The Changing Spectrum of Sexually Transmitted Infections in Europe
As long as 400 years ago, syphilitic ulcers and gonococcal discharge were observed in connection with sexual intercourse. War, poverty, and lack of efficient therapeutic options led to a high incidence of venereal diseases, many of which had devastating outcomes. This situation continued until the beginning of the 20th century, when the microbial aetiology of venereal diseases was discovered. The infection rate dropped with the availability of antibiotic therapy after the Second World War. However, since the beginning of the 21st century, a steady increase in sexually transmitted infections (STIs) has been recognized worldwide. The number of reported cases of syphilis is increasing in Europe, especially in men having sex with men (MSM). Antibiotic resistance in several genital pathogens, such as Neisseria gonorrhoeae and Mycoplasma genitalium, causes therapeutic problems. Viral genital infections have become a therapeutic challenge, especially for prevention of STIs. Due to better knowledge of the long-term consequences of STIs and the connection between genital cancer and papillomavirus infections, sexual health services with screening programmes have been established in many European countries. There is general awareness of the importance of human papilloma virus vaccination programmes for young adolescents as a preventive strategy for genital cancer.
Sexually transmitted infections (STIs) refer to a broad spectrum of bacterial, fungal, viral and protozoal infections that share a common mode of transmission through sexual contact. While syphilis was recognized as long ago as 1496, it took several centuries to detect Treponema pallidum as the agent, and to describe Neisseria gonorrhoeae as the cause of gonorrhoea. Discovery of penicillin, and molecular biological diagnostic advances, were enormous steps forward in the control of STIs, leading to a decrease in the reported numbers of infections worldwide. However, the development of antibiotic resistance in gonococci, and the emergence of new viral infections, such as genital herpes, human papilloma virus and HIV/AIDs, have changed the pattern of STIs. Despite efforts to prevent, diagnose, and treat STIs, they remain a major problem.