Sexually transmitted infections in 2019

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Public Health England (PHE) has released the latest sexually transmitted infection (STI) surveillance data for 2019. Following the upward trend since 2015, STIs diagnoses have risen again and 468,342 diagnoses were made in England in 2019, a 5% increase from 2018.

Total number of STI diagnoses, England 2010 to 2019
Key findings

Diagnoses

  • 468,342 diagnoses of STIs in England in 2019.
    • 249,690 recorded gender ‘male’.
    • 216,058 recorded gender ‘female’.
  • 26% increase in gonorrhoea since 2018, the highest since records began in 1918.
  • 10% increase in syphilis since 2018. In women the increase is 36%, but 81% of infections were recorded in men who have sex with men (MSM), of which almost a third (31%) were MSM living with diagnosed HIV.
  • 7% increase in number of consultations at sexual health services.
    • This is largely driven by a 84% increase in consultations reported by internet services (from 260,708 to 480,112).
  • 11% decrease in genital warts.

Testing and screening

  • The National Chlamydia Screening Programme (NCSP) conducted 2% more tests in 2019 compared to 2018; however, there has been a 13% decline since 2015 (from 1,546,180 in 2015 to 1,339,913 in 2019).
  • 181 sexual health services reported testing for Mycoplasma genitalium (M.Gen) in 2019, compared to 107 in 2018.
    • This increase in testing capabilities has largely influenced the 196% increase in M.Gen diagnoses in 2019, up to 5,311.

Disproportionately impacted populations

Young heterosexuals 15 to 24 years; black ethnic minorities; and gay, bisexual and other MSM continue to report the highest rates of STIs in England.

Young heterosexuals

The majority of chlamydia diagnoses (62%) and gonorrhoea diagnoses (54%) in sexual health services were made in young heterosexuals. This group was also attributed to 41% of genital herpes diagnoses and 40% of genital warts.

MSM

Bacterial STIs are more likely to be diagnosed in MSM than other men. 81% of syphilis diagnoses were in MSM as well as 66% of gonorrhoea. The most common STIs have seen substantial increases in this population, with gonorrhoea diagnoses increasing by 26% and chlamydia diagnoses by 21%.

Of all MSM diagnosed with an STI in sexual health services in 2019, 18% were living with diagnosed HIV. A breakdown of STIs diagnosed in MSM by HIV status is provided in the graph below.

STI diagnoses among MSM by HIV status, 2010-2019

Black minority ethnic and other impacted populations

Black minority ethnic (BME) populations continue to be disproportionately impacted by STIs. In particular, the rate of gonorrhoea in BME people is 3.5x that of the general population and the rate of trichomoniasis is 9x that of the general population.
The largest proportional increase in all new STI diagnoses was in people of Asian ethnicity (16%; from 15,168 to 17,522), this was largely due to large increases in new gonorrhoea (36%) and chlamydia (27%) diagnoses.
The disparities between different ethnic groups are best seen in these images below, looking at rates of STIs for both men and women.

Rates of STI diagnoses by ethnic group among males, England 2019

Rates of STI diagnoses by ethnic group among females, England 2019

PHE has provided data based on World regions of birth, these have shown high overall increases of STI diagnoses in England with:

  • 9% of people born in the EU,
  • 11% of people born in North America,
  • 12% of people born in South Asia,
  • 16% of people born in South America,
  • 21% of people born in Central America.

Impact of COVID-19

The latest data release does not cover the period since the COVID-19 pandemic began. However, PHE has advised that they are already analysing the surveillance data and how the impact of the COVID-19 response in England has affected HIV and STI service provision and epidemiology. Provisional findings are due in the coming months.

The latest report outlines how the national programme with PHE, Terrence Higgins Trust and 56 Dean Street delivered 10,000 free self-sampling HIV (and opt-in syphilis test) kits as part of the summer ‘Break the chain’ campaign.

PHE has also published a new national framework for e-sexual and reproductive healthcare. This provides information on how e-sexual and reproductive services can complement specialist, clinic-based facilities in local areas, providing other methods of accessing healthcare.

Resources from PHE

Sexually transmitted infections and chlamydia screening in England: 2019 [PDF].

Latest STI data tables, infographics and supplemental information.

National framework for e-sexual and reproductive healthcare: User guide [PDF]

Community HIV testing and COVID-19

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Community HIV testing and COVID-19

HIV Prevention England and NAT (National AIDS Trust) invite you to join us for this online event exploring how to deliver safe and effective community HIV testing in the current context of COVID-19, and launching NAT’s two new toolkits, created to support the effective design and evaluation of community HIV testing.

Community-based HIV testing is a valuable contributor to the effort to end HIV transmissions in England. By drawing on the best practice of current community testing providers, these toolkits explore the key questions to consider when designing and delivering community testing interventions in England. They also support stronger evaluation of interventions to ensure that lessons are learned and national understanding of community testing is improved.

This event is intended for:

  • Providers and commissioners of community testing.
  • Community organisations interested in setting up testing interventions.
  • Wider colleagues in sexual and public health.

NAT’s community testing project was funded through the Public Health England Innovation Fund and some of the content of the toolkits is specific to England. However, the toolkits and discussion will still be likely to have relevance in other parts of the UK.

HIV Prevention England and a wider Advisory Group have supported NAT throughout the project.

When: 3.30-5pm, Wednesday 26 August 2020

Register for this event

PrEP knowledge, attitudes and usage among Black African communities in England

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There is overwhelming evidence of the effectiveness of PrEP at preventing HIV transmission. Public Health England has credited PrEP as a key factor for the dramatic drop in new HIV diagnoses in the UK, particularly among gay, bisexual and other men who have sex with men (GBM) (PHE, 2019). Recently, it was announced by the UK government that PrEP would become routinely available across England by autumn 2020.

Despite making up less than 1.8% of the British population (ONS, 2020), Black Africans (BA) are over-represented in the rates of new HIV diagnoses every year. The latest figures showed that they constituted 44% of all new heterosexual HIV cases (PHE, 2019). This population stands to benefit from PrEP, however, there is very limited evidence answering the following questions:

  • Whether Black African communities in the UK are aware of PrEP.
  • Whether Black African communities in the UK are willing to use PrEP.
  • Whether Black African communities are currently using PrEP.
  • Whether the current and forthcoming access options are acceptable for Black African communities.

To determine the knowledge of and attitudes towards PrEP in BA communities in England ahead of the rollout of routine commissioning of PrEP, HIV Prevention England (HPE) is currently reviewing available research and health promotion programme data, including HPE community and evaluation survey results and PHE innovation fund reports.

Key findings

PrEP Knowledge

Initial data suggests that knowledge of PrEP is very low among BA men and women particularly compared to GBM counterparts. HPE ran a small face-to-face community survey in 2019 for BA men and women where only 22% (15/68) people were aware of PrEP. An online survey that was run as part of the It Starts With Me (ISWM) 2019 campaign evaluation found also that just 53% (124/234) of BA had heard about PrEP before, compared to 84% (465/554) of GBM.

In some cases where BA have reported hearing of PrEP, individuals may conflate it with PEP (post-exposure prophylaxis) or believe it to be for GBM only. For example, 21% of people who said they knew what PrEP was in HPE’s face-to-face community survey had these misunderstandings (4/19).

PrEP attitudes

Once BA people know what it is and how it works, many say that they would be willing to take PrEP under certain circumstances. In the HPE community survey, when asked if they would be willing to take PrEP in a scenario where condoms were unavailable, 63% (43/68) said that they would in the following situations:

  • Where personal risk perception is high. For example, if sexual risk-taking behaviour increased or if other methods, such as condoms, were not available or individuals did not want to use them.
  • For protection (‘to be safe’) as a general precaution towards others’ unknown status.
  • Due to belief in the science, that it is effective at prevention.

At the same time, a number of BA people were hesitant to take PrEP for some of the following reasons:

  • Needing more information on PrEP.
  • Scepticism and worries regarding the evidence/science: whether they could trust messages regarding side effects and interactions, PrEP effectiveness.
  • A dislike of taking ‘Western’ medication unless absolutely necessary.
  • Finding it not personally relevant (‘I don’t do those things anymore’ or ‘I prefer condoms’).

PrEP Use

In the ISWM evaluation findings, BA men and women consistently report low condom use: only 18% used condoms ‘all the time’ or ‘often’; 77% ‘never’ or ‘sometimes’ only. Despite this, none reported using PrEP. This contrasts with GBM, where 38% of low condom use individuals reported using PrEP.

When considering data from the rest of the UK, from July 2017-June 2019, there were only 14 individuals with African ethnicity taking PrEP in Scotland (0.4% of all PrEP users) (HPS, 2019). In Wales, from July 2017-March 2019, <10 individuals taking PrEP were of Black ethnicity (<1% of all PrEP users) (PHW, 2019).

Summary

In these examples there is a low level of knowledge among Black Africans about PrEP, which is markedly different from GBM cohorts. In addition to this, people who have heard of PrEP may have misconceptions about what it means, who it is for and how to access it.

A significant proportion of BA individuals are open to taking PrEP in situations where they have the correct information about it and can recognise that they may benefit from taking it.

According to available data, extremely few Black Africans are currently using PrEP in the UK.

As England prepares for the routine commissioning of PrEP in the autumn, it is important that the issues outlined in this article are considered further and appropriate steps taken to ensure that everyone who may stand to benefit, including Black African communities, are aware of and can access PrEP appropriately.