STBBI recrudescence and resistance

Sexually transmissible and blood-borne infections (STBBIs) are avoidable infections. You would think that they would be on the decrease with the amount of information easily accessible nowadays, and yet, the opposite is true – not only have we been seeing a recrudescence in the number of STBBI cases in the past few years, the cases have actually become harder to treat because they have become resistant to treatment.

STBBIs include all the bacterial or viral infections that can be transmitted sexually or through contact with a person’s blood, for example chlamydia, gonorrhea, syphilis, genital herpes, human papillomavirus (HPV), HIV and hepatitis C. Anyone with high-risk behaviours (e.g. unprotected sex or the use of injection drugs) increases his or her likelihood of contracting an STBBI, regardless of age, sexual orientation, background, level of education or social status. 

The number of bacterial STBBIs has been increasing significantly in the past few years. For example, between 1997 and 2011, cases of chlamydia (nearly 20,000 cases in 2011) and gonorrhea have tripled in Quebec, while cases of syphilis went from fewer than 10 to over 600. Nearly 50% of chlamydia cases occur in people between the ages of 15 and 24, making it the most common STBBI in this age group. Not only are chlamydia cases on the increase, however, they are also increasingly resistant to antibiotics, which greatly complicates treatment. The increase in bacterial STBBIs, combined with the fact that there are more and more antibiotic-resistant strains, is worrisome because these STBBIs can lead to serious complications, most notably fertility issues (pelvic inflammatory disease, ectopic pregnancy, sterility).

Even though HIV is no longer a hot news topic, it is still very much present in Quebec. However, treatment advances have helped improve quality of life and life expectancy among persons with the infection. Currently, some 20,000 individuals are thought to be living with HIV in Quebec. The number of new cases diagnosed annually (approximately 300) has been relatively stable for the past few years, but many people may be unaware that they are carrying the virus and may therefore be unknowingly transmitting it. Men who have sex with men are still the group at greatest risk for contracting HIV. Prevention among injection drug users seems to have been successful because this group accounts for fewer than 5% of new cases diagnosed each year.

With the HPV vaccine now included in the universal immunization schedule, in the coming years we are expecting to see a significant drop in the number of infections and complications associated with this virus (e.g. cancers of the cervix, anus, vagina and penis). 

It can be difficult to identify the specific reasons for the marked increase in certain STBBIs, and the reasons vary from one infection to another, but the reasons may include a trivialization of associated risks in certain populations, the search for sexual partners on the Internet, a reduced visibility of prevention campaigns, and possibly the discontinuation of sex education courses in schools.

In all cases, STBBIs can be prevented by choosing low-risk behaviours:

  • Demand that a condom be used with any new sexual partner until the relationship has become stable.
  • If you are not in a monogamous relationship, undergo regular screening. Don’t wait until you notice symptoms, because most STBBIs exhibit very few symptoms, if any.
  • Do not do drugs, whether they are injection drugs or not. While the use of non-injection drugs cannot transmit an STBBI, it can result in a state of impaired judgment in which you may take part in high-risk behaviours (for the same reason, be vigilant when consuming alcohol).
  • If you decide to get a tattoo or piercing, make sure to use a reputable establishment that only uses single-use needles.
  • Don’t think that you are safe from STBBIs due to your age or social status – STBBIs strike without discrimination!
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