In recent years, France has seen a sharp increase in sexually transmitted infections, but there is one in particular that is increasing at an alarming rate: syphilis. Experts are worried. Due to the ongoing fight against HIV, syphilis has long been relegated to a much less discussed second place in French public health policy. Meanwhile, the number of syphilis cases has skyrocketed, increasing by 110 percent between 2020 and 2022.
On the eve of Valentine’s Day, Martin* received particularly bad news from a friend: “I just got tested and you’re the only person I’ve ever had unprotected sex with. Voila“Now I have syphilis.”
Martin rushed to get tested: he tested positive. Once he got over the shock, he quickly reviewed his list of sexual partners and remembered a recent encounter with a woman with whom he had not used protection. After a brief exchange, he confirmed that she had syphilis and that she had been a carrier for some time. But like Martin, she had preferred to take the risk rather than have protected sex.
Martín’s case is not unique. According a report issued by the French health authority Santé Publique in December, sexually transmitted bacterial infections (namely chlamydia, gonorrhea and syphilis, as opposed to HIV, which is a virus) increased sharply in mainland France between 2020 and 2022.
Although chlamydia remains the most recurrent sexually transmitted infection (STI) in absolute terms, 16 percent more than in 2020, with 102 cases per 100,000 inhabitants, experts are alarmed by the sharp increase in gonococcal infections and, in particular, syphilis. The number of gonococcal infections increased by 91 percent (44 cases per 100,000 inhabitants) in the two-year period, while syphilis increased by 110 percent, to 21 cases per 100,000 inhabitants.
Syphilis first appeared in the Middle Ages. and was almost eliminated in the second half of the 20th century, but in recent years it has resurfaced in most Western countries, particularly the United States. According to the US Centers for Disease Control and Prevention, syphilis has already peaked. The 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 latest year for which data is available, the United States now has an infection rate of 17 cases per 100,000 residents, an increase of 80 percent from 2018.
PrEP, a false sense of security?
So why is this happening? Doctors say scientific advances, especially in the fight against HIV, are partly to blame. “People protect themselves less and less, partly because they are no longer afraid of AIDS, since thanks to scientific advances it is possible to lead a life without complications even if you have HIV,” said Pierre Tattevin, director of the Disease Service. Infectious. disease department of the University Hospital of Rennes, he explained.
According to most doctors, people “relax” when they no longer have to fear HIV. “That’s the negative effect of using PrEP,” said Jean-Paul Stahl, an infectious disease specialist and professor emeritus of infectious diseases at the University of Grenoble.
Homework, a pre-exposure prophylaxis, is a retroviral drug taken before any possible exposure to the HIV virus to help prevent contamination. It has become extremely popular in recent years, especially among single gay and bisexual men. The pill is routinely offered in public hospitals to anyone who reports having 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 believe that they can have all kinds of risky sex, 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 sharp increase in STIs. “It has become extremely easy to find sexual partners through dating apps. Couples multiply without knowing who they are, what their habits are or what their (sexual) history is,” said Stahl, who also chairs the French Society of Infectious Diseases (SPILF).
According to the December report by Santé Publique, men higher risk of contracting gonorrhea or syphilis, which represent almost 80% of cases, have multiple partners and a history of STIs.
More generally, men are most affected, accounting for 77 percent of gonococcus cases and more than 90 percent of syphilis cases. In most cases of syphilis, men aged 50 and older are most affected.
Chlamydia, on the other hand, affects women more, especially young women between 15 and 25 years old.
Great risk for pregnant women.
Public fear of syphilis has diminished in the last half century thanks to a safe and highly effective treatment: antibiotics. “It’s a cure, of course, and once cured, there are no further effects or complications if the infection is caught quickly,” Stahl said.
Except, if left untreated, syphilis is a very serious disease. It can damage the heart, brain and eyesight, and could even cause deafness and paralysis. An infection during pregnancy can cause miscarriage or stillbirth. Children who survive until birth may also suffer from vision or hearing problems and developmental delays.
While the number of syphilis cases only increased slightly among heterosexual women in 2021 and 2022, “about three-quarters of syphilis cases involved MSM (men who have sex with men), regardless of the year surveyed,” notes the study.
The researchers further warned that “STIs represent a major public health problem due to their transmissibility (to the partner, mother and fetus), their frequency, the long-term complications they cause (chronic pelvic pain, upper genital infections , infertility, cancer, etc.) .) and its role in the transmission of HIV”.
“You can’t give condoms to everyone”
Doctors say that although the number of recorded STI cases is increasing 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 end up with two more cases, and if you miss two cases, you end up with four,” said Dr. Jay Varma, chief medical officer at Siga Technologies and former New York deputy health commissioner. York City, he said in an interview with the New York Times. “This is how epidemics grow.”
Tattevin agreed. “Our different governments have implemented good policies in recent years, with free testing centers. We need to test even more, especially for at-risk patients,” he said.
In addition to information campaigns, Stahl insisted on personal responsibility. “Those who use PrEP need to know the risks they run. Because some know the risks involved but decide to take them anyway,” she stated. “Scientific information is always beneficial, but in the end the decision falls on each and every individual.”
“The government cannot distribute condoms to everyone,” he said.
Martín, meanwhile, continues his conquests: sometimes protected, sometimes not, but for now at least he is cured.
*Name has been changed at the person’s request.
This article was adapted from the French original.