Why is France experiencing an explosion of syphilis cases?

While most sexually transmitted infections are on the rise in France, the rise in the number of syphilis cases is particularly worrying for experts. In the background of prolonged public policies, especially in the face of the HIV epidemic, this bacterial infection increased by 110% between 2020 and 2022.

A few days before Valentine’s Day, there are surprises we want to do without. Martin* has just received bad news from a close friend, with whom he had sex: “I just got tested, you’re the only person I haven’t protected myself with. And here it is, now I have syphilis. is.”

Martin rushes to get tested: positive for syphilis. Once the shock has passed, he quickly goes back through his multiple partners and recalls a recent adventure, also unsafe. After a brief exchange, this partner confirms that she has been taking it for some time. But like Martin, she prefers to take risks rather than have safe sex.

Martin’s case is not unique. According to the latest Public Health France report from December 2023, between 2020 and 2022 sexually transmitted infections (STIs) of bacterial origin, chlamydia, gonococci and syphilis, the virus that is HIV, have increased sharply in mainland France.

If chlamydia remains the most frequent STI in specific statistics (+16% compared to 2020, with 102 cases per 100,000 inhabitants), the evolution of gonorrhea and especially syphilis alarm experts. The incidence of gonorrhea increased by 91% (with 44 cases per 100,000) and syphilis by 110% to 21 cases per 100,000.

appeared in the Middle Ages, syphilis was nearly eradicated by the late 20th century. But it has re-emerged in recent years in most Western countries, particularly the United States. According to the Agency for Disease Control and Prevention, infections of the disease have reached their highest rate since the 1950s, the New York Times reported in January.

With more than 207,000 cases diagnosed in 2022, the latest year for which data are available, the United States now has 17 cases per 100,000 residents, an 80% increase from 2018.

PrEP, the false miracle solution

At the root of the phenomenon? The scientific advances used to fight AIDS, in particular, are convincing to doctors as a whole. “People protect themselves less and less, because they are no longer afraid of AIDS, because with scientific progress, it is now possible to live without complications while carrying HIV,” summarizes Pierre Tatevin, head of the Department of Infectious Diseases. Rennes University Hospital.

According to many doctors, once the fear of HIV disappears, people “let go.” “PrEP also has a perverse effect,” points out Jean-Paul Stahl, an infectious disease specialist and professor emeritus of infectious diseases at the University of Grenoble.

Also readAgainst HIV, PrEP is both a solution and a problem

PrEP (for Pre-Exposure Prophylaxis) is a retroviral drug used before potential exposure to HIV (the virus that causes AIDS), thus preventing any contamination. Now particularly popular among homosexual and bisexual singles, it is also offered systematically in public hospitals that indicate having had sex with more than 10 different partners in the last 12 months, safe or not.

“PrEP gives users the impression that they are protected from everything, and they believe they are allowed all risky relationships, but it only protects against AIDS,” warns Jean-Paul Stahl.

Truvada pills, in a doctor's hand here in San Francisco in May 2012, are the main drug used in pre-exposure prophylaxis (PrEP), which has become popular in France in recent years.
Truvada pills, in a doctor’s hand here in San Francisco in May 2012, are the main drug used in pre-exposure prophylaxis (PrEP), which has become popular in France in recent years. © Jeff Chiu/AP

The role of dating apps

But according to Pierre Tettevin, another element is contributing to this increase in cases. “Finding partners is now extremely easy thanks to dating apps. And in this case, we multiply our partners when they don’t know who they are, what their practice is or their history,” suggests the doctor, who is also president of the French- . Society of Infectious Pathology.

Many elements confirmed by recent studies. According to researchers, most of the profiles at highest risk of gonorrhea or syphilis infection are men with multiple partners (about 80%), as well as a history of STIs.

More broadly, men are the most affected: they represent 77% of gonorrhea cases and more than 90% of syphilis cases. For most of these, men aged 50 and above are most affected.

Chlamydia cases affect more women, especially between the ages of 15 and 25.

Special concern for pregnancy

Safe Treatment: Syphilis also disappeared from the collective imagination thanks to antibiotics. “Of course, this allows for a cure, and once this is done, there are no further effects or complications if the infection is detected quickly,” Dr. suggests Jean-Paul Stahl.

Except that in the absence of treatment, syphilis is not an unpleasant disease. It damages the heart, brain and eyesight, as well as causing deafness and paralysis. Infection during pregnancy can lead to miscarriage or death. Children who survive may have vision or hearing problems, as well as severe developmental delays.

If the number of syphilis cases “among heterosexual women” increased slightly in 2021 and 2022, “more than three-quarters of syphilis cases were among MSM (men who practice homosexual or bisexuality, editor’s note), whatever the “surveillance year” is outside the study.

The authors of the Public Health France study warn that “STIs represent a major public health problem due to their transmissibility (for partners and mother-fetus), their frequency and long-term complications (chronic pelvic pain, upper genital infections). , infertility. , cancer, etc.) and their role in the transmission of HIV.”

“Government can’t put condoms in everyone’s hands”

According to doctors, although the rate of STI infections in France is increasing, it is proof of a good screening system, which is necessary to prevent the epidemic.

“When you miss one case, you end up with two additional cases, and if you miss two cases, you end up with four cases,” Dr. Jay Verma, Chief Medical Officer of Siga Technologies and former Deputy Commissioner for New Health, summarizes. York City, in an interview with the New York Times. “This is how epidemics develop.”

“Various governments have adopted good policies in recent years, with free screening centers. We still need to test more, especially patients at risk,” summarizes Pierre Tettevin.

In addition to the information campaign, Jean-Paul Stahl emphasizes personal responsibility: “It is a question of everyone’s conscience. Some people use PrEP so they should be aware of the risks they are taking despite this. Because some people know the risks involved and take them anyway, he says. Real scientific information is always beneficial, but is it the ultimate solution to the problem? No.”

“Governments cannot put condoms in everyone’s hands,” concluded Jean-Paul Stahl.

Martin continues his conquests: sometimes safe, sometimes unsafe, but now healed.

* First name has been changed at the request of the witness

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