“Dear Editor”
During the novel coronavirus disease 2019 (COVID-19) pandemic, it was reported that the prioritization of interventions has inadvertently led to neglecting measures against other infectious diseases, such as measles and mpox, in Japan [1]. In addition, particular caution should be paid to the situation regarding sexually transmitted diseases (STIs), which have reached a critical state. Indeed, in 2022, a total of 12,964 cases of syphilis were reported in Japan, representing the highest figure since the commencement of this survey in 1999, and sexual contact was reported as the primary transmission route, contributing to 65% and 81% of syphilis cases in males and females, respectively [2]. However, the rapid surge in syphilis incidence is thought to stem from an interplay of various factors, including the increase in casual sexual encounters, the use of dating applications, and the reported decline in access to testing and sexual health services for STIs globally amid the COVID-19 pandemic [2]. Analogous trends have also been delineated not only in Japan but also in other countries for other STIs, such as gonorrhea and chlamydia, thereby underscoring the imperative for concerted initiatives to combat STIs. Given these STIs' latent and often asymptomatic progression, testing constitutes an indispensable component in their effective management and containment. Consequently, an exigency exists for healthcare professionals to provide sufficient education regarding STIs and to ensure that high-risk individuals are effectively routed toward appropriate testing services.
Of note, communicating information in this realm necessitates careful handling due to the prevalent stigma attached to societal attitudes devaluing the testing and treatment of STIs [3]. Broadcasting messages that associate STIs with the rise in casual sex and usage of dating applications could inadvertently pose considerable obstacles, discouraging individuals from pursuing testing, sharing information about their sexual behaviors, or accepting treatment for STIs. Regrettably, a comprehensive risk communication infrastructure appears to be deficient in Japan. In fact, past instances of messaging that inappropriately correlated HIV with homosexuality have inadvertently augmented the stigma, subsequently posing a potential impediment to adherence to HIV treatment regimens [4]. Indeed, notwithstanding advancements in therapeutics, the number of newly identified HIV infections in Japan has remained largely unchanged over the past decade. Persisting misconceptions about this disease continue to obstruct strides toward its eradication.
One potential strategy entails capitalizing on the advancements in telemedicine, precipitated by the COVID-19 pandemic, to integrate at-home STI testing within the framework of online healthcare services. In Japan, STI testing is typically conducted at public health centers. Although these tests are generally free and can be performed anonymously, they are confined to four types—HIV, syphilis, gonorrhea, and chlamydia—and are subject to constraints regarding testing dates and capacities. If an STI test is performed at home, insurance coverage applies only when symptoms of the disease are present; otherwise, the test often incurs an entirely out-of-pocket expense, ranging between 150 and 200 USD, in cases where symptoms are absent or minimally present. Conversely, telemedicine can provide a straightforward and private means of accessing treatment for STIs, thereby mitigating psychological barriers [5]. Furthermore, it can reduce labor costs, travel expenses, and other ancillary costs, rendering it a more convenient and affordable option for comprehensively testing a broader range of STIs than conventional testing methods [5]. This approach is gaining traction in numerous countries, including Australia, France, and the United States, whereas it is still far from sufficient in many countries, including Japan and South Africa.
In light of the globally reported increase in STIs, it is incumbent upon governments worldwide to draw insights from historical instances and initiatives undertaken in various countries. Given the STI challenges that have been overlooked amid the COVID-19 pandemic, it becomes crucial to divert attention towards addressing these issues in the context of international collaboration and to establish systems ensuring patients are efficiently directed towards testing and treatment.
Author's contributions
Conception and designing of the study; KY.
Data collection; KY.
Data analysis and interpretation; KY.
Writing this paper; KY.
Funding
None.
Declaration of competing interest
None.
Acknowledgment
None.
Handling Editor: Patricia Schlagenhauf
References
- 1.Kaneda Y. Resurgence of infectious diseases in post-COVID-19 era: a Japanese perspective. New Microbes New Infect. 2023;53 doi: 10.1016/j.nmni.2023.101156. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.National Institute of Infectious Diseases . 2022. IDWR 2022 No. 42 <Infectious diseases of Note> syphilis.https://www.niid.go.jp/niid/ja/syphilis-m-3/syphilis-idwrc/11612-idwrc-2242.html [in Japanese] [Google Scholar]
- 3.Lee A.S.D., Cody S.L. The stigma of sexually transmitted infections. Nurs Clin. 2020;55(3):295–305. doi: 10.1016/j.cnur.2020.05.002. [DOI] [PubMed] [Google Scholar]
- 4.Yu F., Hsiao Y.H., Park S., et al. The influence of anticipated HIV stigma on health-related behaviors, self-rated health, and treatment preferences among people living with HIV in East Asia. AIDS Behav. 2023;27(4):1287–1303. doi: 10.1007/s10461-022-03865-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Valentine J.A., Mena L., Millett G. Telehealth services: implications for enhancing sexually transmitted infection prevention. Sex Transm Dis. 2022;49(11S Suppl 2):S36–S40. doi: 10.1097/OLQ.0000000000001699. [DOI] [PubMed] [Google Scholar]