, these figures highlight the urgent need for culturally sensitive initiatives in health promotion, testing and treatment.

The latest Kirby report shows that there has been a decline in Medicare-reimbursed testing for chlamydia and gonorrhea in both men and women between 2019 and 2022, likely due to the ongoing impact of the Covid-19 pandemic.

“Any increase in STIs is bad news, but the increase in STIs against a backdrop of decreased testing and the continued upward trend over the past decade is particularly concerning,” said Dr. Skye McGregor, an epidemiologist at the Kirby Institute who led the report.

“Chlamydia, gonorrhoea and syphilis are all easily treated with antibiotics. The key message we want Australians to take away from this data is that condoms remain highly effective in preventing STIs for every sexually active person, and that regular STI testing is crucial,” McGregor said.

“An important part of this is combating the stigma surrounding sexual health and informing sexual partners when someone has tested positive for an STD.”