A new report indicates a large increase in sexually transmitted infections, amid challenges with HIV and hepatitis

Global HIV, viral hepatitis and sexually transmitted infection (STI) epidemics continue to pose significant public health challenges, causing 2.5 million deaths each year, according to a new WHO report – Implementation of global health sector strategies for HIV, viral hepatitis and sexually transmitted infections, 2022-2030..

New data shows that STIs are on the rise in many regions. In 2022, WHO member states set an ambitious goal of reducing the annual number of syphilis infections in adults tenfold by 2030, from 7.1 million to 0.71 million. However, new cases of syphilis among adults aged 15 to 49 increased by over 1 million in 2022, reaching 8 million. The largest increases occurred in the Americas and Africa regions.

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

“The rising incidence of syphilis is of great concern,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus. “Fortunately, there has been important progress on a number of other fronts, including accelerating access to critical healthcare products, including diagnostics and treatment. We have the tools needed to end these epidemics as a threat to public health by 2030, but now we must ensure that, in the context of an increasingly complex world, countries do all they can to achieve the ambitious targets they have set for themselves.”

The increasing frequency of sexually transmitted infections

Four curable STIs – syphilis (Treponema pale), gonorrhea (Neisseria gonorrhoeae), chlamydia (Chlamydia trachomatis), and trichomoniasis (Trichomonas vaginalis) – account for more than a million infections per day. The report notes an increase in adult and maternal syphilis (1.1 million) and associated congenital syphilis (523 cases per 100,000 live births per year) during the COVID-19 pandemic. In 2022, there were 230,000 syphilis-related deaths.

New data also show an increase in multidrug-resistant gonorrhea. As of 2023, of the 87 countries where enhanced surveillance for gonorrhea antimicrobial resistance was implemented, 9 countries reported elevated levels (from 5% to 40%) of resistance to ceftriaxone, the last-line treatment for gonorrhea. WHO is monitoring the situation and updating its recommended treatment to reduce the spread of this multi-resistant strain of gonorrhea.

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

New HIV infections fell from just 1.5 million in 2020 to 1.3 million in 2022. Five key population groups — men who have sex with men, people who inject drugs, sex workers, transgender people and in prisons and other closed settings — still experience 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. In 2022, there were 630,000 HIV-related deaths, of which 13% occurred in children under 15 years of age.

Gains in expanding access to services

Efforts by countries and partners to expand services related to STIs, HIV and hepatitis are yielding incredible gains. WHO has certified 19 countries to eliminate 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 track to eliminate HIV, and Namibia is the first country to submit a dossier for the triple elimination assessment of mother-to-child transmission of HIV, hepatitis B and syphilis.

Globally, HIV treatment coverage has reached 76%, with 93% of people receiving treatment achieving a reduced viral load. Efforts are underway to increase HPV vaccination and screening for women with HIV. Diagnostics and treatment coverage for hepatitis B and C are showing slight progress at the global level.

Sustainability planning is needed in three disease areas

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

• conduct policy and funding dialogues to develop cross-sectoral investment cases and sustainability plans at national level;
• further consolidate and harmonize disease-specific guidelines, plans and implementation support within the primary health care approach;
• accelerate efforts to address ongoing criminalization, stigma, and discrimination within health care settings, particularly against populations most affected by HIV, viral hepatitis, and sexually transmitted diseases;
• expand multi-disease elimination approaches and packages, drawing on lessons learned from the triple elimination of mother-to-child transmission and
• strengthen the focus on primary prevention, diagnosis and treatment of all diseases in order to raise awareness especially of hepatitis and sexually transmitted diseases.

While the ambitious targets set by Member States for 2025 and 2030 are helping to drive progress – progress is uneven across all disease areas. With many indicators still not on track to achieve the global goals, more political will and commitment is needed to urgently accelerate efforts.

Note to the editor

This report describing progress in implementation global health sector strategies on HIV, viral hepatitis and sexually transmitted infections (STIs) for 2022-2030. will be discussed at the Seventy-seventh World Health Assembly.

In 2022, the Seventy-fifth World Health Assembly took note with appreciation of the Global Health Sector Strategies for HIV, Viral Hepatitis and Sexually Transmitted Infections (STIs) 2022-2030. The strategies intend to guide the health sector in implementing strategically focused responses to achieve the goals of ending AIDS, viral hepatitis B and C and sexually transmitted infections by 2030, as part of efforts towards achieving the 2030 Agenda for Sustainable Development. The strategies promote synergies across all disease areas in within the framework of universal health insurance and promote implementation within the primary health care approach.