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France sees explosion in syphilis cases

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In the past few years, France has seen a steep rise in sexually transmitted infections, but there is one in particular that is rising at an alarming rate: syphilis. Experts are worried. Due to the ongoing fight against HIV, syphilis has long been relegated to a much less talked about second place in French public health policy. In the meantime, the number of syphilis cases has exploded, soaring by 110 percent between 2020 and 2022.

On the eve of Valentine’s Day, Martin* received a piece of particularly bad news from a friend: “I’ve just been tested, and you’re the only person I have had unprotected sex with. Voilà, I have syphilis now.”

Martin rushed off to get tested: He tested positive. Once he had gotten over the shock, he quickly went through his list of sexual partners and remembered a recent encounter with a woman with whom he had not used protection. After a brief exchange, she confirmed she had syphilis and had been a carrier for some time. But just like Martin, she had preferred taking the risk rather than having protected sex.

Martin’s case is not unique. According to a report issued by the French health authority Santé Publique in December, sexually transmitted bacterial infections (namely, chlamydia, gonorrhoea and syphilis, as opposed to HIV, which is a virus) rose sharply in mainland France between 2020 and 2022.

Although chlamydia remains the most recurring sexually transmitted infection (STI) in absolute terms, up 16 percent from 2020 with 102 cases per 100,000 inhabitants, experts are alarmed by the sharp rise in gonococcal infections, and especially the huge increase in syphilis. The number of gonococcal infections jumped by 91 percent (44 cases per 100,000 inhabitants) in the two-year period while syphilis soared 110 percent, to 21 cases per 100,000 inhabitants.

Syphilis first appeared in the Middle Ages and was nearly eliminated in the second half of the 20th century, but in recent years it has resurfaced in most Western countries, particularly in the United States. According to the US Centers for Disease Control and Prevention, syphilis has now reached its highest infection rate since the 1950s, the New York Times reported in a January article.

With more than 207,000 cases diagnosed in 2022, the last year for which data is available, the US now has an infection rate of 17 cases per 100,000 inhabitants – an increase of 80 percent since 2018.

PrEP, a false sense of safety?

So why is this happening? Doctors say scientific advances, especially in the fight against HIV, are partly to blame. “People are protecting themselves less and less, in part because they’re no longer afraid of AIDS, since the scientific advances mean that it is now possible to lead an uncomplicated life even you have HIV,” Pierre Tattevin, the head of the infectious diseases department at Rennes University Hospital, explained.

According to most doctors, people “relax” when they don’t have to fear HIV anymore. “That’s the negative effect of using PrEP,” said Jean-Paul Stahl, infectiologist and emeritus professor of infectious diseases at Grenoble University.

PrEP, a pre-exposure prophylaxis, is a retroviral drug that is taken before any potential exposure to the HIV virus in order to help prevent contamination. It has become extremely popular in the past few years, especially among gay and bisexual men who are single. The pill is routinely offered in public hospitals to anyone reporting to have had sex with more than 10 different partners in the past 12 months, regardless of whether they have had protected sex or not.

“PrEP gives users the impression that they are protected from everything, and they think they can have all kinds of risky sexual relations, but it only protects them against HIV,” Stahl warned.

The danger of dating apps

But according to Pierre Tattevin, there is also another reason for the steep rise in STIs. “It’s become extremely easy to find sexual partners via dating apps. You multiply partners without knowing who they are, what their habits are, or what their [sexual] history is,” Stahl, who also presides the French Infectious Diseases Society (SPILF), said.

According to the December report by Santé Publique, the men most at risk of contracting gonorrhoea or syphilis, representing nearly 80% of cases, have multiple partners and a history of STIs.

More generally, it is men who are most affected: they account for 77 percent of gonococcal cases and more than 90 percent of syphilis cases. For the majority of syphilis cases, men aged 50 and over are most affected. 

Chlamydia, on the other hand, affects women more, especially young women aged between 15 and 25.

Great risk to pregnant women

The public fear of syphilis has diminished in the past half century or so thanks to a safe and very effective treatment for it: antibiotics. “It’s a cure, of course, and once it’s cured, there are no further effects or complications if the infection is detected quickly,” Stahl said.

Except that, if left untreated, syphilis is a very serious disease. It can damage the heart, brain and eyesight, and could go as far as to cause deafness and paralysis. An infection during pregnancy can lead to miscarriage or stillbirth. Children who survive through birth may also suffer vision or hearing problems, and developmental delays.

While the number of syphilis cases only increased slightly among heterosexual women in 2021 and 2022, “around three quarters of syphilis cases involved MSM [men who have sex with men], regardless of the year surveyed”, the study said.

The researchers further warned that “STIs represent a major public health problem because of their transmissibility (to partners and mother and foetus), their frequency, the long-term complications they cause (chronic pelvic pain, upper genital infections, infertility, cancer, etc.) and their role in HIV transmissions”.

‘Can’t hand out condoms to everyone’

Doctors say that although the number of registered STI cases is on the rise in France, it is also a testament to the fact that the country has a well-functioning testing system, which is essential to stopping an epidemic.

“When you miss one case, you then end up with two more cases, and if you miss two cases, you then end up with four,” Dr Jay Varma, chief medical officer at Siga Technologies and a former deputy commissioner of health for New York City, said in an interview with the New York Times. “That’s how epidemics grow.”

Tattevin agreed. “Our different governments have pursued good policies in recent years, with free testing centres. We need to test even more, especially patients at risk,” he said.

In addition to information campaigns, Stahl insisted on  personal responsibility. “Those who use PrEP need to know what they’re risking. Because some know about the risks involved but decide to take them anyway,” he said. “Scientific information is always beneficial, but at the end of the day, the decision comes down to each and every individual.”

“The government can’t hand out condoms to everyone,” he said.

Martin, meanwhile, continues his conquests: sometimes protected, sometimes not, but for now, at least he is cured.

*The first name has been changed at the request of the person.

This article was adapted from the original in French.

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