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• W4285992603 abstract "Yang Zheng and colleagues re-analysed estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 and report age-standardised incidence rates and disability-adjusted life-years (DALYs) caused by five sexually transmitted infections (STIs)— syphilis, gonorrhoea, chlamydia, trichomoniasis, and genital herpes—from 1990 to 2019.1Zheng Y Yu Q Lin Y et al.Global burden and trends of sexually transmitted infections from 1990 to 2019: an observational trend study.Lancet Infect Dis. 2022; 22: 541-551Summary Full Text Full Text PDF PubMed Scopus (16) Google Scholar We urge caution in the use and interpretation of the results. First, the overall burden of disease reported, 1·31 million DALYs (95% uncertainty interval [UI] 0·80–2·20), is a large underestimate because the analysis is restricted to people aged 10 years and older. The GBD 2019 database for all ages reports 8·22 million DALYS for the five STIs, of which 7·26 million are years of life lost due to congenital syphilis. In fact, the total burden of disease for these five STIs is even higher than the GBD database reports, because GBD estimates do not account for an estimated 7·7% (95% UI 4·6–12·0) of stillbirths worldwide that are caused by syphilis,2Lawn JE Blencowe H Waiswa P et al.Stillbirths: rates, risk factors, and acceleration towards 2030.Lancet. 2016; 387: 587-603Summary Full Text Full Text PDF PubMed Scopus (834) Google Scholar the consequences of congenital herpes simplex virus, pregnancy-specific effects of other STIs, or the impact of STIs on HIV transmission.3Vallely LM Egli-Gany D Wand H et al.Adverse pregnancy and neonatal outcomes associated with Neisseria gonorrhoeae: systematic review and meta-analysis.Sex Transm Infect. 2021; 97: 104-111Crossref PubMed Scopus (23) Google Scholar, 4Cohen MS Council OD Chen JS Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention: the biologic basis for epidemiologic synergy.J Int AIDS Soc. 2019; 22e25355 Google Scholar All of these adverse outcomes disproportionately affect low-income and middle-income countries. Second, data underlying the GBD 2019 are themselves subject to limitations, which are a source of uncertainty.5Fu L Sun Y Han M et al.Incidence trends of five common sexually transmitted infections excluding HIV from 1990 to 2019 at the global, regional and national levels: results from the Global Burden of Disease Study 2019.Front Med (Lausanne). 2022; 9851635 Google Scholar STI incidence estimates are based on a small number of prevalence studies, most of which include only women and use heterogeneous sampling and data collection methods. Prevalence data are combined with assumptions about disease remission, a robust database for cause-specific mortality, and Bayesian regression methods to produce estimates for all locations, even where data are absent. Third, Zheng and colleagues conclude that age-standardised STI incidence rates declined from 1990 to 2019. Although the global estimated annual percent change (EAPC) is negative, its 95% UI includes zero, which is compatible with stable levels. Furthermore, the EAPC summarises changes over a 29-year period, but country-by-country review of full time-series estimates reveals many countries with increases in age-standardised incidence in the past 5 years. Lastly, although the numbers of incident cases reported do align with the GBD tool, it is unclear why age–group-specific incidence rates are much higher than in GBD, and why the 10–24 years age group has the highest numerical STI rates. Complete and reliable STI burden estimates are essential for global investment, policy development, and programme implementation. Limitations of existing GBD estimates should be acknowledged. Efforts to provide a more comprehensive estimation of STI health impact and to close gaps in primary data are urgently needed. NL is on the scientific board of Sefunda, a start-up company that develops point-of-care diagnostics for STIs. RPHP, RMC, and JR declare no competing interests. We thank Maegan Dirac and Hannah Han at the University of Washington (WA, USA) for checking the numerical results presented in Zheng and colleagues’ study and this Correspondence. Global burden and trends of sexually transmitted infections from 1990 to 2019: an observational trend studyAlthough most countries showed a decrease in age-standardised rates of incidence and DALYs for STIs, the absolute incident cases and DALYs increased from 1990 to 2019. Therefore, STIs still represent a global public health challenge, especially in sub-Saharan Africa and Latin America, which warrants more attention and health prevention service. Full-Text PDF Estimating the global burden of sexually transmitted infections – Authors' replyOn behalf of our coauthors, we thank Remco P H Peters and colleagues for their comments on our Article.1 Sexually transmitted infections (STIs) can spread through both horizontal and vertical modes. The horizontal transmission of STIs can be prevented and controlled by behaviour counselling, condom use, partner education, timely diagnosis, and treatment.2 In our study, we focused on horizontal transmission of STIs in a sexually active population and potential strategies for public health intervention. Full-Text PDF" @default.
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• W4285992603 title "Estimating the global burden of sexually transmitted infections" @default.
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