1. The Epidemiology of STIs in the HIV and AIDS Era
A/Prof Darren Russell
Cairns Sexual Health Service
James Cook University

2. Conflict of Interest
No conflicts of interest to declare

3. Epidemiology of STIs versus HIV
You only find what you look for…
Generally poorer testing and notification systems for STIs
Many countries have no STI surveillance system in place
Where data exists, it may be patchy, or not current
STIs are ‘the poor cousins’ of HIV

4. WHO regional estimates of new cases of 4 curable STIs
Figure 1
WHO regional estimates of new cases of 4 curable STIs
Data are estimated numbers of incident cases in millions for chlamydia, gonorrhoea, syphilis, and trichomoniasis in 2012, by WHO region.
The Lancet Infectious Diseases  , e235-e279DOI: ( /S (17) )

5. Historic Trends in Gonorrhoea in the UK
Penicillin G
AIDS
Hughes and Field, Future Microbiol. (2015) 10(1), 35–51

6. Crude mortality rates for syphilis and AIDS USA 1900-1996

7. Syphilis diagnoses in high income countries
USA
Canada
Sweden
Germany

8. Reported STIs in France: National Data for Syphilis and Gonorrhoea
increasing at an alarming rate among MSM
INVS Santé Publique France 2016

9. Syphilis incidence in two MSM cohorts in Sydney
HIM (HIV neg)
pH (HIV pos)
Incidence per 100 person years
0.5
3.6
95% confidence interval
After adjusting for age: HR if HIV+ 9.2 (95% CI, )
Jin F et al. Sexual Health 2009; 6: 281

10. New diagnoses of STIs from 1996 to 2015 in MSM in England
Figure 10
New diagnoses of STIs from 1996 to 2015 in MSM in England
New diagnoses of HIV infection, early syphilis, gonorrhoea, and chlamydia
Data are new diagnoses from 1996 to 2015 in men who have sex with men (MSM) in England.402–406 Early syphilis includes primary, secondary, and early latent infections. New diagnoses of bacterial STIs and HIV were stable immediately after the introduction of cART and cPEP. Syphilis and HIV increased from 2000 onwards. Publication of the Swiss statement407—that people taking cART with suppressed viral load do not need to use condoms—coincided with increases in new diagnoses of gonorrhoea and chlamydia and further increases in syphilis, but no change in HIV infections. These trends have continued since the introduction of the TasP recommendation and the PROUD trial.408 PROUD=PRe-exposure Option for reducing HIV in the UK, immediate or Deferred trial. cART=combination antiretroviral therapy. cPEP=combination post-exposure prophylaxis. TasP=treatment as prevention.
The Lancet Infectious Diseases  , e235-e279DOI: ( /S (17) )

11. Reported STIs in the US: National Data for Chlamydia, Gonorrhoea and Syphilis
2015: Second year in a row with an increase in all 3 STIs
1.5 million cases of chlamydia, 400,000 gonorrhoea and 24,000 syphilis, increasing “at an alarming rate” among MSM
CDC fact sheet October 2016

12. PrEP and STIs The QPrEPd study is based in Queensland, Australia
>1800 MSM on PrEP at 22 sites
STI rate at entry = 12.4%
At 3 months =12.1%
At 6 months = 13.3%
At 12 months = ??

13. Condom use for anal sex in MSM in Sydney, 1997-2016
Figure 11
Condom use for anal sex in MSM in Sydney,
Condom use for anal sex in men who have sex with men
Data are for Sydney, Australia, in 1997–
The Lancet Infectious Diseases  , e235-e279DOI: ( /S (17) )
Copyright

14. Infectious syphilis in Queensland by Indigenous status, 2002-2016
Source: NOCS, Australia

15. Proportion of Australian born women diagnosed with genital warts at first visit, by age group,
85%
96%
Ali H et al. BMJ 2013 (extended data)

16. Acknowledgements Pr Jean-Michel Molina (Paris)
Prof Basil Donovan (Sydney)
Simon Doyle-Adams, Michael Rodriguez, Rohan Pratt (Cairns)