Incidence Trends of Five Common Sexually Transmitted Infections Excluding HIV From 1990 to 2019 at the Global, Regional, and National Levels: Results From the Global Burden of Disease Study 2019

Abstract

Objective: Sexually transmitted infections (STIs) are common worldwide and pose a challenge to public health. We conducted this study to assess the annual incidence of five common STIs, including syphilis, chlamydia, gonorrhea, trichomoniasis, and genital herpes at the global, regional, and national levels.

Materials and methods: We obtained detailed data on STIs excluding HIV from 1990 to 2019 from the Global Burden of Disease (GBD) 2019 database. Estimated annual percentage change (EAPC) was calculated to quantify trends in age-standardized incidence rates (ASR) of STIs, stratified by gender, sociodemographic index (SDI) region, and pathogenic microorganism.

Results: Globally, incident cases of STIs increased by 58.15% from 486.77 million in 1990 to 769.85 million in 2019, but the annual change in ASR was only -0.04% (95% CI -0.09 to 0.01) per year. EAPC was 0.16 (0.06 to 0.26) for syphilis, 0.09 (0.05 to 0.13) for genital herpes, 0.06 (0.03 to 0.09) for trichomoniasis, -0.21 (-0.36 to -0.06) for chlamydia, and -0.14 (-0.19 to -0.08) for gonorrhea. High SDI regions reported significant increases in ASR of syphilis and chlamydia.

Conclusions: The burden of disease from STIs remains large, though control of STIs has contributed to the decreasing incidence in most regions, especially in the low-SDI regions. Globally, over the past 20 years, the ASR has remained stable for trichomoniasis and genital herpes decreased for chlamydia and gonorrhea, and increased for syphilis.

Keywords: STIs; chlamydia; genital herpes; global burden; gonorrhea; syphilis; trichomoniasis.

Figure 1

The global disease burden of STIs excluding HIV for men and women in 204 countries and territories. (A) The ASR of STIs excluding HIV in 2019; (B) The relative change in incident cases of STIs excluding HIV between 1990 and 2019; (C) The EAPC in STI ASR from 1990 to 2019 ASR, age-standardized rate; EAPC, estimated annual percentage change; STIs, sexually transmitted infections; HIV, human immunodeficiency virus.

Figure 2

Global STIs incident cases by 20 GBD age groups. (A) Global STIs incident cases by age for men and women combined in 1990 and 2019. For each group, the left column presents case data from 1990 and the right column presents data from 2019. (B) Difference by gender in global STI incident cases by age in 2019 GBD, Global Burden of Disease; STIs, sexually transmitted infections.

Figure 3

Number of incident cases of STIs excluding HIV 1990-2019, stratified by SDI region. SDI regions with lower number of cases are magnified in the top- right of the panel SDI, sociodemographic index; STIs, sexually transmitted infections; HIV, human immunodeficiency virus.

Figure 4

(A) Number of incident cases of STIs excluding HIV at the regional level. The left column in each group presents cases in 1990 and the right column presents cases in 2019. Regions with lower numbers of cases are magnified in the top right of the panel. (B) Proportion of syphilis, chlamydia, gonorrhea, trichomoniasis, and genital herpes in all incident cases of STIs 1990-2019, at the global, SDI region, and regional levels STIs, sexually transmitted infections; HIV, human immunodeficiency virus.

Figure 5

EAPCs in STI ASR excluding HIV from 1990 to 2019, at global, regional, and national levels. (A) EAPC in STI ASR from 1990 to 2019, by pathogenic microorganism and by region. EAPC in each region are presented as an overall and an absolute maximum caused by pathogenic microorganism. The correlation between EAPC and (B) STI ASR in 1990 and (C) HDI in 2019. The circles represent countries with available HDI data. Circle size represents total number of STI cases. The ρ indices and p values presented in (B) and (C) were derived from Pearson correlation analysis ASR, age-standardized rate; EAPC, estimated annual percentage change; HDI, human development index; STIs, sexually transmitted infections; HIV, human immunodeficiency virus.