Frequency of sexually transmitted infections in German specialist practices

A retrospective database analysis

More than one million sexually transmitted infections (STIs) are diagnosed worldwide every day [1]. Chlamydia, gonorrhea, syphilis, and trichomoniasis account for 25% of the STIs diagnosed annually worldwide. The incidence of bacterial STIs is steadily increasing in the European Union (European Centre for Disease Prevention and Control, 2022). The prevalence of STIs among men in Germany has been investigated in only a few studies over the past decade. Bremer et al. reported that a total of 6,834 syphilis infections were registered in 2015, representing an increase of 1,491% since 2009. Jacob et al. found that approximately 1,251% of men examined in urological practices in Germany between 2013 and 2015 were diagnosed with at least one STI (Jacob et al., 2018). The same author showed that the most common infection in gynecological practices was chlamydia (prevalence: 0.59%, 1%, 3%, 5 ...

>> Data from the nationwide IQVIA Disease Analyzer database were used for this study. The demographic, clinical, and pharmaceutical data contained in this database were obtained from a nationwide sample of general practitioners and specialists' practices [Rathmann et al., 2018]. The quality of the information is regularly assessed by IQVIA, and the representativeness of the Disease Analyzer database for general practitioners has been underscored in previous studies [Rathmann et al., 2018].
This study examined patients from 69 dermatologists', 148 gynecologists', and 55 urologists' practices between 2014 and 2023. Only practices with continuous data collection from 2014 to 2023 were included. The outcome of the study is the number of individuals diagnosed with at least one STI (ICD-10: A54-A64) in 2014 and 2023. STIs included included infections with chlamydia (ICD-10: A55, A56), gonococci (A54), anogenital warts (A63.0), anogenital herpes (A60), trichomoniasis (A59), chancroid (A57), syphilis (A50-A53), and the ICD code for other, undefined infections (A64).
The study is a descriptive work without statistical analyses.
Results
This cross-sectional study included 6,535 patients in 2014 and 6,491 patients in 2023 with a confirmed diagnosis of an STI in 69 dermatologists', 148 gynecologists', and 55 urologists' practices. In 2023, each dermatologist's practice treated an average of 31 patients, one gynecologist's practice treated 21 patients, and one urologist's practice treated 23 patients with an STI. The number of patients per practice did not change significantly in 2023 compared to 2014 (Fig. 1).
The most common sexually transmitted infection in 2023 is anogenital wart, which was found in 75.3% of all patients compared to all STIs in dermatology practices. This STI was followed by 54.7% in urology practices and 31.8% in gynecology practices. The number of patients per practice with this diagnosis increased from 22 in dermatology practices in 2014 to 23 in 2023, remained around 12 in urology practices, and decreased from 8 to 7 in gynecology practices (Fig. 2).
Another finding of the study is an increase in the average patient age. In dermatology practices, the age increased from 40.3 to 44.3 years, in gynecology practices from 34.8 to 37.6 years, and in urology practices from 35.2 to 38.6 years (Fig. 3).
discussion
The number of patients treated for sexually transmitted diseases in dermatology, gynecology, and urology practices changed only minimally between 2014 and 2023. On average, each dermatology practice treated 310 patients with STIs in 2023, each gynecology practice treated 21 patients, and each urology practice treated 23 patients. The stability of patient numbers over time suggests that the need for sexually transmitted disease-related healthcare services in these specialties remains high.
This high demand reflects the ongoing challenges of reducing STI incidence in relation to STI prevention, screening, and treatment. The persistence of these case numbers underscores the need for continued and potentially intensified public health interventions.
Anogenital warts were the most commonly diagnosed sexually transmitted disease across all specialties, with prevalence varying by specialty. Interestingly, the number of patients per practice with anogenital warts increased slightly in dermatology and urology practices between 2014 and 2023, while it decreased slightly in gynecology practices. The increase in dermatology and urology practices may reflect broader epidemiological trends, such as rising rates of human papillomavirus (HPV) infection in populations frequently seen by these specialists. However, the decline in gynecology practices can be attributed to several factors, including the success of HPV vaccination programs, which target the very virus responsible for most cases of anogenital warts. Osmani et al. investigated HPV vaccination rates from 2008 to 2018 and the effects of HPV vaccination on anogenital warts and precancerous lesions in young women in Bavaria and showed a promising decrease in anogenital warts and precancerous lesions in vaccinated young women (Osmani et al, 2022).
A notable finding of this study is the increase in the average age of patients receiving treatment for an STI in all three specialties between 2014 and 2023. This shift toward older patient groups could have several explanations. First, increasing age could reflect higher life expectancy and quality of life in the older population, allowing continued sexual activity into old age. Furthermore, these results could indicate increasing awareness of STIs and their diagnosis among older people, who were historically underrepresented in STI statistics because they were tested less frequently or avoided screening due to stigma. This increase in age has important implications for everyday clinical practice.
Older patients may have more complex comorbidities that can complicate STI treatment. They may also require different education, prevention, and treatment approaches than younger populations. Consequently, healthcare providers will need to adapt to this changing situation to meet the unique needs of an aging patient population while also considering the risks of STI transmission in this patient group.
The results of this study underscore the importance of continued vigilance in the treatment of STIs in dermatological, gynecological, and urological practices. Despite public health campaigns and the availability of preventive measures and an effective HPV vaccine, the persistence of STIs such as anogenital warts highlights the need for continued public health efforts. This includes promoting education on safe sexual practices, improving vaccination rates, and regular screening.
In summary, this study underscores that despite vaccination efforts and awareness campaigns in various medical specialties, patient numbers remain virtually unchanged, and STIs thus continue to pose a persistent and increasing challenge in the aging patient population. The results call for further public health initiatives and the adaptation of routine practice to the specific needs of these patient groups.