Rates of sexually transmitted infections are rising

In June 2023, the UK Health Security Agency reported a 23.8% increase in sexually transmitted infection (STI) diagnoses in 2022 compared with 2021,1 including for chlamydia (24.3%), gonorrhoea (50.3%), and syphilis (15.2%). Most of the syphilis infections occurred in men who have sex with men.1 These increases exceed the 13.4% rise in STI testing in 2022 compared with 2021,1 indicating true increases in transmission, not better case finding from more testing. Similar trends have emerged in the United States—where the number of syphilis diagnoses rose by 28.6% and gonorrhoea by 4.6% in 2020-21 compared with 20192—and in Canada, where rates of syphilis rose by 20% in 2020-21.3

This situation is important for a few reasons. Firstly, STIs cause harm, including pelvic inflammatory disease, disseminated gonococcal infection, and neurosyphilis.14 Secondly, drug resistant gonorrhoea is now being reported internationally,24 showing the spread of antimicrobial resistance. Thirdly, in Canada and the US, growth in the incidence of syphilis among gay, bi, and queer men has been followed by increases more broadly, including in congenital …