Public health experts in Australia are sounding alarms over a record number of new cases of syphilis and a dramatic rise in viral hepatitis deaths. Experts trace the spike in syphilis and other sexually transmitted infections (STIs) to a decrease in condom use, particularly among men who have sex with men (MSM), and they see the hepatitis death toll as the inevitable result of long-term trends in injecting drug use.
The alarming numbers and the underlying behaviors are examined in a pair of reports on HIV, viral hepatitis, and STIs in Australia released today by the Kirby Institute for Infection and Immunity in Society and the Centre for Social Research in Health, both at the University of New South Wales in Sydney.
"Unfortunately, it's really bad news for STIs in Australia," says epidemiologist David Wilson of the Kirby Institute. And for hepatitis, "there is a very large epidemic that largely went on under our nose but it is catching up with us right now," he says.
Rates of chlamydia infections illustrate the scope of the STI problem. Physicians reported 82,537 new cases in 2013, with males only slightly more likely to be victims than females. And that number "is just the tip of the iceberg," Wilson says. Those infected often don't have symptoms or don't recognize them and never get diagnosed or treated. The real number of infections could be four or five times higher, Wilson says. He adds that chlamydia is particularly common among those in their late teens who are reluctant to use condoms.
Since 2009, gonorrhea has surged 81% to 14,947 new cases; syphilis infections have risen 34% to 1765 new cases. For both diseases, MSM account for most of the increases. Wilson says the trend is likely due to success in controlling HIV infections. Data on HIV in Australia were announced in July during the 20th International AIDS Conference held in Melbourne.
As Science reported, antiretroviral HIV medications widely used in Australia substantially cut the amount of virus in those infected and may reduce the likelihood of transmitting the virus to partners. This assumption has unfortunately led to more unprotected sex among MSM. "One of the drawbacks is that HIV treatment doesn't work against [other] STIs," says John de Wit, a social psychologist at the Centre for Social Research in Health. "There is quite a lot of room for improvement" in getting MSM regularly and comprehensively tested for STIs and in promoting condom use, he says.
The hepatitis situation is particularly grim. The figure of 1019 people who died of hepatitis B and C last year exceeds the peak for AIDS in the 1980s. There is a long lag between the time of infection and the onset of serious illness. Wilson says that, with an estimated 440,000 people living with the viruses, the number of deaths "will get worse in years to come."
The largest culprit in the spread of hepatitis is dirty needles for injecting drugs, with such risky behavior more prominent among younger people and MSM. One national survey found that more than 40% of MSM injecting drugs reused or passed on used injection paraphernalia despite the country's needle and syringe exchange programs. "It's time to strengthen hepatitis prevention through awareness raising and education," de Wit says.
Government restrictions on eligibility have limited the availability of hepatitis treatments, Wilson says. There’s also "the massive stigma that pervades society around people who inject drugs," de Wit says.
The one bit of good news is that human papillomavirus (HPV) infections have dropped dramatically since a vaccination program for high school students began in 2007. Before the program, more than 14% of females younger than 21 who received sexual health checks were diagnosed with genital warts, a symptom of HPV infection. That number has since dropped to 0.5%. "It's a dramatic decrease that is all attributable to the vaccine," Wilson says. However, except for hepatitis B there are no vaccines for the other infectious diseases covered in the survey.
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