A new report finds most STIs in Australia remain undiagnosed and untreated, highlighting a need to increase STI testing across the country.
New data released today by the Kirby Institute at UNSW Sydney reveals how the COVID-19 pandemic has impacted testing and diagnoses of sexually transmissible infections (STI) in Australia.
The report, titled “HIV, viral hepatitis and sexually transmissible infections in Australia: Annual surveillance report,” shows that in 2021 there were 86,916 diagnoses of chlamydia in Australia, 26,577 of gonorrhea and 5,570 of infectious syphilis.
says Dr. Skye McGregor from the Kirby Institute, one of the report’s authors.
Most STIs remain undiagnosed: Test, test, test
According to modeling in the report, most STIs in Australia remain undiagnosed and untreated, highlighting a need to increase STI testing across the country. More than one in 25 young people aged between 15–29 in Australia had chlamydia during 2021 but less than a third of those young people received a chlamydia diagnosis.
"But based on Medicare testing data, between 2019 and 2021, the number of people aged 15 to 24 years getting a chlamydia or gonorrhea test declined by 14% in Australia. It's important we encourage people who have deferred or interrupted their sexual health care to get tested,"
says Dr. McGregor.
The frequency of testing depends on your risk behavior, says Professor Basil Donovan who is a sexual health physician and heads up the Sexual Health Program at the Kirby Institute.
Concern over multiple syphilis outbreaks
Syphilis diagnoses have been increasing in Australia since 2011, initially with outbreaks among gay and bisexual men in cities and among Aboriginal and Torres Strait Islander people in regional and remote areas of central, northern and western Australia.
The report also reveals a dramatic increase in syphilis among women of reproductive age in both Aboriginal and Torres Strait Islander women (four-fold) and non-Indigenous women (eight-fold), over the 10-year reporting period.
says Dr. McGregor.
Congenital syphilis occurs when syphilis is transmitted during pregnancy to an unborn child. Between 2012 and 2019, diagnoses were low, ranging from 0 to 8 each year. In 2020 and 2021 there were 17 and 15 congenital syphilis diagnoses, respectively, representing a considerable increase. In 2021, 60% of congenital syphilis diagnoses were among Aboriginal and Torres Strait Islander babies, who make up approximately 5% of newborns.
"With timely screening, syphilis can be cured, so even one case of congenital syphilis is completely avoidable and unacceptable. At the Kirby Institute, we're working with our partners to understand what proportion of pregnant women are not receiving adequate antenatal STI screening,"
Dr. McGregor says.
Good news for genital warts
Diagnoses of genital warts at first sexual health clinic visit are tracked as a marker of infection with human papillomavirus (HPV). In 2021, diagnoses of genital warts among non-Indigenous people aged under 21 years declined to less than 1% among female clinic attendees, or five diagnoses overall, and 0% among heterosexual male clinic attendees, or no diagnoses overall—reflecting the success of Australia’s HPV vaccination program.
STIs higher among Aboriginal and Torres Strait Islander populations
In 2021, rates of diagnoses of STIs among Aboriginal and Torres Strait Islander people remained much higher than among the non-Indigenous population, with rates of gonorrhea and syphilis more than five times as high, and rates of chlamydia more than three times as high.
Robert Monaghan, a Bundjalung-Gumbaynggir man and Manager of Aboriginal and Torres Strait Islander health research at the Kirby Institute, says,
Mr. Monaghan says that the success in driving down other STIs is cause for optimism about what can be achieved working in partnership with Aboriginal communities.
Gonorrhea and syphilis increasing in gay and bisexual men
While HIV has been declining among Australian-born gay and bisexual men thanks to high coverage of the HIV prevention medication pre-exposure prophylaxis and use of treatment as prevention, gonorrhea and syphilis diagnoses have been increasing in recent years among this population.
says Professor Andrew Grulich from the Kirby Institute.
The number of gay and bisexual men attending sexual health clinics and getting tested for STIs declined between 2019 and 2021. Professor Grulich says that while it made sense that there was a reduction in testing during the pandemic when people were having less casual sex,
"We've had tremendous success in HIV prevention. We need to carry this over to STIs, to drive down infections among this group."