Record STI levels in Europe:: Gonorrhea, syphilis, and congenital syphilis cases hit all-time highs in 2024 across the EU/EEA, with congenital syphilis cases nearly doubling from 78 to 140 in a single year ([ECDC data](https://www.ecdc.europa.eu?ref=yanuki.com)).
Drug-resistant gonorrhea is a growing concern:: With 82 million new cases globally in 2020, extensively drug-resistant strains detected in Cambodia have spread to France and Australia. Only one last-resort antibiotic (ceftriaxone) remains effective, and resistance to it is rising.
Why this matters:: The STI surge signals that AMR is spreading in the community, not just in hospitals. Drug-resistant bacteria now move through routine interactions, travel, and dense urban populations globally.
New Salmonella discovery offers hope:: Researchers at the University of Vermont found that intestinal epithelial cells use a metal transporter (SLC11A2) to starve Salmonella of iron and manganese, limiting bacterial growth — a natural defense mechanism that could inspire novel treatments for foodborne and other bacterial infections.
The sharp rise in sexually transmitted infections across Europe is not the result of a single cause. Compiled by Yanuki using the latest trends and data, the analysis reveals a convergence of factors:
1. The End of Fear of HIV
Antiretroviral therapy (ART), introduced in 1996, transformed HIV from a deadly disease into a manageable chronic condition. While this was a medical triumph, it also removed a powerful behavioral deterrent. Studies from Brazil (2004) confirmed that 0% to 55% of new bacterial STI cases could be attributed to reduced fear of HIV, as condom use declined.
2. Risk Compensation and PrEP
HIV pre-exposure prophylaxis (PrEP) offers reliable protection against HIV, but researchers at the University of Melbourne documented a "risk compensation" effect: reduced condom use among PrEP users led to higher rates of gonorrhea, chlamydia, and syphilis. A Madrid study (2017–2019) found that STI incidence among PrEP users was very high, particularly for rectal gonorrhea.
3. Chemsex and Psychoactive Substances
The rise of chemsex — the deliberate use of drugs to enhance sexual experiences — is amplifying transmission. In Spain, 89% of PrEP users reported using psychoactive substances. Austrian researchers found that those engaging in chemsex had significantly higher rates of gonorrhea (38% vs. 21%) and syphilis (17% vs. 5%).
4. Funding Cuts and System Failures
Following the 2008 financial crisis, many European countries cut funding for sexual health services. The UK eliminated contact tracing positions and scaled back outreach to high-risk groups. Meanwhile, 8 European countries have reported shortages of benzathine penicillin — the gold-standard treatment for syphilis — due to global supply chain vulnerabilities.
5. The Post-COVID Rebound
During COVID-19 lockdowns, STI cases fell sharply — but transmission likely continued undetected. Once restrictions lifted, cases surged. In Spain (2021), gonorrhea rose by 49%, HIV by 45%, chlamydia by 39%, and syphilis by 32%. Among women aged 20–24, gonorrhea rates rose by nearly 200% between 2021 and 2023.
6. Detection Gaps and Inequality
Men who have sex with men (MSM) account for 62% of gonorrhea and 69% of syphilis cases in the EU/EEA — but this overrepresentation may reflect higher testing rates rather than true prevalence. In contrast, 50–80% of gonorrhea and syphilis cases in women are asymptomatic, leading to underdiagnosis. Marginalized groups — Roma communities in Bulgaria, migrant sex workers in the Netherlands, and trafficking victims — face severe barriers to screening and care.
While the STI data paints a troubling picture, research from the University of Vermont's Larner College of Medicine offers a promising counterpoint. Published in the *Proceedings of the National Academy of Sciences*, the study reveals that intestinal epithelial cells actively starve *Salmonella* bacteria of essential metals (iron and manganese) using a transporter called SLC11A2.
How It Works:
When *Salmonella* breaches the intestinal barrier, host cells pump these trace metals away from the bacteria, restricting their growth. Using specialized fluorescent sensors, researchers traced exactly where this "nutritional immunity" occurs in the gut.
Why This Matters:
*Salmonella* sickens more than one million Americans each year and can become life-threatening in children, the elderly, and immunocompromised individuals. By understanding how the body naturally limits bacterial growth, scientists can develop drugs that enhance this metal-starvation mechanism — offering a novel approach to treating infections without relying on traditional antibiotics, which are losing effectiveness worldwide.
Next Steps:
Researchers plan to examine dozens of other metal transporters in the gut to determine whether they also contribute to pathogen control, potentially unlocking a whole new class of treatments for diarrheal and foodborne illnesses.
Why are STIs rising so sharply in Europe right now?
Multiple factors are converging: reduced fear of HIV (due to effective antiretroviral therapy), risk compensation among PrEP users (less condom use), the rise of chemsex, post-COVID behavioral rebounds, funding cuts to sexual health services, and unequal access to testing and care across different populations.
What makes drug-resistant gonorrhea so dangerous?
*Neisseria gonorrhoeae* has developed resistance to nearly all antibiotics used against it. Only one last-resort drug (ceftriaxone) remains broadly effective, and resistant strains are emerging. Gonorrhea is in danger of becoming one of the first diseases to become untreatable.
How does the new Salmonella research help fight antimicrobial resistance?
The discovery reveals that human intestinal cells use a metal transporter (SLC11A2) to starve *Salmonella* of iron and manganese, limiting bacterial growth. This "nutritional immunity" mechanism could be targeted by new drugs that enhance the body's natural defenses, reducing reliance on traditional antibiotics.
Who is most affected by the STI surge?
Men who have sex with men (MSM) account for the majority of reported cases, though this partly reflects higher testing rates. Women are significantly underdiagnosed due to asymptomatic infections. Marginalized groups — including Roma communities, migrant sex workers, and trafficking victims — face the greatest barriers to care and the highest risks.
Get tested regularly:: Many STIs are asymptomatic, especially in women. Routine screening is the only way to know your status. If you are sexually active with new or multiple partners, request STI testing — including for gonorrhea, chlamydia, and syphilis — at your next healthcare visit.
Use protection consistently:: Condoms remain highly effective at preventing bacterial STIs. Even if you are on PrEP for HIV, condoms protect against other infections that are becoming increasingly drug-resistant.
Be aware of food safety:: *Salmonella* is the most common cause of bacterial food poisoning in the U.S. Proper food handling, thorough cooking, and hand hygiene remain essential, especially for vulnerable populations.
Support AMR research:: The fight against antimicrobial resistance requires new approaches. The Salmonella metal-starvation discovery exemplifies how understanding the body's natural defenses can lead to innovative treatments that reduce reliance on antibiotics.
The rise of drug-resistant infections is one of the defining public health challenges of our time. From the record surge in STIs across Europe to promising new discoveries in nutritional immunity, the landscape is shifting rapidly.
Do you think governments are doing enough to combat antimicrobial resistance? What more should be done to improve STI testing and treatment access? Share your thoughts and join the conversation!
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