A new report by Public Health England (PHE) shows a rise in STI diagnoses in 2018. They 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.