Trends in sexually transmitted infections at a tertiary care center (2022–2024): A cross-sectional study

Abstract

Background:

Sexually transmitted infections (STIs) remain a significant public health concern, with increasing trends observed globally.

Aims and Objectives:

This study aimed to analyze the prevalence and trends of STIs at a tertiary care center in east India over a two-year period.

Materials and Methods:

This cross-sectional study was conducted at a tertiary care center in east India from 2022 to 2024. A total of 11,803 patients were included.

Results:

The male-to-female ratio was 1.13:1. The majority of cases were in the age group of 18–30 years (60.8%), and high-risk behaviors, including multiple sexual partners and substance abuse, were prevalent. The findings indicate a rising trend in genital ulcer disease due to herpes, secondary syphilis, and HIV-positive cases. Men who have sex with men with anal warts and individuals with a history of multiple exposures also showed increasing numbers.

Conclusion:

The results highlight the urgent need for enhanced STI surveillance, awareness programs, and targeted interventions to curb infection rates. Strengthening routine screening, expanding access to treatment, and implementing strategic public health initiatives are critical in addressing the rising burden of STIs.

Introduction

Sexually transmitted infections (STIs) are on the rise globally, posing a significant public health challenge alongside the persistent threats of HIV and viral hepatitis. The latest report of the World Health Organization (WHO), Implementing the Global Health Sector Strategies on HIV, Viral Hepatitis, and Sexually Transmitted Infections, 2022–2030, highlights an alarming increase in STIs, particularly syphilis and antimicrobial-resistant gonorrhea.[1] When compared with previous trends, the data present a worrying scenario that demands urgent action. STIs remain a major public health concern worldwide. This article presents an analytical observational study on STI prevalence trends from 2022 to 2024 based on the provided statistical data at a tertiary health care center in east India. By examining the variation in reported cases over the years, we can identify patterns, emerging concerns, and possible interventions.

Surge in sexually transmitted infections: A global concern

According to the WHO data, syphilis cases among adults (aged 15–49 years) increased by over 1 million in 2022, bringing the total to 8 million cases. This is a setback, considering the ambitious 2030 goal of reducing syphilis cases to 0.71 million. Similarly, gonorrhea is becoming increasingly resistant to treatment, with 9 out of 87 countries reporting resistance levels of 5% to 40% for ceftriaxone, the last-line treatment. These figures indicate that STIs are not only spreading but also becoming harder to treat.[1]

When compared to earlier trends, these statistics reveal a sharp increase in infections. The COVID-19 pandemic may have exacerbated this crisis by disrupting routine STI screening and treatment services. The increase in congenital syphilis (523 cases per 100,000 live births annually) underscores the impact on maternal and child health, adding another layer of urgency to the problem.[1]

This study aims to assess STI trends at a tertiary care center from 2022 to 2024, providing insights into the changing epidemiology of these infections. The study follows a cross-sectional design, capturing annual trends over 3 years.

Methodology

A retrospective analysis of STI cases reported at a tertiary care center from 2022 to 2024 was conducted. Patient records at the Suraksha Clinic, under the Dermatology Department at a tertiary care center in east India were maintained using a standardized pro forma. This study included cases diagnosed by dermatologists and treated according to the National AIDS Control Organization (NACO) guidelines for syndromic management of STIs. Patient data from January 2022 to December 2024 were evaluated and analyzed. Incomplete or inadequate pro formas were excluded from the study. In addition, patients presenting with sexual dysfunction, prostatorrhea, spermatorrhea, phimosis, paraphimosis, or nonvenereal genital dermatoses (e.g., pearly penile papules) without clinical evidence of STIs were also excluded. The study recorded epidemiological parameters, including age, gender, marital status, occupation, duration and nature of presenting complaints, sexual behavior, and diagnosis. Laboratory investigations included HIV testing, hepatitis B surface antigen, anti-hepatitis C virus antibody, Venereal Disease Research Laboratory test, and treponema pallidum hemagglutination assay. STIs were classified based on NACO’s syndromic approach. The data were entered into Microsoft Excel (Microsoft Corporation, Redmond, WA, USA) and analyzed using IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY, USA), at a tertiary care hospital in East India, West Bengal, India. Continuous variables were expressed as mean ± standard deviation, median, and range, whereas categorical variables were represented as frequencies, charts, and percentages.

Prevalence of sexually transmitted infections in 2022

The pie chart illustrates the prevalence of STIs in 2022. Genital ulcer disease due to herpes (GUDH; 26.3%) was the most reported condition, followed by secondary syphilis (19.0%), urethral discharge (UD; 15.8%), and history of multiple exposures (11.5%). Men who have sex with men (MSM) with anal warts accounted for 9.1%, while genital ulcer nonherpetic (GUDNH) and asymptomatic cases made up 6.8% each. Other conditions, including venereal contact dermatitis (VCD), flying sex workers, inguinal bubo, and HIV-positive cases, had lower prevalence percentages. These findings emphasize the need for targeted STI prevention and control strategies.

This trend is clearly illustrated in Figure 1.

Figure 1.

The pie chart displays sexually transmitted infection prevalence in 2022. GUDH: Genital ulcer disease due to herpes, GUDNH: Genital ulcer nonherpetic, MSM: Men who have sex with men, UD: Urethral discharge, VCD: Venereal contact dermatitis

Prevalence of sexually transmitted infections in 2023

The pie chart displays STI prevalence in 2023. GUDH (21.8%) remained the most reported condition, followed by history of multiple exposures (19.0%), secondary syphilis (16.3%), and UD (13.5%). MSM with anal warts accounted for 8.3%, while GUDNH (5.5%) and asymptomatic cases (6.3%) showed moderate prevalence. Other conditions, including VCD, flying sex workers, inguinal bubo, and HIV-positive cases, had lower proportions. The trends indicate a continued need for STI awareness, screening, and prevention efforts.

This trend is clearly illustrated in Figure 2.

Figure 2.

The pie chart displays sexually transmitted infection prevalence in 2023. GUDH: Genital ulcer disease due to herpes, GUDNH: Genital ulcer nonherpetic, MSM: Men who have sex with men, UD: Urethral discharge, VCD: Venereal contact dermatitis

Prevalence of sexually transmitted infections in 2024

The pie chart represents STI prevalence in 2024. GUDH (20.8%) remained the most common condition, followed by history of multiple exposures (17.3%), UD (15.7%), and secondary syphilis (14.2%). MSM with anal warts accounted for 9.3%, while GUDNH (7.8%) and asymptomatic cases (7.0%) showed a steady presence. Other conditions, including VCD, flying sex workers, inguinal bubo, and HIV-positive cases, had lower prevalence rates. The trends highlight the ongoing need for STI surveillance, preventive measures, and targeted interventions.

This trend is clearly illustrated in Figure 3.

Figure 3.

The pie chart displays sexually transmitted infection prevalence in 2024. GUDH: Genital ulcer disease due to herpes, GUDNH: Genital ulcer nonherpetic, MSM: Men who have sex with men, UD: Urethral discharge, VCD: Venereal contact dermatitis

Results

Trends in sexually transmitted infections from 2022 to 2024

The findings highlight variations in the prevalence of different STIs over the study period.

A total of 11,803 patients were included in our study during the time period of 2022–2024 (males: 6257 and females: 5546). The male-to-female ratio was 1.13:1. The majority of patients were in the age group of 18–30 years (60.8%), followed by 31–40 years (24.5%), 41–50 years (8.9%), 51–60 years (2.5%), <18 years (2.3%), and >60 years (1.0%), with a mean age of diagnosis being 30.12 ± 9.18 years. The mean age of diagnosis in males was 30.75 ± 9.44 years, while in females, it was 29.33 ± 8.89 years.

The majority of the patients were married (79.2%), whereas unmarried individuals accounted for 19.8%. Marital status was not recorded in 1% of cases. A total of 10,250 (86.9%) patients were literate. The most common occupations included homemakers (34.5%), private jobs (28.1%), and students (8.3%). High-risk professions such as laborers, drivers, guards, and rickshaw pullers contributed 16.4% of the total cases.

More than 53.2% of the patients had a history of substance abuse. Alcoholism was present in 37.8%, smoking in 33.1%, and other forms of addiction in 1.3% of cases. High-risk behavior (premarital, extramarital, and >1 partner) was recorded in 67.2% of the patients.

• HIV positivity was observed in 156 cases, increasing from 47 in 2022 to 56 in 2024

• Secondary syphilis was diagnosed in 1897 patients, showing an upward trend

• History of multiple exposures was noted in 1985 cases, steadily increasing each year

• GUDH cases were highest, totaling 2651 over the study period

• MSM with anal wart cases rose from 273 in 2022 to 443 in 2024, totaling 1048 cases

• Flying sex workers increased from 54 in 2022 to 110 in 2024, totaling 261 cases.

Analyses

1. HIV-positive cases: The number of cases increased from 47 in 2022 to 53 in 2023 and further to 56 in 2024

2. GUDH: Cases rose steadily from 788 in 2022 to 876 in 2023 and 987 in 2024, indicating a significant upward trend

3. History of multiple exposures: A sharp increase was observed, with cases rising from 344 in 2022 to 765 in 2023 and 876 in 2024

4. MSM with anal wart: The number of cases increased from 273 in 2022 to 332 in 2023 and 443 in 2024

5. Secondary syphilis: A steady rise was seen, with cases increasing from 569 in 2022 to 654 in 2023 and 674 in 2024

6. UD: Cases increased from 474 in 2022 to 543 in 2023 and 745 in 2024, suggesting a growing prevalence of infections presenting with this symptom

7. GUDNH: Cases increased from 203 in 2022 to 221 in 2023 and 371 in 2024

8. Asymptomatic cases: There was a significant fluctuation in asymptomatic infections, rising from 82 in 2022 to 217 in 2023, followed by a slight decline to 201 in 2024.9

9. VCD: Cases increased from 152 in 2022 to 251 in 2023 and 331 in 2024

10. Flying sex workers: This group saw an increase in reported cases from 54 in 2022 to 97 in 2023 and 110 in 2024

11. Inguinal bubo: Cases showed variability, with 4 cases in 2022, 7 in 2023, and a decline to 3 in 2024.

This is clearly illustrated in Table 1.

Table 1.

The highlight variations in the prevalence of different sexually transmitted infections over the study period: (2022–2024)

Condition	2022	2023	2024
HIV positive	47	53	56
GUDH	788	876	987
History of multiple exposures	344	765	876
MSM with anal wart	273	332	443
Secondary syphilis	569	654	674
UD	474	543	745
GUDNH	203	221	371
Asymptomatic	82	217	201
VCD	152	251	331
Flying sex worker	54	97	110
Inguinal bubo	4	7	3

HIV=Human immunodeficiency viruses; GUDH=Genital ulcer disease due to herpes; MSM=Men who have sex with men; UD=Urethral discharge; GUDNH=Genital ulcer nonherpetic; VCD=Venereal contact dermatitis

This trend is clearly illustrated in Figure 4.

Figure 4.

Stacked bar chart visualizing sexually transmitted infection trends from 2022 to 2024. This graph shows how different conditions contribute to the overall increase in cases over time. GUDH: Genital ulcer disease due to herpes, GUDNH: Genital ulcer nonherpetic, MSM: Men who have sex with men, UD: Urethral discharge, VCD: Venereal contact dermatitis

Key takeaways

• The highest increase in cases was observed in 2024, suggesting a potential rise in risk factors such as unsafe sexual practices or gaps in preventive measures

• GUDH remains the most dominant STI, with a sharp increase from 2022 to 2024

• HIV-positive cases and asymptomatic infections continue to pose risks, emphasizing the need for increased screening and awareness.

This trend is clearly illustrated in Figure 5.

Figure 5.

Bar chart representing the total number of sexually transmitted infection cases for each year from 2022 to 2024. Yellow (2024): The highest overall trend, indicating an increase in sexually transmitted infection cases compared to previous years. Red (2023): Intermediate values, showing a rise from 2022 but lower than 2024. Blue (2022): The lowest values, marking the baseline year

Discussion

STIs and reproductive tract infections are a significant cause of global burden of disease.[2]

STIs remain a significant global public health challenge, with the WHO estimating 370 million new STI cases annually.[3] The general population in India has an STI prevalence between 0% and 3.9%, but key populations experience a significantly higher burden.[2] In India, STIs are increasingly prevalent, especially among high-risk populations such as MSM, transgender individuals (TG), injecting drug users, and female sex workers.[3] The syndromic approach remains the primary method of STI management due to limited access to laboratory diagnostics.[4,5] A cross-sectional study in Delhi aimed at estimating STI prevalence among married women in urban and periurban areas found significant cases of gonorrhea, chlamydia, and trichomoniasis.[6] Recent studies indicate a shifting trend in STIs in India, with viral and fungal infections becoming more prevalent than bacterial ones.[7] Herpes genitalis, condyloma acuminata, and candidal infections are now among the most common STIs.[7,8,9] Bacterial STIs such as syphilis and chancroid show a declining trend, although syphilis cases have increased in some regions.[7,9] The most affected age group is 25–44 years.[7] Despite various health initiatives, the overall number of STI cases is rising.[8] There is also an increase in cases among MSM, highlighting the need for targeted interventions.[8] These changing patterns necessitate a reassessment of STI control strategies and prevalence estimation at the national level across various populations and geographical areas.[10]

This trend is clearly illustrated in Table 2.

Table 2.

Various studies highlighting trends in sexually transmitted infections

Trend	Details	Reference(s) (year)
Rise of viral and fungal infections	Herpes genitalis, condylomata acuminata, and candidal infections are now among the most common STIs	Goel et al.,[7] Verma et al.,[10] Mendiratta et al.[9]
Decline in bacterial STIs	Syphilis and chancroid cases show a decreasing trend, although syphilis cases have risen in some regions	Goel et al.,[7] Verma et al.[10]
Most affected age group	The highest prevalence is observed in individuals aged 25–44 years	Goel et al.[7]
Overall increase in STI cases	Despite various health initiatives, the total number of STI cases is rising	Mendiratta et al.[9]
Increase in MSM cases	More cases are being reported among MSM, necessitating targeted interventions	Mendiratta et al.[9]
Need for reassessment of control strategies	Changing epidemiological patterns require updated national-level strategies for STI control and prevalence estimation	Aggarwal[11]
Increase in syphilis cases globally	Syphilis cases among adults (aged 15–49) increased by over 1 million in 2022, reaching 8 million cases	WHO[12]
Gonorrhoea resistance concerns	9 out of 87 countries report resistance levels of 5%–40% for ceftriaxone, the last-line treatment	WHO[12]
Increase in congenital syphilis	523 cases per 100,000 live births annually highlight maternal and child health risks	WHO[12]

STIs=Sexually transmitted infections; MSM=Men who have sex with men; WHO=World Health Organization

The increasing trend in most STIs suggests a rising burden of infections, emphasizing the need for enhanced STI screening, prevention programs, and public health interventions. The notable increase in gonococcal infections, syphilis, and cases among high-risk groups such as MSM and sex workers highlights the need for targeted awareness campaigns and preventive measures. In addition, the fluctuation in asymptomatic cases underscores the importance of routine screening to detect infections that may otherwise go unnoticed.

Conclusion

This cross-sectional study at a tertiary care center reveals a rising trend in several STIs over 3 years. The findings highlight the urgent need for improved STI surveillance, enhanced public health education, and strategic interventions to curb the growing prevalence of these infections.

Recommendations

• Strengthening STI awareness programs, particularly among high-risk populations

• Expanding routine screening and early detection initiatives

• Enhancing access to STI treatment and preventive measures, including condom distribution and preexposure prophylaxis for at-risk groups

• Conducting further research to understand behavioral and epidemiological factors contributing to the observed trends.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.