A new report by Public Health England (PHE) shows numbers of new STI diagnoses in 2018 increased by 5% in comparison to 2017 (from 424,724 to 447,694). The number of consultations at sexual health services, both in clinic settings and online, increased by 7% between 2017 and 2018 (from 3,337,677 to 3,561,548). The rise in STIs is likely to be due to people not using condoms correctly and consistently with new and casual partners, and an increase in testing improving detection of the most common STIs.
Importantly, in 2018, gonorrhoea diagnoses rose by 26% from 2017 (from 44,812 in to 56,259). Gay, bisexual and other men who have sex with men (herein known as MSM) are at higher risk and over-represented, with almost half of cases diagnosed in this group. This trend is concerning given the emergence of extensively-drug resistant gonorrhoea. PHE actively monitors and investigates the spread of antibiotic resistance in gonorrhoea and potential treatment failures to help reduce the spread of resistance.
Cases of syphilis also increased and have more than doubled over the past decade (from 2,847 in 2009 to 7,541 in 2018). PHE has worked with stakeholders to develop a syphilis action plan to tackle this rise, which is most notable amongst MSM, who accounted for 75% of cases in 2018. The main aims of this action plan include increasing testing frequency of high-risk MSM; improving partner notification; and maintaining high rates of antenatal screening.
Chlamydia remained the most commonly diagnosed STI, accounting for almost half of new STI diagnoses (218,095). Chlamydia most commonly affects 15 to 24 year olds, who account for 60% (131,269) of new diagnoses – an increase of 2% since 2017. This is in line with the National Chlamydia Screening programme’s aim to increase detection and reduce prevalence of chlamydia by proactively offering screening to young people.
The report highlights that the HPV vaccination programme has led to a marked decline in genital warts diagnosis, which are caused by some strains of HPV that the vaccine protects against. The rate of genital warts diagnoses among girls aged 15 to 17 years, most of whom would have been offered the quadrivalent HPV vaccine aged 12 to 13 years old, was 92% lower in 2018 compared to 2014. A decline of 82% was seen in same aged heterosexual boys over this time period, which suggests substantial herd protection.
Across all STIs, the highest rates of diagnoses continue to be seen in 15 to 24 year olds, MSM, and black minority ethnic groups. This is likely due, in part, to higher rates of partner change and/or more concurrent sexual partnerships without consistent condom use. Among a minority of MSM, chemsex may facilitate these risk behaviours. The rates of STIs are far lower in older age groups but are increasing, with the largest proportional increase in gonorrhoea and chlamydia seen in people over 65.
Often, individuals with STIs may not realise they have one because these infections are often symptomless. This means people can easily contract an STI or pass one on without knowing it and should take up the offer of STI screening, regardless of whether they show symptoms if they have had sex with a new or casual partner without using a condom.
Those at risk of STIs can access services through sexual health clinics. Many clinics offer online testing, which means people can order tests using clinics’ websites, take them in the privacy of their own home, send kits off to a laboratory for testing and receive results either via text, phone call or post. PHE recommends regular HIV and STI testing for those with new or casual partners. Local STI services can be found online via NHS.UK.
In 2018, there were 447,694 diagnoses of sexually transmitted infections (STIs) made at sexual health services in England, a 5% increase since 2017. Of these, the most commonly diagnosed STIs were chlamydia (218,095; 49% of all new STI diagnoses), first episode genital warts (57,318; 13%), gonorrhoea (56,259; 13%), and genital herpes (33,867; 8%).
The number of consultations at sexual health services, both in clinic settings and online, increased by 7% between 2017 and 2018 (from 3,337,677 to 3,561,548).
The total number of sexual health screens (tests for chlamydia, gonorrhoea, syphilis, and HIV) increased over this time period (22%; from 1,603,744 in 2014 to 1,955,108 in 2018).
The increase in the total number of new STIs was due to a large increase in gonorrhoea (26%; from 44,812 to 56,259) and more moderate increases in chlamydia (6%; from 205,365 to 218,095), syphilis (primary, secondary and early latent stages: 5%; from 7,149 to 7,541), and first episode genital herpes (3%; from 32,828 to 33,867) diagnoses. There were 7,541 diagnoses of syphilis reported in 2018, a 5% increase since 2017.
Between 2017 and 2018 increases in STIs were reported in heterosexual women (2%; from 138,398 to 141,440), heterosexual men (1%; from 134,160 to 134,897), women who have sex with women (WSW: 16%; from 571 to 661), and MSM (17%; from 55,357 to 64,831).
In people over 65, gonorrhoea increased by 42% (from 236 to 336) and chlamydia increased by 24% (from 416 to 517); however, the population diagnosis rates of these STIs remain far lower than those of people under the age of 35 years.
There were 193 diagnoses of first episode genital warts in 15 to 17 year old girls in 2018, a 56% decrease relative to 2017, and 100 diagnoses of first episode genital warts in same aged heterosexual boys, a 46% decrease relative to 2017.
Through the National Chlamydia Screening Programme, 1,304,113 chlamydia tests were carried out among young people aged 15 to 24 years, a 1% decline since 2017 and a 22% decline since 2014. Due to an increase in the proportion testing positive, this resulted in 131,269 chlamydia diagnoses in this age group, an increase of 2% since 2017.
Syphilis action plan
‘Addressing the increase in syphilis in England: PHE Action Plan’ has been published. There is a need to strengthen public health measures to reduce transmission of syphilis. National clinical guidelines recommend frequent testing in high-risk MSM, but surveillance data suggests this is not uniformly carried out. There are also concerns about poor knowledge and awareness of syphilis among MSM.
A wide range of measures to control transmission already exists, but the continued increase in cases suggests that these are either not being applied consistently or that new, additional measures should be considered.
The actions specified in the plan are aimed at clinicians, public health specialists, specialty societies and commissioners of specialist sexual health services and focus on the main affected populations.
A successful response to the current increase in syphilis incidence is dependent upon action that optimises four prevention pillars fundamental to syphilis control and prevention:
- Increase testing frequency of high-risk MSM and testing of syphilis cases after treatment
- Deliver partner notification to BASHH standard
- Maintain high antenatal screening coverage and vigilance for syphilis throughout antenatal care
- Sustain targeted health promotion.
Read the full report and breakdown of data.