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Gonorrhoea and Syphilis Cases at Record Levels in 2022

Editor's note: This article was updated with additional information on the antibiotic resistant strain of Neisseria gonorrhoeae.

Data from the UK Health Security Agency (UKHSA) showed record numbers of cases of gonorrhoea and syphilis were diagnosed in 2022. Gonorrhoea, in particular, had the highest number of diagnoses since records began in 1918, while syphilis cases were the highest they have been since 1948.

Today's figures showed that gonorrhoea cases increased to 82,592 in 2022, an increase in 50.3% compared to 2021 (54,961), and 16.1% higher than prior to the coronavirus pandemic in 2019. Infectious syphilis diagnoses increased to 8692 in 2022, 15.2% higher than 2021 (7543), and an increase of 8.1% compared to 2019.

The Agency said that the increase in cases was partly due to an increase in testing, but also "the scale of the increase in diagnoses strongly suggests that there is more transmission of STIs within the population". 

Without antibiotic treatment, sexually transmitted infections (STIs) some can cause serious health problems. Chlamydia and gonorrhoea can cause infertility and pelvic inflammatory disease, while syphilis can lead to serious, irreversible, and possibly life-threatening issues with the brain, heart, or nerves.

More Than 400 Diagnoses Per Day of STIs in Young People

Overall, young people aged 15-24 are the most likely to be diagnosed with an STI. Last year, there were more than 400 diagnoses of STIs made each day among young people, said the UKHSA.

Due to the serious health concerns caused by syphilis, the Agency wanted to alert healthcare professionals to look out for signs of infection.

Dr Hamish Mohammed, consultant epidemiologist in the STI section at UKHSA, said: "We are alerting healthcare professionals, whatever your specialty, to be aware that syphilis remains a concern and diagnosis rates are rising in adults of all ages. Syphilitic complications present in many different ways so, given the increase in diagnoses in the population, it's important to consider syphilis on the differential diagnosis for compatible illness."

President of the British Association for Sexual Health and HIV (BASHH), Dr Claire Dewsnap, said: "The rates of syphilis are increasing in all genders. Specialist GUM services are seeing a significant increase in presentations of both asymptomatic syphilis and, more worryingly, complex secondary and neurosyphilis. This means people are going undiagnosed and may be left with long term sequelae."

They said healthcare personnel should be on the lookout for syphilis if patients complain of unexplained:

  • Ulcer

  • Rash 

  • Swollen lymph nodes (anywhere on the body) 

  • Headache

  • Abnormal LFTs

  • Rapid onset visual disturbance

  • Glandular fever-like symptoms

"If you see any pregnant woman with an unexplained rash, consider repeating a syphilis test. Always check for syphilis If you are checking for HIV and other BBVs," stressed Dr Dewsnap. "If you have concerns about a patient or a positive result, please speak to your local GUM service."

Increase in STI Testing

Last year there were almost 2.2 million sexual health screens performed by sexual health services, an increase of 13.4% over 2021 (1.9 million).

One of the reasons for the increase in gonorrhoea infections is that the bacteria is becoming increasingly resistant to antibiotics, UKHSA said. Because of this, they stressed the importance of testing early and diagnosing the infection so transmission can be prevented. A strain of antibiotic-resistant Neisseria gonorrhoeae was discovered in December 2021 in a heterosexual man living in the UK. The strain was resistant to ceftriaxone, which is the standard first-line treatment for gonorrhoea, following years of rising resistance of N gonorrhoeae to other antibiotics.

The Agency advocates regularly testing for STIs and HIV, on "at least" an annual basis, for anyone having unprotected sex with new or casual partners. In addition, they advise that sexually active women under the age of 25 should test annually for chlamydia, and gay, bisexual, and other men who have sex with men should test every 3 months if having condomless sex with new or casual partners.