The figures from the health institute Sciensano are based on incomplete data from last year, but the trend is clear: just like in other European countries, STDs are becoming increasingly common in our country.
Chlamydia is the most common STD: last year there were an estimated 195 diagnoses per 100,000 women, and 176 per 100,000 men. This represents an increase of 15 percent and 31 percent respectively compared to 2019.
However, the steepest flight is for the second most common STD: gonorrhea. For men, Sciensano notes an increase of 93 percent compared to five years ago, and for women there are 145 percent more diagnoses. Despite this significant increase, gonorrhea is still three times more common in men than in women. In third place is syphilis, which is still mainly a male condition, but has been diagnosed noticeably more often in women in recent years.
According to the Flemish expertise center for sexual health Sensoa, these figures are increasing for various reasons. “This boom has been going on for about ten years, but in recent years STDs that almost only occurred in men who have sex with men have also been found in young women and straight men,” says Veerle Doossche, policy officer at Sensoa. “The reasons are still being investigated, but more testing plays a role. People are aware that it is best to get tested after a risky contact, and doctors are also more likely to suggest this. Furthermore, condom fatigue may be a thing, for example among gay men, who are usually very conscientious about their sexual health.”
Since the use of PrEP (pre-exposure prophylaxis) has increased, pills that you can take preventively to avoid HIV infection, some men may find it easier to forego a condom, says Doossche. “They experience a false sense of security, because they can still contract an STD. Moreover, there are more people experimenting with their sexuality and with open relationships. Or with chemsex, the trend of taking drugs during sex, which can cloud judgment during the heat of the moment. The pandemic also plays a role. The youth were at home, could experiment less and perhaps also heard fewer prevention messages.”
Friends with benefits
After a long monogamous relationship, student Laura was diagnosed with chlamydia twice. “I had sex with one friend with benefits who assured me that he had been tested. I was on the pill, so I thought it was okay not to use a condom,” she says. “It turned out that he also had sex with another girl, and that she had tested positive. I had to take one pill, but a year later I had an IUD inserted and tested positive again. I then had to take a seven-day course of antibiotics. Now I have condoms in my pocket, to which men sometimes react indignantly, as if I suggest that they have an STD anyway. Perhaps women are more concerned with it because the consequences for them are often greater.”
In some cases, women are actually at greater risk, confirms Marie-Angélique De Scheerder, infectious disease specialist at Ghent University Hospital. “Women infected with gonorrhea or chlamydia often have no or less pronounced symptoms, which means that these STDs remain unnoticed for a long time and, especially in the case of chlamydia, can cause reduced fertility due to chronic inflammation of the ovaries.”
Antibiotic resistance is not good news for anyone. “We often have to prescribe heavy second-line antibiotics for the treatment of gonorrhea because the first-line antibiotics are no longer efficient enough,” says De Scheerder. “As long as people think that STDs are an innocent, distant story, not only the number of diagnoses will increase, but also antibiotic resistance, and therefore also the pressure on the healthcare system.”
To relieve this pressure, the Institute of Tropical Medicine (ITM) is working on an online platform that offers people who have been at sexual risk, but do not (yet) have symptoms, the opportunity to be tested. “Test2Know is still in a pilot phase, but the intention is to integrate the platform into regular, reimbursed care in a few years,” explains Irith De Baetselier, researcher at ITM. “To make a good risk assessment, people will first complete a questionnaire. We recommend that anyone who has symptoms go to the doctor immediately. We do not want to test too much unnecessarily, so anyone who takes the HIV prevention pill will not be able to participate. And if you have not run a major risk, for example during group sex, we do not test for syphilis. Those who are eligible will be sent a kit. You take samples at home – one blood-self-sampling-We are also developing a device – and you send it to a certified laboratory.”
“Such online platforms already exist, especially in the Netherlands, but we see that they operate in a very commercial manner,” De Baetselier outlines. “You can get tested for everything, including infections that are very common but not very harmful. Such an extensive test could easily cost you a hundred euros. Moreover, the follow-up is virtually non-existent. Customers only receive an email with the message: ‘You have this STD. Go see a doctor.’ We want to make that link to a doctor very concrete, so that people really receive help. If we can also link our platform with Partner Alert, an online application with which you can anonymously let your (ex-)bed partners know that they should be tested, the circle will be complete.”
The Great Condom Study
In the meantime, Sensoa is also working on a way to help Belgians go to bed more safely. The results of the Great Condom Survey will not be available until September, but a few general trends are already visible. “Sometimes people think that they are less susceptible to STDs,” says researcher Eva Koppen. “Straight people who are dating again after a long relationship think that STDs only happen to young people or gay men. And those who have been dating exclusively for a while often drop the condom based on subjective confidence in the other person’s health. Without an objective test. The feeling that a condom creates a mental and physical barrier also plays a role.” There is one group that does fall back on condoms: young people in their thirties in a steady relationship. “Due to hormone fatigue, women abandon the pill and the IUD and use condoms periodically, in combination with the calendar method.”
External incentives that examine the risks of STDs seem very welcome, but with the disappearance of specific final objectives about sexual health, the opposite movement is happening in secondary schools. Annelies Van Den Haute, clinical psychologist and sexologist, is in her final year of sex education at the Óscar Romero College in Dendermonde. “It is currently an optional subject for the sixth-year Progression (the former ASO), but soon sexuality education will no longer be a separate entity and relationships and sexuality may be discussed in every subject. This is feasible in a subject such as psychology, but for mathematics it is much more difficult,” Van Den Haute responds.
She graduated barely ten years ago, but remembers her information classes as very sec. “It was in biology class and it was actually more about reproduction, and just penis-and-vagina sex. Oral sex or masturbation was not discussed at all,” she reflects. “For a long time, information has had a purely biological guideline: don’t get pregnant, sex is dangerous.”
She approaches it completely differently. She does not slide a condom over a banana, but over a demonstration penis, and she opts for total openness. “Flirting, relationship problems, sexual identity… All these themes are discussed, but they are also curious about STDs, some more than others. They know that STDs exist, but are mainly afraid of becoming pregnant: ‘I’m already taking the pill, what should I do with a condom?’ They have already heard about cold sores, but they often do not know that they should not give or receive oral sex. They know that HIV and AIDS exist, but for many it is something that can only happen to gay men. One person thinks that AIDS is by definition a fatal disease, the other does not know that medication exists.”
“I try to approach it interactively, through games, concrete cases and role plays in which no questions are avoided. It is the only way to get sex and STDs out of the taboo atmosphere, and to ensure that they later dare to bring up the tricky topics with their partner, such as: ‘Are you also taking an STD test?’”
De Scheerder also knows that there is still a stigma surrounding STDs: “It remains a problem for both patients and healthcare providers. tricky subject. Many GPs still attribute STDs to the ‘old’ risk categories, but anyone who has unsafe sex is a person at risk. Also that 45-year-old who just got out of a marriage.”
