This worries doctors This sexually transmitted disease that grows among young people

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Franco suspected that something was not right when he found a painless pimple in his genital area. In less than a week, that first symptom disappeared to give way to red spots on his chest. Although they did not cause him any kind of discomfort, he decided to investigate on the internet and got scared: the results found suggested that he could have HIV (human immunodeficiency virus). It was at that moment – April 2019 – that he decided to consult a specialist who diagnosed him with syphilis. “He was surprising but relieving,” Franco told LA NACION, who was 32 years old at the time.

Franco’s case — his name has been changed to preserve his identity — is not an isolated one. “In recent times there has been a sustained increase in sexually transmitted infections (STIs) in our country and in the world. One of the ones that increased its incidence the most was syphilis,” said Claudia Salgueira, president of the Argentine Society of Infectious Diseases (SADI).

“Although there are no complete statistics in our country, different sources show a rising trend of the most frequent STIs such as syphilis, gonorrhea, chlamydia trachomatis, trichomoniasis, herpes simplex and human papillomavirus (HPV). Others, such as HIV and hepatitis B and C viruses, remain stable or declining,” said Adriana Durán, coordinator of the Epidemiology Area of ​​the Ministry of Health of the city of Buenos Aires.

After the diagnosis—early, in this case—Franco was able to get treatment. Based on the tests carried out, they gave him a single intramuscular injectable dose of penicillin and that was enough for the spots to disappear in just over two weeks. However, during the first year he had to be monitored every three months and, after that time, he was able to stretch the checkups to twice a year.

“STIs are basically treated with antibiotics and, in the case of primary syphilis, it is cured with a single dose of injectable penicillin. Hepatitis B and C are curable with antiviral treatment. There is no cure for HIV, but it is controlled with antiretroviral treatment that keeps the viral load undetectable, avoiding immune deterioration and sexual transmission,” Durán explained.

In addition to personal care, Franco had to notify his sexual partners. The specialists with whom he was treated recommended that he review his sexual encounters up to three months before finding the first symptom. “There were three couples with whom I did not take care of myself in that period. I was able to talk to one of them without problems and the other two stopped responding to me”, Franco was honest, specifying that the person with whom he was able to continue in dialogue “was not infected”.

In the latest newsletter published by the Ministry of Health of the Nation last December, “Response to HIV and STIs in Argentina”, it is noted that the age group with the highest incidence in tests studied during 2020 is 15- 24 years with 28.6% positivity. However, the age group between 25-34 years old obtained 23.5% positivity, adding between both groups a total of 51.5% of positive tests.

“It is essential to emphasize prevention and awareness actions, emphasizing the young group who are the most vulnerable,” said Salgueira.

The causes

For María Marta Greco and Romina Mauas, coordinator and secretary, respectively, of the SADI HIV and STI commission, “the increase in STIs is multifactorial.” In this sense, the specialists listed as possible causes: “Changes in people’s sexual behavior such as the influence of recreational drugs (chemsex phenomenon), risky sexual practices, less fear of acquiring HIV associated with the paradigm ‘undetectable=untransmittable ‘, the use of PreP (pre-exposure prophylaxis), little information on reproductive sexual health and budget cuts for sexual health services”.

It is known as chemsex —sexodoping in Spanish— sexual practices that introduce drugs to facilitate or intensify sexual activity.

Salgueira agreed with Greco and Mauas. “There are some reasons that could explain this increase, including changes in sexual behavior, the use of designer drugs and the reduction of protection measures in sexual relations,” said the specialist, while deepening that narcotics “cause a decrease in the perception of risk.”

Reduced fear of contracting HIV and the use of PrEP

“Another thing that can lead to an increase in cases is the fact that a patient who is HIV positive but is on treatment and with undetectable viral loads is not contagious. If I am not afraid of HIV, I do not use a prophylactic and I expose myself to the rest of the STIs”, explained the head of Internal Medicine of the German Hospital, Cristina Freuler, to LA NACION

The use of PrEP is closely related to this phenomenon. “It is one of the HIV prevention strategies in which people who do not have HIV, but who have practices that can expose them to the transmission of the virus, take an antiretroviral drug and thus reduce the possibility of acquiring it,” reports the Fundación Huésped in his web page.

Freuler explained that the use of this drug “involves taking medication, very similar to that taken by patients with HIV infection, which greatly reduces the chances of infection. By using PrEP, you stop using the prophylactic, which is what protects against the rest of the STDs.”

And he added: “The recommendations for those who use PrEP is always to continue using condoms.”

Although PreP is not available in Argentina as a public policy, “many patients buy the medication themselves and use it,” said Salgueira.

How to avoid transmission

“We say that they are transmitted and not that they are spread because they require sexual contact through fluids in most cases, unlike respiratory viruses that are spread by flügge droplets without physical contact,” Durán explained.

The use of “barrier methods” or prophylactic is essential. Along the same lines, the president of the SADI emphasized: “It is very important to highlight the hierarchy of carrying out health checks on asymptomatic people.”

For their part, Greco and Mauas list a series of actions to be considered by public policy makers and medical institutions:

Educate and advise people on how to avoid STIs by changing sexual habits and approaching prevention services

Vaccinate the population (hepatitis B, HPV)

Diagnose asymptomatic and symptomatic infected people in a timely manner

Apply rapid treatment and follow-up of people with STIs and evaluate their sexual partners

Meanwhile, Durán added: “An expansion of the supply of services is required with greater access to timely diagnosis and treatment, avoiding stigmatization, discrimination, inequalities and the criminalization of the most vulnerable populations that increase the risk of infection.”

What happened during the pandemic

In the last informative bulletin released by the Ministry of Health of the Nation in relation to syphilis and HIV, it is detailed that during 2020 there was a sharp drop in the notification of all sexually transmitted events. Focusing on the rate of syphilis, in the general population there was a drop of more than 59%. However, the report warns that these numbers should not be taken as an absolute product of the pandemic.

“Since 2010, the incidence rate of syphilis at the national level grew steadily, very markedly in the last five years, until its peak in 2019 with 56.12 infected people per 100,000 inhabitants for both sexes throughout the country. In 2020, this rate was reduced to 22.84 people per 100,000 inhabitants, a figure that must be taken with caution due to the decrease in diagnosis and notification due to the epidemiological context linked to the Covid pandemic,” Durán warned.

Along the same lines, Freuler said: “It is difficult to have accurate data because there is a lot of underreporting. There were many people who stopped getting checkups and controls. It seems more important to me to see the evolution of syphilis cases in pregnant women since every pregnant person must be studied by law.

When the data on which the specialist from the German Hospital focuses is reviewed, it is evident that the cases of syphilis in pregnant women continued to increase during the health emergency, sustained since 2015.

“The percentage of positivity (in pregnant women) was 5.5%, almost 20% above what was registered in the previous year,” was specified in the report released by the national health portfolio.

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