New report highlights sharp global rise in sexually transmitted infections amid HIV and hepatitis challenges

Global HIV and viral hepatitis epidemics, as well as sexually transmitted infections (STIs), continue to pose a significant public health challenge, causing 2.5 million deaths each year, according to a new WHO report, Implementing global health sector strategies on HIV, viral hepatitis and sexually transmitted infections 2022–2030.

New data shows that sexually transmitted diseases are increasing in many regions. In 2022, WHO member states set the ambitious goal of reducing the annual number of syphilis infections in adults tenfold, from 7.1 million to 0.71 million by 2030. Still, new syphilis infections among adults ages 15 to 49 rose by over 1 million in 2022, reaching 8 million. The highest increases occurred in the Americas and Africa regions.

Combined with an insufficient decline in the reduction of new HIV and viral hepatitis infections, the report highlights threats to achieving the associated targets of the Sustainable Development Goals (SDGs) by 2030.

“The rising incidence of syphilis is of grave concern,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus. “Encouragingly, there have also been important advances in a number of other areas, including in accelerating access to essential healthcare supplies, including diagnostics and treatment.

“We have the tools necessary to end these epidemics as a public health threat by 2030. But now we must ensure that, in the context of an increasingly complex world, countries do everything they can to achieve the ambitious goals they have set for themselves.”

Increasing number of sexually transmitted infections

Four curable sexually transmitted diseases – syphilis (Treponema pallidum), gonorrhea (Neisseria gonorrhoeae), chlamydia (Chlamydia trachomatis) and trichomoniasis (Trichomonas vaginalis) – cause more than 1 million infections every day. The report notes an increase in adult and maternal syphilis (1.1 million) and related congenital syphilis (523 cases per 100,000 live births per year) during the COVID-19 pandemic. There were 230,000 syphilis-related deaths in 2022.

New data also show a rise in multidrug-resistant gonorrhea. In 2023, nine out of 87 countries that implemented enhanced surveillance of antimicrobial resistance against gonorrhea reported increased levels of resistance (ranging from 5% to 40%) to ceftriaxone, the last line of treatment for gonorrhea. WHO is monitoring the situation and has updated its recommended treatment to contain the spread of this multidrug-resistant strain of gonorrhea.

In 2022, about 1.2 million new hepatitis B cases and almost 1 million new hepatitis C cases were recorded. The estimated number of deaths from viral hepatitis increased from 1.1 million in 2019 to 1.3 million in 2022, despite effective prevention, diagnosis and treatment tools.

The number of new HIV infections only fell from 1.5 million in 2020 to 1.3 million in 2022. Five key populations—men who have sex with men, people who inject drugs, sex workers, transgender people, and those in prisons and other confined facilities—continue to have significantly higher HIV prevalence rates than the general population.

An estimated 55% of new HIV infections occur among these populations and their partners. The number of HIV-related deaths remains high. There were 630,000 HIV-related deaths in 2022, 13% of which occurred in children under 15 years of age.

Profits through expanded service access

Efforts by countries and partners to scale up services for STIs, HIV and hepatitis are yielding tremendous results. WHO has certified 19 countries as having eliminated mother-to-child transmission of HIV and/or syphilis, reflecting investments in testing and treatment coverage for these diseases among pregnant women.

Botswana and Namibia are on the path to eliminating HIV. Namibia is the first country to submit a dossier to evaluate the triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis.

Globally, HIV treatment rates are 76%, with 93% of people receiving treatment achieving viral load suppression. Efforts to increase HPV vaccination and screening for HIV-infected women are ongoing. There are slight improvements in diagnosis and treatment rates for hepatitis B and C worldwide.

Sustainability planning required for all three disease areas

The report makes the following recommendations for countries to strengthen common approaches to achieving the goals:

• Conducting policy and financing dialogues to develop cross-cutting investment cases and sustainability plans at national level;
• further consolidate and align disease-specific guidelines, plans and implementation support within a primary health care approach;
• Accelerate efforts to combat persistent criminalization, stigmatization and discrimination in the health sector, particularly against populations most affected by HIV, viral hepatitis and sexually transmitted diseases;
• Scaling up approaches and packages for multi-disease elimination, taking into account lessons learned from the triple elimination of mother-to-child transmission
• Increase focus on primary prevention, diagnosis and treatment of all diseases to raise awareness, particularly with regard to hepatitis and sexually transmitted diseases.

While the ambitious goals that member states have set for 2025 and 2030 are contributing to progress, progress is patchy across the various disease areas. With many indicators still insufficient to achieve the global goals, efforts urgently need to be accelerated through greater political will and commitment.