Tag: diseases

Sounding the alarm: France sees explosion in syphilis cases

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In the past few years, France has seen a steep rise in sexually transmitted infections, but there is one in particular that is rising at an alarming rate: syphilis. Experts are worried. Due to the ongoing fight against HIV, syphilis has long been relegated to a much less talked about second place in French public health policy. In the meantime, the number of syphilis cases has exploded, soaring by 110 percent between 2020 and 2022.

On the eve of Valentine’s Day, Martin* received a piece of particularly bad news from a friend: “I’ve just been tested, and you’re the only person I have had unprotected sex with. Voilà, I have syphilis now.”

Martin rushed off to get tested: He tested positive. Once he had gotten over the shock, he quickly went through his list of sexual partners and remembered a recent encounter with a woman with whom he had not used protection. After a brief exchange, she confirmed she had syphilis and had been a carrier for some time. But just like Martin, she had preferred taking the risk rather than having protected sex.

Martin’s case is not unique. According to a report issued by the French health authority Santé Publique in December, sexually transmitted bacterial infections (namely, chlamydia, gonorrhoea and syphilis, as opposed to HIV, which is a virus) rose sharply in mainland France between 2020 and 2022.

Although chlamydia remains the most recurring sexually transmitted infection (STI) in absolute terms, up 16 percent from 2020 with 102 cases per 100,000 inhabitants, experts are alarmed by the sharp rise in gonococcal infections, and especially the huge increase in syphilis. The number of gonococcal infections jumped by 91 percent (44 cases per 100,000 inhabitants) in the two-year period while syphilis soared 110 percent, to 21 cases per 100,000 inhabitants.

Syphilis first appeared in the Middle Ages and was nearly eliminated in the second half of the 20th century, but in recent years it has resurfaced in most Western countries, particularly in the United States. According to the US Centers for Disease Control and Prevention, syphilis has now reached its highest infection rate since the 1950s, the New York Times reported in a January article.

With more than 207,000 cases diagnosed in 2022, the last year for which data is available, the US now has an infection rate of 17 cases per 100,000 inhabitants – an increase of 80 percent since 2018.

PrEP, a false sense of safety?

So why is this happening? Doctors say scientific advances, especially in the fight against HIV, are partly to blame. “People are protecting themselves less and less, in part because they’re no longer afraid of AIDS, since the scientific advances mean that it is now possible to lead an uncomplicated life even you have HIV,” Pierre Tattevin, the head of the infectious diseases department at Rennes University Hospital, explained.

According to most doctors, people “relax” when they don’t have to fear HIV anymore. “That’s the negative effect of using PrEP,” said Jean-Paul Stahl, infectiologist and emeritus professor of infectious diseases at Grenoble University.

PrEP, a pre-exposure prophylaxis, is a retroviral drug that is taken before any potential exposure to the HIV virus in order to help prevent contamination. It has become extremely popular in the past few years, especially among gay and bisexual men who are single. The pill is routinely offered in public hospitals to anyone reporting to have had sex with more than 10 different partners in the past 12 months, regardless of whether they have had protected sex or not.

“PrEP gives users the impression that they are protected from everything, and they think they can have all kinds of risky sexual relations, but it only protects them against HIV,” Stahl warned.

The danger of dating apps

But according to Pierre Tattevin, there is also another reason for the steep rise in STIs. “It’s become extremely easy to find sexual partners via dating apps. You multiply partners without knowing who they are, what their habits are, or what their [sexual] history is,” Stahl, who also presides the French Infectious Diseases Society (SPILF), said.

According to the December report by Santé Publique, the men most at risk of contracting gonorrhoea or syphilis, representing nearly 80% of cases, have multiple partners and a history of STIs.

More generally, it is men who are most affected: they account for 77 percent of gonococcal cases and more than 90 percent of syphilis cases. For the majority of syphilis cases, men aged 50 and over are most affected. 

Chlamydia, on the other hand, affects women more, especially young women aged between 15 and 25.

Great risk to pregnant women

The public fear of syphilis has diminished in the past half century or so thanks to a safe and very effective treatment for it: antibiotics. “It’s a cure, of course, and once it’s cured, there are no further effects or complications if the infection is detected quickly,” Stahl said.

Except that, if left untreated, syphilis is a very serious disease. It can damage the heart, brain and eyesight, and could go as far as to cause deafness and paralysis. An infection during pregnancy can lead to miscarriage or stillbirth. Children who survive through birth may also suffer vision or hearing problems, and developmental delays.

While the number of syphilis cases only increased slightly among heterosexual women in 2021 and 2022, “around three quarters of syphilis cases involved MSM [men who have sex with men], regardless of the year surveyed”, the study said.

The researchers further warned that “STIs represent a major public health problem because of their transmissibility (to partners and mother and foetus), their frequency, the long-term complications they cause (chronic pelvic pain, upper genital infections, infertility, cancer, etc.) and their role in HIV transmissions”.

‘Can’t hand out condoms to everyone’

Doctors say that although the number of registered STI cases is on the rise in France, it is also a testament to the fact that the country has a well-functioning testing system, which is essential to stopping an epidemic.

“When you miss one case, you then end up with two more cases, and if you miss two cases, you then end up with four,” Dr Jay Varma, chief medical officer at Siga Technologies and a former deputy commissioner of health for New York City, said in an interview with the New York Times. “That’s how epidemics grow.”

Tattevin agreed. “Our different governments have pursued good policies in recent years, with free testing centres. We need to test even more, especially patients at risk,” he said.

In addition to information campaigns, Stahl insisted on  personal responsibility. “Those who use PrEP need to know what they’re risking. Because some know about the risks involved but decide to take them anyway,” he said. “Scientific information is always beneficial, but at the end of the day, the decision comes down to each and every individual.”

“The government can’t hand out condoms to everyone,” he said.

Martin, meanwhile, continues his conquests: sometimes protected, sometimes not, but for now, at least he is cured.

*The first name has been changed at the request of the person.

This article was adapted from the original in French.

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‘Unprecedented’ situation as two African countries report outbreaks of Marburg virus

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For the first time, the world is seeing two simultaneous outbreaks of the Marburg virus – one in Equatorial Guinea, the other in Tanzania. The Marburg virus is just as deadly as Ebola, to which it is closely related, but it has been extremely rare until now.

The situation with the Marburg virus entered uncharted territory on March 21, when Tanzania announced an outbreak of the disease in addition to the one in Equatorial Guinea, on the other side of the African continent.

Five people have died out of eight confirmed cases as of April 6, according to the US Center for Disease Control (CDC), which issued a health alert warning that doctors in the US should “be aware of the potential for imported cases”, even if the risk of the disease reaching the US is low.

The situation in Equatorial Guinea currently seems the most worrying. The World Health Organisation (WHO) issued an alert on February 25 after the discovery of several suspected deaths from Marburg in two villages in the north of the country in early January.

Since the first cases appeared, there have been 15 confirmed cases of Marburg in Equatorial Guinea. According to a report by the country’s health ministry, eleven of those patients died just days after symptoms of the disease appeared – vomiting, diarrhoea, nausea and high fever.

But the WHO has concerns that the official tallies are underestimating the disease’s real toll. Indeed, the cases in Equatorial Guinea come from regions quite far from each other, which suggests there “may be undetected community spread of the virus in the country”, the CDC noted.

The WHO suspects that Equatorial Guinea is not being fully transparent in reporting cases.

“This is a problem – this unprecedented outbreak of the Marburg virus in two different countries,” said Paul Hunter, an epidemiologist at the University of East Anglia.

“There has been an acceleration in the number of Marburg virus outbreaks over recent years,” added Cesar Munoz-Fontela, a specialist in tropical infectious diseases at the Bernhard Nocht Institute for Tropical Medicine in Hamburg.

From bat caves to humans

First detected in humans in 1967 in the German city of Marburg, the virus has broken out a dozen times in Africa since the late 1970s. But until recent years, the was never more than one outbreak every three or four years.

A bat – namely the Egyptian fruit bat – is the virus’s natural host, and transmits it to humans either directly or via an intermediate host such as monkeys.

Most of these outbreaks have been small – affecting no more than a dozen people each time, according to official statistics. That is lucky because Marburg is one of the most deadly viruses along with Ebola, which also belongs to the filovirus family of diseases. The two related diseases have mortality rates as high as 90 percent.

This grim statistic was borne out in the two largest Marburg outbreaks. Between 1998 and 2000, 128 patients died out of a total of 154 confirmed cases in DR Congo. Four years later, Marburg struck Angola, killing 227 out of 252 infected patients.

Since then, specialists have concluded that it is possible to reduce the fatality rate with rapid medical intervention. But even with speedily provided care, the fatality rate is still close to 50 percent, according to the WHO.

No vaccine

Marburg is much more dangerous than Ebola because – unlike with Ebola – there is “no vaccine or post-exposure treatment”, said Munoz-Fontela. There is no vaccine because, until now, there has been “no market” for one. “Without the 2014 Ebola epidemic in West Africa, we wouldn’t have an Ebola vaccine,” he continued, referring to the Everbo jab created in 2015.

The 2014-2016 Ebola epidemic in West Africa killed more than 11,000 people.

The WHO said at the end of March that it was ready to test vaccine candidates in Equatorial Guinea and Tanzania – implementing a policy of rapid vaccine development it developed in response to the accelerating emergence of epidemics in recent years.

But this phenomenon of one new outbreak a year since 2020 may be a product of the “improved detection of infectious diseases in Africa since Ebola and Covid-19”, Hunter said.

National health authorities in Africa have become increasingly aware of the risk of such viruses spreading – and are consequently looking more actively and efficiently for potential outbreaks.

But this is not necessarily so reassuring, Munoz-Fontela pointed out, because it suggests that “we’ve missed Marburg virus outbreaks in the past”, meaning it is not as rare as previously thought.

Meanwhile, environmental conditions have become much more amenable to the spread of the virus. “Global warming and other human activities are increasing the risk of new diseases spreading,” Hunter said.

Notably, the encroachment of humans into the natural habitats of animals means that people are more readily exposed to new infectious diseases.

“In the past, a person could go into a forest, get infected by a bat in a cave, and then die far away from other people,” Hunter said. “But now the forest is retreating and humans are moving closer to animals’ natural habitats – so viruses spread more easily.”

Less transmissible than Covid-19

Scientists have suggested the same phenomenon of increased human exposure to animal habitats may have caused the emergence of Covid-19.

But there are important differences between Marburg and Covid-19. Thankfully, the outbreak of a global Marburg (or indeed Ebola) pandemic is a lot less likely than it proved to be in the case of the coronavirus.

First, Marburg only starts to become contagious at the same time symptoms start appearing, between two and 21 days after the virus has been contracted. So there is zero risk of undetected transmission by asymptomatic carriers.

Second, the Marburg virus is “much less easily transmissible than Covid-19”, Munoz-Fontela said. While the coronavirus spreads by respiratory droplets – with coughing and sneezing spreading it into the air – transmission of Marburg requires contact with the bodily fluids of an infected person.

On the other hand, it only takes a small amount of the Marburg pathogen to infect another person. “Most of the time, the disease spreads during the haemorrhagic phase of Marburg, exposing in particular healthcare workers and family members around the patient’s bedside,” Hunter noted.

Filoviruses also appear to be “more stable than coronaviruses such as Sars-CoV-2 [Covid-19],” Munoz-Fontela said. That means the virus is not likely to mutate – and that in turn means that a vaccine would not require regular updates to stay effective.

But in the meantime, development of vaccines against Marburg virus are only in the earliest stages. The WHO estimated that both ongoing outbreaks pose “moderate” risk at the regional level. “Equatorial Guinea has porous borders with Cameroon and Gabon, and so far the cases have appeared in geographically diffuse parts of the country. In Tanzania, the Kagera region has busy borders with Uganda, Rwanda and Burundi,” The New York Times noted.

The next few weeks will prove illuminating about how much the disease has spread, Hunter concluded: “No new cases have been reported, but it will take as long as three weeks to find out if contacts of the previous recorded cases have been infected.” 

This article was translated from the original in French.

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