2024-02-12 19:00:25
While most sexually transmitted infections are on the rise in France, the increase in the number of syphilis cases is particularly alarming to specialists. Long relegated to the background of public policies, particularly in the face of the HIV epidemic, this bacterial infection increased by 110% between 2020 and 2022.
A few days before Valentine’s Day, there are surprises we would like to do without. Martin* has just received bad news from one of his close friends, with whom he had sex: “I just got tested, you are the only person with whom I did not protect myself. And here it is, now I have syphilis.”
Martin quickly runs to get tested: positive for syphilis. Once the shock has passed, he quickly goes back through his multiple partners and remembers a recent adventure, also unprotected. After a brief exchange, this partner confirms that she has been carrying it for some time. But like Martin, she prefers to take the risk, rather than having protected sex.
Martin’s case is not unique. Sexually transmitted infections (STIs) of bacterial origin (chlamydia, gonococci and syphilis, unlike HIV which is a virus) experienced a sharp increase between 2020 and 2022 in mainland France, according to the latest report from Public Health France, dated December 2023.
If chlamydia remains the most recurrent STI in absolute figures (+16% compared to 2020, with 102 cases per 100,000 inhabitants), the evolution of gonorrhea and especially syphilis alarms specialists. The proportion of gonorrhea infections jumped by 91% (with 44 cases per 100,000) and that of syphilis increased by 110%, to reach 21 cases per 100,000.
Appeared in the Middle Ages, syphilis had almost been eradicated since the second half of the 20th century. But it has resurfaced in most Western countries in recent years, notably in the United States. According to the Agency for Disease Control and Prevention, infections with this disease have reached their highest rate since the 1950s, reported the American daily New York Times in January.
With more than 207,000 cases diagnosed in 2022, the latest year for which data is available, the United States now has a rate of 17 cases per 100 000 habitantsan increase of 80% since 2018.
PrEP, a false miracle solution
At the origin of the phenomenon? The scientific advances used to fight AIDS, in particular, affirm the doctors as a whole. “People protect themselves less and less, in part because they are no longer afraid of AIDS, since with scientific advances, it is now possible to lead a life without complications while carrying HIV,” summarizes Pierre Tattevin , head of the infectious diseases department at Rennes University Hospital.
According to many doctors, once the fear of HIV disappears, people “let go.” “There is also a perverse effect of PrEP,” points out Jean-Paul Stahl, infectious disease specialist and professor emeritus of infectious diseases at the University of Grenoble.
Read also Against HIV, PrEP both solution and problem
The PrEP (for pre-exposure prophylaxis) is a retroviral medication used before possible exposure to HIV (the virus that causes AIDS), thus blocking any contamination. Now very popular especially among homosexual and bisexual singles, it is also systematically offered in public hospitals to anyone indicating having had sex with more than 10 different partners over the last 12 months, protected or not.
“The PrEP gives users the impression that they are protected from everything, and they believe they are allowed all risky relationships, but it only protects against AIDS”, warns Jean-Paul Stahl.
Truvada pills, here in the hands of a doctor in San Francisco in May 2012, are the main drug used in pre-exposure prophylaxis (PrEP), which has been popularized in France in recent years. © Jeff Chiu/AP
The role of dating apps
But according to Pierre Tattevin, another element contributes to this increase in cases. “It is now extremely easy to find partners thanks to dating applications. And in this case, we multiply our partners while not knowing who they are, what their practices are, nor their history,” indicates the doctor, also president of the French-speaking Society of Infectious Pathology.
So many elements confirmed by the latest study. According to researchersthe vast majority of profiles most at risk of infection with gonorrhea or syphilis of the men with several partners for almost 80%as well as a history of STIs.
More broadly, men are the most affected: they represent 77% of cases of gonorrhea, and more than 90% of cases of syphilis. For the majority of these, men aged 50 and over are the most affected.
Cases of chlamydia affect more women, especially between 15 and 25 years old.
A particular concern for pregnancy
Syphilis had also disappeared from the collective imagination thanks to a safe treatment: antibiotics. “This allows for a cure, of course, and once this is done, there are no more effects or complications if the infection is detected quickly,” indicates Dr. Jean-Paul Stahl.
Except that in the absence of treatment, syphilis is not an anecdotal disease. It can damage the heart, brain and eyesight, as well as cause deafness and paralysis. Infection during pregnancy can lead to miscarriage or stillbirth. Children who survive may have vision or hearing problems, as well as severe developmental delays.
If the number of cases of syphilis increased slightly in 2021 and 2022 “among heterosexual women”, “approximately three quarters of syphilis cases affected MSM [hommes ayant des pratiques homosexuelles ou bisexuelles, ndlr]regardless of the year of monitoring”, points out the study.
The authors of the Public Health France study warn that “STIs represent a major public health problem due to their transmissibility (to partners and maternal-fetal), their frequency, and the long-term complications they induce ( chronic pelvic pain, upper genital infections, infertility, cancer, etc.) and their role in the transmission of HIV.”
“The government cannot put condoms in everyone’s hands”
According to doctors, although the rate of STI infections is increasing in France, it is also proof of a good screening system, essential to stopping an epidemic.
“When you miss one case, you end up with two additional cases, and if you miss two cases, you end up with four cases,” summarizes Dr. Jay Varma, chief medical officer of Siga Technologies and former deputy commissioner for health of New York City, in an interview with the New York Times. “This is how epidemics develop.”
“The various governments have pursued good policies in recent years, with free screening centers. We need to test even more, especially patients at risk,” summarizes Pierre Tattevin.
Beyond information campaigns, Jean-Paul Stahl insists on individual responsibility: “There is the question of everyone’s conscience. Some people use PrEP so they must know what they risk despite this. Because some people know the risks involved and take them anyway, he says. Real scientific information is always beneficial, but is it the final solution to the problem? No.”
“The government cannot put condoms in everyone’s hands,” concludes Jean-Paul Stahl.
Martin continues his conquests: sometimes protected, sometimes unprotected, but now cured.
*The first name has been changed at the request of the witness
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