New data released by the UNSW’s Kirby Institute has shown how the pandemic impacted testing and diagnoses of sexually transmissible infections (STI) in Australia.
The report, published 8 December 2022, revealed that while the total number of chlamydia, gonorrhoea, HIV and HPV diagnoses declined nationally, there was also a drop in the number of Australians getting tested for an STI due to COVID – as much as 14% down from pre-pandemic levels for some cohorts and conditions.
In contrast, infectious syphilis diagnoses increased in 2021, following a steady decline between 2019 and 2020, with a noted rise in the number of cases observed among gay and bisexual men, as well as Aboriginal and Torres Strait Islander communities in regional and remote areas of central, northern, and western Australia.
The report, HIV, viral hepatitis, and sexually transmissible infections in Australia: Annual surveillance report, detailed that in 2021 there were 86,916 diagnoses of chlamydia, 26,577 of gonorrhoea and 5,570 of infectious syphilis in Australia.
Lead author Dr Skye McGregor, from the Kirby Institute, explained that according to their modelling, most chlamydia and gonorrhoea cases in Australia remained undiagnosed and untreated, highlighting a need to increase STI testing across the country.
“Prior to the pandemic we were seeing increases in chlamydia and gonorrhoea, but in 2021 we recorded a small decline. We believe this reduction is a consequence of both reduced testing and reduced sexual activity with new or casual partners, due to social restrictions and lockdowns during 2020 and 2021,” Dr McGregor said.
“On the other hand, syphilis has been steadily increasing among women of reproductive age, gay and bisexual men, and Aboriginal and Torres Strait Islander people. This reflects sustained and ongoing transmission across Australia, which is extremely concerning.”
Professor Andrew Grulich, also from the Kirby Institute, explained that while HIV has been declining among Australian-born gay and bisexual men – thanks to high coverage of the HIV prevention medication pre-exposure prophylaxis and use of treatment as prevention – yet gonorrhoea and syphilis diagnoses have been increasing in recent years among this population.
“Some 69% of gonorrhoea diagnoses are among men, as are 81% per cent of syphilis diagnoses. From this we can infer that these infections are occurring disproportionately among gay and bisexual men,” Professor Grulich said.
“Some of this increase may be related to decreases in condom use, which have occurred in an era of greater use of other highly effective biomedical HIV prevention and treatment strategies.”
The report also showed that the number of gay and bisexual men attending sexual health clinics to get tested for STIs declined between 2019 and 2021, and Professor Grulich said that while it made sense that there was a reduction in testing during the pandemic, when people were having less casual sex, “as people returned to their pre-pandemic sexual behaviours, it was important to return to regular STI testing.”
“We have had tremendous success in HIV prevention, and we need to carry this over to STIs, to drive down infections among this group.”
Among Aboriginal and Torres Strait Islander people, rates of gonorrhoea and infectious syphilis were more than five times as high as non-indigenous Australians, while rates of chlamydia diagnosis were almost three times as high – with even greater prevalence in remote areas of Australia.
The report also revealed a four-fold increase in syphilis among women of reproductive age in both Aboriginal and Torres Strait Islander women over the ten-year reporting period, and an eight-fold jump among non-Indigenous women.
“While the numbers among women in cities are still relatively small, the upward trend in this group over the last 10 years has been substantial,” Dr McGregor said.
“We are particularly concerned about syphilis in women aged 15-44 years due to the potential impact on pregnancy outcomes.
“The data tells us that we may need to focus on enhanced sexual health messaging about syphilis for all sexually active people who may be at risk and ensure appropriate education for health providers.”
While diagnoses of congenital syphilis remained low between 2012 and 2019, ranging from 0-8 each year, they jumped to 17 in 2020, and while there was a slight decrease to 15 in 2021, nearly 60% of diagnoses were among Aboriginal and Torres Strait Islanders – who made up only 5% of newborns.
“This is particularly worrying, as pregnant women should be tested regularly for STIs as part of pre and antenatal health screening, but COVID has put additional strains on health service delivery and access,” Dr McGregor said.
“With timely screening, syphilis can be cured, so even one case of congenital syphilis is completely avoidable and unacceptable, and we are working with our partners to understand what proportion of pregnant women are not receiving adequate STI screening.”
She stressed that regular testing and treatment was crucial for STI control.
“But based on Medicare testing data, between 2019 and 2021, the number of people aged 15 to 24 years getting a chlamydia or gonorrhoea test declined by 14% in Australia,” Dr McGregor said.
“It is important we encourage people who have deferred or interrupted their sexual health care to get tested.”
However, the report also revealed good news for the elimination of genital warts amongst this same age category, with the figures for 2021 showing that diagnoses of genital warts among heterosexuals aged under 21, who attended a sexual health clinic, declined to less than 1% among females and was almost zero for males.
Similarly, there were no reported diagnoses of genital warts in 2021 among Aboriginal and Torres Strait Islander peoples aged under 21 years who attended sexual health clinics – reflecting the success of the national HPV vaccination program.