Gonorrhea cases spike among young women in Europe, new study reveals
A sharp increase in gonorrhea cases has been observed among young women across 15 European countries in 2022 and 2023. Among young men, gonorrhea cases have increased at a relatively smaller magnitude.
A detailed report is published in the journal Eurosurveillance.
Rapid communication: Sharp increase in gonorrhoea notifications among young people, EU/EEA, July 2022 to June 2023. Image Credit: Kateryna Kon / Shutterstock
Background
Gonorrhea is a sexually transmitted bacterial infection that primarily occurs in the genitals, rectum, and throat. Mostly, young people aged 15 to 24 years get this infection through their involvement in sexual activities with infected persons. A pregnant woman with gonorrhea infection can also transmit the bacterium to the infant during childbirth.
The European Center for Disease Control and Prevention (ECDC) has reported an increase in gonorrhea cases in early 2022 among young people residing in four countries in the European Union (EU) and European Economic Area (EEA). The gonorrhea incidence started to increase during the second half of 2022 and exceeded the incidence rate reported before the coronavirus disease 2019 (COVID-19) pandemic.
In this study, scientists have determined the magnitude of the increase in gonorrhea cases in 2022 and 2023 and have assessed in which countries the increase is significant.
Study design
Given the increase in gonorrhea cases, the ECDC invited countries to submit preliminary data on diagnosed cases for the first six months of 2023. A total of 17 countries submitted data from January to June 2023.
A total of 15 countries consistently reported gonorrhea incidence for five years before the start of the pandemic (2020) and in 2022 – 2023. Data from these countries was used to estimate gonorrhea prevalence among women.
The prevalence among men was determined by distinguishing them based on their modes of infection transmission (heterosexual and homosexual transmission). Nine countries that reported the mode of infection transmission in more than 45% of male gonorrhea cases during 2015 – 2019 and 2022 – 2023 were selected for the analysis of gonorrhea prevalence among men.
Important observations
A sharp increase in gonorrhea cases was observed in mid-2022 among women aged 20 to 24 years. The increase was relatively lower among women aged 15 to 19 and 25 to 29.
These increases were similar to that observed in mid-2022 among 20–24-year-old and 25–29-year-old men with heterosexual mode of transmission. Among men with homosexual mode of transmission, a gradual increase in gonorrhea cases has been observed since 2015 for all age groups, except for those aged 15 to 19 years.
Among women aged 20 to 24 years, gonorrhea cases increased by 73% and 89% than the expected prevalence (based on 2015-2019 historical data) from July to December 2022 and January to June 2023, respectively. The exceedances in reported cases were relatively smaller among women aged 15 to 19 and 25 to 29.
Among men infected through heterosexual mode of transmission, the highest exceedance (36%) was observed in the first six months of 2023. Overall, the exceedances among these men were of smaller magnitudes than that observed among young women.
A country-level analysis conducted on women aged 20 to 24 showed more than 100% exceedances in Denmark, Iceland, Ireland, the Netherlands, Norway, Portugal, and Slovenia during the second half of 2022 or the first half of 2023.
In Spain, about 116% and 98% exceedances were observed in 2022 and 2023, respectively. The exceedances were smaller in magnitude in Finland, Italy, and Sweden. No exceedance was observed in Estonia, Hungary, and Latvia.
Study significance
The study finds a significant increase in gonorrhea cases among young women in several EU/EEA countries during 2022 – 2023. Although data for 2023 is preliminary, the observed increase is concerning as gonorrhea infection can lead to several health complications, including pelvic inflammation, chronic pain, and subsequent infertility.
National experts have stated in a series of ECDC-organized meetings that changes in sexual behaviors, such as the number of sexual partners, types of sexual practices, and condom use, could be responsible for the recent increase in gonorrhea cases.
Another possibility is that the Neisseria gonorrhea lineages responsible for the increased incidence cause no or low-grade symptoms, making it difficult to diagnose the infection in a timely manner and prevent infection transmission between people. The lineages could also be more transmissible than previously circulating lineages.
The study findings highlight the need for increasing awareness among young people about the risks of sexually transmitted infections. Awareness campaigns should particularly highlight the benefits of safe sexual practices and routine testing.
