I have been practicing as a urologist for more than 30 years. From early in my career, I became deeply involved in the study and treatment of sexually transmitted infections (STIs). During my residency and graduate studies, I focused on microbiology, and my master’s thesis examined chlamydial urethritis using PCR diagnostic methods. Later, while serving as a public health physician at a regional health center, I was responsible for issuing health certificates and providing related medical care. Even during my time at a general hospital, I frequently treated younger male patients, which naturally led to continued experience in managing STI cases.
For the past five years, I have been practicing in a private clinic. In addition, I have long served as an advisory member for STI prevention and management with the Korea Disease Control and Prevention Agency. Through these roles, I have consistently reflected on the issue of sexually transmitted infections. Recently, however, I have become increasingly concerned as I observe changes in the patterns of STIs in Korea compared to the past.
First, the number of STI patients continues to rise. Data from the Health Insurance Review and Assessment Service and annual reports published by the Korea Disease Control and Prevention Agency indicate that many sexually transmitted infections have been steadily increasing. News reports often highlight the recent surge of syphilis cases in neighboring Japan, yet reports about the increasing trend of STIs in Korea are rarely covered in domestic media.
From my clinical experience, the number of patients with gonorrhea has decreased compared to the past, but cases of HIV infection and syphilis appear to have increased. I have also observed a noticeable rise in patients with herpes simplex virus type 2 and genital warts caused by human papillomavirus (HPV).
There may be several reasons behind the increasing prevalence of STIs. One factor may be changes in sexual culture among younger generations. Compared to the past, relationships between young people often progress more quickly to sexual activity. Condom use also appears to be less common in some cases, and the average age of first sexual experience may be decreasing.
Although the numbers are smaller, there also appears to be a gradual increase in STIs among older adults. Longer life expectancy and the use of medications for erectile dysfunction may contribute to more frequent sexual activity in this population compared with previous generations.
Another factor, in my personal view, may be declining immune resilience among some younger individuals. Physical fatigue, psychological stress, sleep deprivation, and other lifestyle factors may weaken immune defenses, which could partly explain the rise in viral STIs. In addition, the lower rate of circumcision compared with the past may also play a role. Some research supports this possibility, and the difference is noticeable in clinical practice.
Second, globalization has increased cross-border movement and cultural exchange. International travel by Korean citizens, foreign tourists visiting Korea, foreign workers living in Korea, and international marriages have all increased. As interactions between people from different countries grow, the epidemiological patterns of STIs in Korea may also gradually change.
These changes may not only contribute to the increase in STI cases but may also make treatment more complex and, in some cases, lead to more severe disease presentations. For example, antibiotic resistance among bacteria that cause urethritis tends to be higher in some other countries. In addition, when treating patients with HPV-related genital warts, I sometimes observe that infections believed to have been acquired abroad progress more aggressively or recur more frequently.
Third, clinical experience reveals that some individuals tend to underestimate the seriousness of STIs. Some patients simply say, “If I get infected, I can just get treated,” or show little concern about the possibility of transmitting infection to others. When asked why they do not use condoms, some respond that it is inconvenient or that their partner does not prefer it.
Some patients come to the clinic requesting only a urine PCR test for urethritis pathogens and ask whether they can continue sexual activity during treatment. Situations like these can make clinical care challenging.
I recall one case where a patient living with HIV visited the clinic because he had developed gonorrhea. When I expressed concern, he explained that he had used a condom but still became infected. In this case, the infection was likely transmitted through oral sexual contact. In fact, infections transmitted through oral sex are more common than many people realize.
HIV infection requires lifelong treatment. Herpes simplex virus type 2 remains in the body permanently once acquired. Syphilis can be treated, but blood test markers often remain detectable for life. Despite this, some patients who have had high-risk sexual exposure come to the clinic worrying only about urethritis, without considering the possibility of other infections. In situations where STI exposure is suspected, comprehensive testing for multiple infections is recommended.
Fourth, there are also individuals who worry excessively about STIs. Some people visit the clinic frequently for testing even when there has been little risk exposure. Because testing costs are relatively affordable, some patients undergo repeated testing unnecessarily. In addition, some physicians may unintentionally create excessive fear among patients, and the overwhelming amount of online information can contribute to misunderstandings.
In the digital age, unverified information spreads quickly. Personal anecdotes lacking medical evidence are sometimes presented as if they were professional opinions, and many people accept them as fact. This phenomenon has become increasingly problematic.
HPV infection is one example. HPV is indeed associated with several types of cancer, and women may require regular monitoring even if infection is detected without visible lesions. However, the clinical situation for men is somewhat different. HPV is a very common virus transmitted through contact with skin or mucous membranes, and in many cases the infection resolves naturally over time. Nevertheless, some patients seek testing even when no lesions are present, often due to anxiety rather than medical necessity.
Finally, society has made important progress in promoting respect for women and gender equality. However, in discussions about STIs, there sometimes appears to be a tendency to place disproportionate responsibility on men.
Throughout my career, I have delivered many lectures on STIs to people of various age groups and professions. One point I always emphasize is that medically speaking, women are often more vulnerable to the complications of STIs than men. Therefore, men should take responsibility not only for their own health but also for protecting their partners by preventing infection and transmission.
Yet in clinical practice, some male patients arrive anxious after being told by their spouse or partner that they must be responsible for an infection detected during gynecological testing. When I review the laboratory results they bring, the detected organisms are often normal vaginal flora that naturally exist in the female genital tract. Even if the same bacteria are detected in men, they may have been transmitted from the female partner rather than the other way around.
HPV testing in men without visible lesions often yields negative results. Similarly, herpes simplex virus type 2 remains dormant in the body once acquired. In many cases, men are more likely to notice symptoms and avoid sexual activity when lesions appear. In women, however, lesions may be more difficult to detect visually, and symptoms may go unnoticed. For this reason, assigning responsibility solely to men is not always appropriate.
These reflections are based on what I have observed in clinical practice regarding the current situation of STIs in Korea. While these issues cannot be resolved quickly, continued education and public awareness are essential to improve understanding and prevent transmission.
This is a complex social and medical challenge that requires further research and broader efforts to shift public perception. No physician can fully master every aspect of STI management alone. In addition to urologists and gynecologists who frequently treat STI patients, all healthcare professionals would benefit from more comprehensive education on sexually transmitted infections.
In an era where information spreads rapidly, managing the circulation of inaccurate or misleading information is also crucial. The most effective strategy for STI prevention remains education and public awareness. Helping the general public understand these infections accurately is essential, even though achieving that goal is not easy. Ultimately, addressing this issue will require collective effort from both the medical community and society as a whole.