Research

Latest STI data show significant rise in gonorrhoea and syphilis cases

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On 6 June, the UK Health Security Agency (UKHSA) released the latest data on sexually transmitted infections (STIs) for England.

The new data show there were 392,453 STIs diagnosed in England in 2022, which represents a rise of 24% from 2021. Gonorrhoea diagnoses were the highest annual number on record and syphilis diagnoses were the highest since 1948. Key information includes:

  • Gonorrhoea diagnoses increased by 50% from 54,961 in 2021 to 82,592 in 2022
  • Chlamydia diagnoses increased by 24% from 160,279 in 2021 to 199,233 in 2022
  • Syphilis diagnoses increased by 15% from 7,543 in 2021 to 8,692 in 2022
  • There was a 21% increase in chlamydia in young people despite no increase in testing among this group
  • There were 2,195,909 sexual health screens performed by sexual health services, a 13% increase from 2021.

Whilst the rise in testing may contribute to the increases in STI diagnoses, the scale of increase in gonorrhoea and syphilis cases indicates there is likely more transmission of STIs within the population.

The greatest burden of STI diagnoses continues to be on young people (aged 15 t0 24 years), gay, bisexual, and other men who have sex with men (GBMSM), and some people of Black ethnicity. In 2022, people of Black Caribbean ethnicity had the highest diagnosis rates of chlamydia, gonorrhoea, infectious syphilis, trichomoniasis, and genital herpes. This ethnic disparity is most likely caused by underlying socio-economic factors as opposed to any clinical or behavioural factors.

The main STI prevention messages include:

  • Consistent condom use
  • Regular screening for STIs and HIV as part of maintaining good sexual health. A person who is sexually active should be advised to test at least once a year, and those having sex with new partner(s) should be advised to test every 3 months
  • Using HIV pre-exposure prophylaxis (PrEP) for those at an increased likelihood of acquiring HIV. PrEP is available on the NHS from sexual health services
  • Ensure everyone who is eligible is up to date with vaccinations, including for HPV, Hepatitis A & B, and Mpox.

Responses to the STI data release

UKHSA conclude that there is evidence of a rebound in service provision at sexual health services, following the disruption during the Covid-19 pandemic. The scale up of online sexual health provision has continued in 2022, which has contributed to an increase in overall consultations at sexual health services. However, UKHSA highlight the importance of monitoring equity of access to reduce health inequalities.

Dr Hamish Mohammed, Consultant Epidemiologist in the STI Section at UKHSA, responded to the data:

“We saw more gonorrhoea diagnoses in 2022 than ever before, with large rises in gay and bisexual men. STIs aren’t just an inconvenience – they can have a major impact on your health and that of any sexual partners. Condoms are the best defence, but if you didn’t use one the last time you had sex with a new or casual partner, get tested to detect any potential infections early and prevent passing them on to others. Testing is important because you may not have any symptoms of an STI.

“PrEP only provides protection from HIV, so you still need a condom to avoid getting or passing on an STI such as syphilis or gonorrhoea.”

However, whilst increasing the uptake in STI testing is crucial for reducing the number of diagnoses, calls from civil society also warn that sexual health services must be adequately funded to effectively respond to increasing demand. In their statement on the STI data release, the British Association for Sexual Health and HIV (BASHH) reaffirm that these latest stats are against a backdrop of substantial pressures on sexual health services.

You can order information resources, including leaflets on gonorrhoea, chlamydia, and syphilis from the HPE resources portal, and find out more information about STIs at startswithme.org.uk.

Read the full report on ‘Sexually transmitted infections and screening for chlamydia in England: 2022 report’

Read the full statement from BASHH.

Using antibiotics to prevent STIs

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The use of antibiotics to prevent (rather than treat) sexually transmitted infections (STIs) is not endorsed by the British Association for Sexual Health and HIV (BASHH) or the UK Health Security Agency (UKHSA). However, this self-management approach to sexual health has been used informally for some time, especially by some gay and bisexual men.

There is currently a renewed interest in better understanding if antibiotics can and should be used in this way – and what the potential drawbacks to this approach might be – in an era of declining condom use, HIV pre-exposure prophylaxis (PrEP) and rising rates of bacterial STIs.

This briefing paper, produced by NAM aidsmap for HIV Prevention England, provides an overview of the latest research on STI prophylaxis. This technical briefing is based on research that has been carried out with cisgender men who have sex with men (MSM) and transgender women. There is a lack of research in this area with other groups.

The HPE team would like to acknowledge Krishen Samuel for producing this resource.

Read briefing: Using antibiotics to prevent STIs (2022) [PDF]

See all our HPE briefings

New HIV diagnoses continue to fall in England

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On World AIDS Day, the UK Health Security Agency (UKHSA) published its HIV testing, new HIV diagnoses, outcomes and quality of care for people accessing HIV services: 2021 report [PDF].

The report provides an update on the UK HIV epidemic against the backdrop of the emergence and continuation of the COVID-19 pandemic during 2020. COVID-19 affected all aspects of life, including sexual behaviour and access to testing and services. Significant resources continue to be required to respond to the pandemic, and the latest UKHSA report does not include HIV data from Scotland in 2020. Unless stated, this overview looks at data in England only.

The impact of COVID-19

The latest surveillance data follows figures published in September 2021, which reported a 32% drop in new sexually transmitted infections (STIs) in England. Whilst the new report reaffirms that the UK is continuing to see a downward trend in new HIV diagnoses, it is clear COVID-19, and in particular, lockdown restrictions implemented to respond to the pandemic have contributed to this decline during 2020.

  • The number of people tested for HIV in sexual health services (SHS) fell by 30%, and 47% of people who tested for HIV did so online in 2020.
  • An estimated 4,980 – 6,960 people with HIV were not seen in care during the year, either virtually or face-to-face, more than twice the number in 2019.
  • Sadly, at least 99 deaths recorded between March and June 2020 amongst people with HIV were due to COVID-19.

New diagnoses

It is now estimated that there are 106,890 people living with HIV in the UK, of which an estimated 5,150 (5%) remain undiagnosed.

The number of new HIV diagnoses fell by a third (33%) in England, from 3,950 in 2019 to 2,630 in 2020. The decrease was 47% in gay and bisexual men (GBM), but less apparent in people who likely acquired HIV via heterosexual contact (23%), although there were stark variations between different ethnicities.

In relation to GBM, it is believed the year-on-year decline is a continuation of the downward trend reported in recent years, with only a 7% fall in numbers testing for HIV, and access to pre-exposure prophylaxis (PrEP) maintained in 2020. However, the numbers of heterosexuals testing in 2020 fell considerably, and the reduced numbers of new HIV diagnoses are likely a reflection of this.

Late diagnoses

UKHSA have reclassified late HIV diagnoses in 2020, and retrospectively applied a new methodology to provide direct year-on-year comparisons. Using evidence of recent HIV seroconversion, UKHSA have removed people likely to have recent acquired HIV from the late diagnosis data.

Despite this reclassification, late HIV diagnoses continue to remain stubbornly high in England. In 2020, 42% of people first diagnosed in England were diagnosed late. UKHSA warn that in people diagnosed late in 2019 had more than a seven-fold increased risk of death within a year of diagnosis, compared to those diagnosed promptly.

Populations with more than 50% late diagnoses in 2020:

  • People aged 65+ (66%).
  • People aged 50-64 (59%).
  • People of Black African ethnicity (54%).
  • Men who likely acquired HIV from heterosexual contact (55%).
  • Women who likely acquired HIV from heterosexual contact (51%).

HIV care and treatment

For the first time the UK has surpassed the UNAIDS 95-95-95 targets, in 2020:

  • 95% of people living with HIV were diagnosed.
  • 99% of those diagnosed were on treatment
  • 97% of those on treatment had an undetectable viral load.

Coming soon: in-depth analysis of the latest HIV data

HIV Prevention England will explore the latest HIV surveillance data in more detail in a series of blog posts in early 2022. We will look at the groups most affected by HIV, as well as specific areas of interest, such as HIV testing, people living with HIV and what the latest data means for England’s new HIV Action Plan.

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