The authors place the post-AIDS increase in STIs within a historic context. Gonorrhoea cases in the UK have been recorded since 1918 and syphilis since 1922, when the UK’s network of free and confidential STI clinics was set up. This was after a Royal Commission on Venereal Diseases (as STIs used to be called) recommended a clinic network in 1916, partly as a response to alarming increases in the two diseases leading up to and during World War I.
The historic figures for gonorrhoea show that the 2015 and 2017 figures of around 45,000 cases of gonorrhoea are the highest total since 1986. However, the first time gonorrhoea diagnoses reached this figure was in 1928-1930. As the UK population has increased by 46% since 1930, this represented a much higher rate per head of population. Gonorrhoea diagnoses remained at about 40,000 a year throughout the 1930s, fell by about 20% during World War II, then peaked abruptly in 1946 to 54,000 as soldiers came home from the front.
The advent of antibiotics brought that figure down to about 20,000 during the 1950s but then both antibiotic resistance, and the new era of sexual freedom, led to gonorrhoea cases rising to over 60,000 cases during the 1970s, with an all-time high of over 64,000 a year between 1973 and 1977. Cases then began to fall rapidly and reached a historic low of 10,000 a year between 1993 and 1995.
However diagnoses started to rise again as soon as antiretroviral combination therapy for HIV became available. There was a period between 2004 and 2010 when diagnoses were contained below 20,000 a year, but they have more than doubled since then.
The epidemic curve for gonorrhoea, in other words, shows a complex interplay between behaviour, testing and antibiotic resistance. It is an adaptable organism that retains the capacity to outwit medications.