Research and analysis

Spotlight on sexually transmitted infections in the South East: 2021 data

Updated 5 March 2024

Applies to England

Summary

This report focusses on sexually transmitted infections (STIs) in the South East reported in 2021, but 2022 data is presented for some infections where available. HIV is reported on separately. Please access the UK Health Security Agency (UKHSA)’s report on STIs and screening for chlamydia in England for a national perspective (1).

STIs remain an important public health problem in the South East.

More than 36,800 new STIs were diagnosed in South East residents in 2021, representing a rate of 412 diagnoses per 100,000 population, which is lower than that seen in England as a whole (551 per 100,000).

New STI rates were higher in England in the following local authorities:

• Brighton and Hove (1,054 per 100,000)
• Portsmouth (871 per 100,000)
• Southampton (785 per 100,000)
• Reading (685 per 100,000)

The number of new STIs diagnosed in South East residents decreased by 1% between 2020 and 2021. Increases in diagnoses were seen in:

• syphilis (6%)
• genital herpes (11%)
• genital warts (3%)

Gonorrhoea diagnoses decreased by 7% and chlamydia by 3%. The number of gonorrhoea and syphilis diagnoses remained higher in 2021 than in 2017.

Overall, there was an increase in the number of consultations delivered by sexual health services (SHSs) in the South East in 2021 compared to 2020 (12% increase from 452,362 to 508,262).

Of all consultations in 2021:

• 51% (259,217) were delivered face to face
• 33% (168,102) were via the internet (compared to 17% in 2019)
• 16% (80,943) were via telephone

Compared to 2020, rises were seen in 2021 in consultations via the internet (22% increase), telephone (111% increase) but there was a fall in face-to-face consultations (6% decrease).

STI testing (excluding chlamydia in people aged under 25 years) in the South East increased by 6% between 2020 and 2021, but remained 24% lower than prior to the coronavirus (COVID-19) pandemic in 2019. There was a corresponding decrease in the STI positivity reported in the South East, from 5.5% in 2020 to 5.2% in 2021.

In June 2021, the National Chlamydia Screening Programme (NCSP) changed to focus on reducing reproductive harm of untreated infection in young women. This led to a change in the recommended chlamydia detection rate indicator (DRI) included in the Public Health Outcomes Framework (PHOF).

UKHSA recommends that local authorities work towards the revised female-only PHOF benchmark DRI of 3,250 per 100,000 females aged 15 to 24 years. This report relates to 2021 data, for the most part of which the NCSP recommended an offer of screening to all sexually active young people aged under 25 years.

In 2021, the chlamydia detection rate among South East residents aged 15 to 24 years (all recorded genders) was 1,082 per 100,000 residents, lower than the previous recommended DRI of least 2,300 per 100,000 residents aged 15 to 24 years (all recorded genders). The proportion of South East residents aged 15 to 24 years screened for chlamydia increased from 11.4% in 2020 to 12.0% in 2021.

Men have higher rates of new STIs than women (411 and 380 per 100,000 residents, respectively).

Where gender and sexual orientation are known, gay, bisexual and other men who have sex with men (GBMSM) account for 21% of South East residents diagnosed with a new STI, excluding chlamydia diagnoses reported via CTAD Chlamydia Surveillance System (CTAD) surveillance system. They represent 78% of those diagnosed with syphilis and 56% of those diagnosed with gonorrhoea.

The number of new STIs in GBMSM increased by 6% from 2020 to 2021, with diagnosis increases seen:

• genital herpes
• genital warts
• gonorrhoea
• chlamydia

STIs disproportionately affect young people. South East residents aged between 15 and 24 years accounted for 45% of all new STI diagnoses in 2021. A steep decline (93% decrease) has been seen between 2017 and 2021 in genital warts diagnosis rates in females aged 15 to 19 years.

The white ethnic group has the highest number of new STI diagnoses (24,149; 83%). Although only 2% of new STIs are in the black Caribbean ethnic group, the group has the highest rate (1,656 per 100,000), which is 5 times the rate seen in the white ethnic group. The rate of new STIs was also high in the black African ethnic group (1,591 per 100,000).

Where country of birth was known, 82% of South East residents diagnosed with a new STI in 2021 (excluding chlamydia diagnoses reported via CTAD) were UK-born.

Mpox (monkeypox) is a zoonotic infection, caused by the monkeypox virus (MPXV), that previously occurred mostly in West and Central Africa and is transmitted through close contact. Previous cases in the UK had been either imported from countries where mpox is endemic or contacts with documented epidemiological links to imported cases. In 2022, there was a very large outbreak of mpox in the UK, mainly in GBMSM. In the South East 326 cases were reported between 6 May and 19 December 2022 (2).

Implications for prevention

STIs continue to show marked geographic and socioeconomic variation and they disproportionately impact GBMSM, black ethnic groups, and young people aged 15 to 24 years.

STI prevention efforts should include a range of measures. Proactive health promotion and high quality health education improve risk awareness and encourage safer sexual behaviour and testing. Consistent and correct condom use substantially reduces the risk of being infected with an STI. Immunisation reduces the risk of being infected with certain infections. STI screening, open access to SHSs for STI diagnosis and treatment and robust contact tracing, allows earlier diagnosis and reduces the length of time that people are infectious. Such measures need to be effectively commissioned, including targeting those groups highlighted above that are at greatest risk.

Following the disruptions in service delivery during the first year of the COVID-19 pandemic, the number of consultations at sexual health services for South East residents increased between 2020 and 2021 and now exceeds the number reported in 2019 (pre-COVID-19 pandemic). This provides evidence of a recovery in service provision, after the lifting of COVID-19 restrictions in the summer of 2021, partially driven by the continued widespread provision of online consultations which now make up a third of consultations for South East residents.

The number of sexual health screens (for chlamydia, gonorrhoea, syphilis and HIV) in the South East also increased between 2020 and 2021, although the overall number of STI diagnoses remained stable. The increase in sexual health screens may be a result of built-up demand for SHSs as well as a return to pre-COVID-19 pandemic levels of social and sexual mixing and the substantial number of tests being accessed through online services (3 to 6). It will remain important to continue to monitor and understand whether these changes have affected equity of access to SHS (7, 8). The decline in positivity may indicate more testing among lower risk populations.

The high rates of STIs among young people aged 15 to 24 years are likely to be due to greater rates of partner change (9). Implementation of Relationships Education in primary schools, as well as Relationships, Sex and Health Education (RSHE) in all secondary schools is expected to provide young people with the information and skills to prepare to look after their sexual health (10, 11, 12).

Many areas in England continue to provide condom schemes which distribute condoms to young people (mostly aged under 20 years) through a variety of outlets (13) and condoms are provided free from sexual health clinics for all ages.

The NCSP promotes screening for chlamydia, the most commonly diagnosed bacterial STI, in sexually active young women and other people with wombs or ovaries, on change of partner or annually (14). This reflects a change in focus in June 2021 to reducing the reproductive harm of untreated chlamydia infection.

The National HPV Vaccination Programme introduced vaccination against human papillomavirus (HPV), the virus which causes genital warts, for young women in 2008 and for young men in 2019. The programme has achieved high coverage in young women and has been successful in producing a longer-term decline in genital warts since 2009, which continued to fall in 2021 in those aged 15 to 19 years.

In GBMSM, diagnoses of STIs increased. High levels of gonorrhoea and infectious syphilis suggest that rapid STI transmission is occurring in dense sexual networks through condomless sex, including those living with HIV. Condomless sex increases the risk of infection of a range of infections that can be transmitted sexually, including hepatitis B and hepatitis C.

As GBMSM continue to experience high rates of STIs they remain a priority for targeted prevention and health promotion, including immunisation against hepatitis A, hepatitis B, HPV and mpox.

There is a continued need to strengthen public health measures to reduce transmission of syphilis. National clinical guidelines recommend frequent testing in high-risk GBMSM (15), but surveillance data suggests this is not uniformly carried out. There are also concerns about poor knowledge and awareness of syphilis among GBMSM (16). The Syphilis Action Plan includes recommendations to address the increase in syphilis diagnoses in England (17).

The 2022 mpox outbreak predominantly affected GBMSM. SHSs were instrumental in responding, including delivering vaccination to protect high risk GBMSM. The UK strategy for mpox control was published in December 2022 and outlines the UK’s plan to continue reducing mpox transmission (18).

In 2021, the population rates of STI diagnoses remained high among people of black ethnicity, but this varied across black ethnic groups. Research has found, that when compared to all other ethnic groups, there were no unique clinical or behavioural factors explaining the disproportionately high rates of STI diagnoses among people of black Caribbean ethnicity; this ethnic disparity in STIs is likely influenced by underlying socioeconomic factors and the role they play in the structural determinants of the health of this community (19).

Several HIV prevention activities may impact on STI control and promote safer sexual behaviours. The Department of Health and Social Care (DHSC) have commissioned Terrence Higgins Trust to deliver a new National HIV Prevention Programme from November 2021 to March 2024. The programme aims to improve knowledge, understanding and uptake of combination HIV prevention interventions among populations most at-risk of HIV in England, particularly aimed at GBMSM and people of black ethnicity and other groups in which there is a higher or emerging burden of infection (20).

UKHSA’s main messages

Providers and commissioners have an important role in communicating messages about safer sexual behaviours and how to access services.

Important prevention messages

Using condoms consistently and correctly protects against HIV and other STIs such as chlamydia, gonorrhoea, and syphilis, and can prevent unplanned pregnancy.

Regular screening for STIs and HIV is essential to maintain good sexual health. Everyone should have an STI screen, including an HIV test, on at least an annual basis if having condomless sex with new or casual partners.

In addition:

• women and other people with a womb or ovaries aged under 25 years who are sexually active should have a chlamydia test annually and on change of sexual partner
• GBMSM should have an annual test for HIV and STIs or every 3 months if having condomless sex with new or casual partners

HIV pre-exposure prophylaxis (PrEP) can also be used to provide protection to people at risk of HIV while HIV post-exposure prophylaxis (PEP) can be used after condomless sex if someone has potentially been exposed to HIV, to reduce the risk of contracting HIV. Both of these can be obtained from specialist SHSs.

People living with diagnosed HIV who are on treatment and have an undetectable viral load are unable to pass on the infection to others during sex. This is known as ‘Undetectable = Untransmittable’ or ‘U=U’.

Vaccination against MPXV, HPV, hepatitis A and hepatitis B will protect against disease caused by these viruses and prevent the spread of these infections:

• GBMSM can obtain the mpox, hepatitis A and hepatitis B vaccines from specialist sexual health services; these vaccines are also available for other people at high risk of exposure to the viruses
• GBMSM aged 45 years and under, can also obtain the HPV vaccine from specialist SHSs

SHSs are free and confidential and offer testing and treatment for HIV and STIs, condoms, vaccination, HIV PrEP, and PEP:

• online self-sampling for HIV and STIs is widely available
• information and advice about sexual health, including how to access services, is available at Sexwise and from the national sexual health helpline on 0300 123 7123

Charts, tables and maps

Figure 1. New STI diagnosis rates by UKHSA region of residence, England, 2021

Data sources: GUMCAD STI Surveillance System (GUMCAD), CTAD

Figure 1 is a bar chart showing the rate of new STI diagnosis in the South East (411.6 per 100,000 population). The South East rate is the third lowest among the English regions in 2021.

Figure 2. Number of diagnoses of the 5 main STIs, South East residents, 2017 to 2021

Data sources: GUMCAD, CTAD

[note 1] Any increase in gonorrhoea diagnoses may be due to the increased use of highly sensitive nucleic acid amplification tests (NAATs) and additional screening of extra-genital sites in GBMSM. Any decrease in genital wart diagnoses may be due to a moderately protective effect of HPV-16/18 vaccination. Any increase in genital herpes diagnoses may be due to the use of more sensitive NAATs. Increases or decreases may also reflect changes in testing practices.

Figure 2 shows trend lines of the number of diagnoses of the 5 main STIs for South East residents from 2017 to 2021. The highest number of diagnoses was in chlamydia. This was followed by genital warts, gonorrhoea, genital herpes and syphilis.

Figure 3. Diagnosis rates of the 5 main STIs, South East residents, 2017 to 2021

Data sources: GUMCAD, CTAD

See [note 1] above.

Figure 3 shows a trend line of the rate of diagnosis per 100,000 population of the 5 main STIs in the South East from 2017 to 2021. The highest rate of diagnosis is in chlamydia. This is followed by genital warts, gonorrhoea, genital herpes and syphilis.

Table 1. Percentage change in new STI diagnoses, South East residents

Diagnoses	2021	Percentage change from 2017 to 2021	Percentage change from 2020 to 2021
New STIs	36,825	-31%	-1%
Syphilis	817	12%	6%
Gonorrhoea	3,971	1%	-7%
Chlamydia	19,237	-24%	-3%
Genital herpes	3,201	-31%	11%
Genital warts	4,330	-52%	3%

Data sources: GUMCAD, CTAD

See [note 1] above.

Table 1 shows there was almost a 31% decrease in new STIs from 2017 to 2021 and a 1% fall from 2020 to 2021. 

Between 2017 and 2021, syphilis and gonorrhoea increased, but genital warts, genital herpes and chlamydia decreased.

From 2020 to 2021, genital herpes, syphilis and genital warts increased, but there were declines in gonorrhoea and chlamydia.

Figure 4. Rates of new STIs per 100,000 residents by age group (for those aged 15 to 64 years only) and gender in the South East, 2021

Data sources: GUMCAD, CTAD

Figure 4 is a bar chart showing rates of new STIs by age group. The rates of new STIs per 100,000 were highest among both females and males in the group aged 20 to 24 years (2,528 and 1,729 per 100,000 respectively). Rates were also high among females aged 15 to 19 years (1,415 per 100,000) and males aged 25 to 34 years (1,223 per 100,000).

Figure 5. Rates of gonorrhoea per 100,000 residents by age group [note 2] in the South East, 2017 to 2021

Data sources: GUMCAD

[note 2] Age-specific rates are shown for those aged 15 to 64 years only.

Figure 5 shows trend lines for rates of gonorrhoea per 100,000 in the South East from 2017 to 2021. Rates were highest among those aged 20 to 24 years and lowest among those aged 45 to 65 years. Rates declined from 2020 to 2021 for the younger age groups (aged under 35 years) and increased slightly for the older age groups (aged 35 to 64 years).

Figure 6. Rates of genital warts per 100,000 residents aged 15 to 19 years by gender in the South East, 2017 to 2021

Data sources: GUMCAD

Figure 6 shows trend lines for the rates of genital warts among residents aged 15 to 19 years by gender in the South East. It shows that rates have fallen steeply for both males and females from 2017 to 2021, although the rate in females remained stable from 2020 to 2021.

Figure 7. Rates of new STIs by ethnic group per 100,000 residents in the South East, 2021

Data sources: GUMCAD, CTAD

Figure 7 is a bar chart showing rates by ethnic group per 100,000 population of South East residents diagnosed with the new STI in 2021. It shows the rate of new STIs per 100,000 is significantly higher among the black Caribbean ethnic group and the black African ethnic group compared to the white and other ethnic groups.

Table 2. Proportion of South East residents diagnosed with a new STI by ethnicity, 2021

Ethnic group	Number	Percentage excluding unknown
White	24,149	83%
Black Caribbean	525	2%
Black African	1,182	4%
All other ethnic groups combined	3,358	11%
Unknown	7,611

Data sources: GUMCAD, CTAD

Table 2 shows the number and proportion of South East residents diagnosed with a new STI by ethnicity in 2021. It shows that the number and proportion of new STIs were highest in the white ethnic group (24,149). Where ethnicity was known, the black African ethnic group made up 4% of the total, and the black Caribbean group made up 2%.

Figure 8. Proportion of South East residents diagnosed with a new STI by world region of birth [note 3], 2021

Data sources: GUMCAD

[note 3] Data on country of birth is not collected by CTAD. All information about world region of birth is based on diagnoses made in specialist and non-specialist services which report to GUMCAD.

Figure 8 is a bar chart showing the proportion of South East residents diagnosed with a new STI by world region of birth in 2021. It shows that 82% of South East residents diagnosed with a new STI were born in the UK, 8% were born in Europe (excluding UK), 4% born in Sub-Saharan Africa and 2% born in the Caribbean or Central and South America.

Figure 9. Diagnoses of the 5 main STIs among GBMSM [note 4], South East residents, 2017 to 2021

Data sources: GUMCAD

[note 4] Data on sexual orientation is not collected by CTAD. All information about GBMSM is based on diagnoses made in specialist and non-specialist services which report to GUMCAD.

GUMCAD started in 2009. Reporting of sexual orientation is less likely to be complete for earlier years, so rises seen may be partly artefactual.

Any increase in gonorrhoea diagnoses may be due to the increased use of highly sensitive nucleic acid amplification tests (NAATs) and additional screening of extra-genital sites in GBMSM. Any decrease in genital wart diagnoses may be due to a moderately protective effect of HPV-16/18 vaccination. Any increase in genital herpes diagnoses may be due to the use of more sensitive NAATs. Any increase or decrease may reflect changes in testing.

Figure 9 shows trend lines for diagnoses of the 5 main STIs in specialist sexual health clinics among GBMSM, from 2017 to 2021. Gonorrhoea and chlamydia diagnoses increased from 2020 to 2021, but the number diagnosed remained lower than 2019. Over the 5 years from 2017 to 2021, syphilis diagnoses have increased slightly, genital warts have more than halved and there has been a fall in genital herpes.

Table 3. Percentage change in new STI diagnoses in GBMSM residents in the South East

Diagnoses	2021	Percentage change from 2017 to 2021	Percentage change from 2020 to 2021
New STIs	5,418	-9%	6%
Syphilis	580	4%	-1%
Gonorrhoea	2,061	5%	3%
Chlamydia	1,824	12%	9%
Genital herpes	145	-33%	10%
Genital warts	227	-52%	8%

Data sources: GUMCAD

See [note 4] above.

Table 3 shows the number of the main STI diagnoses among GBMSM South East residents in 2021 and the percentage change since 2017 and 2020.

From 2017 to 2021, the percentage increase among GBMSM was highest for chlamydia and the percentage decrease was greatest for genital warts. The percentage increase was highest for genital herpes from 2020 to 2021.

Figure 10a. Rate of new STI diagnoses per 100,000 population among South East residents by upper tier local authority of residence, 2021

Data sources: GUMCAD, CTAD

Figure 10a is a bar chart showing the rate of new STI diagnoses per 100,000 population among South East residents by upper tier local authority (UTLA) of residence in 2021. It shows that the rate of new STIs for all ages was highest in Brighton and Hove (1,054). Four UTLA had rates above the England average (Brighton and Hove, Portsmouth, Southampton and Reading).

Figure 10b. Rate of new STI diagnoses (excluding chlamydia diagnoses in people aged 15 to 24 years) per 100,000 population aged 15 to 64 years among South East residents by upper tier local authority of residence, 2021

Data sources: GUMCAD, CTAD

Figure 10b is a bar chart showing the rate of new STI diagnoses (excluding chlamydia diagnoses in people aged 15 to 24 years) per 100,000 population aged 15 to 64 years among South East residents by UTLA in 2021. The rate of new STIs for all ages was highest in Brighton and Hove (1,157) and lowest in West Berkshire (313).

Figure 11. Chlamydia detection rate per 100,000 population aged 15 to 24 years in South East residents by upper tier local authority of residence, 2021

Data sources: GUMCAD, CTAD

Figure 11 is a bar chart showing the chlamydia detection rate per 100,000 population aged 15 to 24 years in South East residents by UTLA of residence in 2021. The chlamydia detection rate among 15 to 24 year olds was highest in Portsmouth residents (2,236) and lowest in West Sussex (382).

Figure 12. Rate of gonorrhoea diagnoses per 100,000 population in South East residents by upper tier local authority of residence, 2021

Data sources: GUMCAD

Figure 12 is a bar chart showing the rate of gonorrhoea diagnoses per 100,000 population in South East residents by UTLA of residence in 2021. It shows the rate of gonorrhoea was highest among residents in Brighton and Hove (167) and lowest in the Isle of Wight (11).

Figure 13. Map of new STI rates per 100,000 residents by upper tier local authority in the South East, 2021

Data sources: GUMCAD, CTAD. Map contains Ordnance Survey data (© Crown copyright and database right 2021) and National Statistics data © Crown copyright and database right 2021)

Figure 13 shows a map of new STI rates per 100,000 residents by UTLA in 2021. The map shows the rate of new STIs for all ages was highest in Brighton and Hove and lowest in West Sussex. Rates tended to be higher in denser urban areas.

Figure 14. Map of new STI rates per 100,000 residents by middle super output area (MSOA) in the South East, 2021

Data sources: GUMCAD, CTAD

Figure 14 shows a map of new STI rates per 100,000 residents by middle super output area of residence in 2021. The map shows that as well as the more urban local authorities shown as having higher new STI diagnosis rates on the previous map, there are also areas with higher diagnosis rates in other local authorities, such as an area in west Oxfordshire and areas in northern Kent.

Figure 15. STI testing rate (excluding chlamydia in those aged under 25 years) per 100,000 population in South East residents aged 15 to 64 years, 2017 to 2021

Data sources: GUMCAD, CTAD

Figure 15 shows trend lines for the STI testing rate (excluding chlamydia in those aged under 25 years) per 100,000 population in South East and England residents aged 15 to 64 years from 2017 to 2021. The STI testing rate in the South East increased in 2021, but remained lower than seen 5 years prior. The testing rate in the South East was consistently lower than the England rate.

Figure 16. STI testing positivity rate [note 5] (excluding chlamydia in those aged under 25 years) in South East residents, 2017 to 2021

Data sources: GUMCAD, CTAD

[note 5] The numerator for the STI testing positivity rate now only includes infections, which are also included in the denominator. These are chlamydia (excluding diagnoses in those aged under 25 years), gonorrhoea, syphilis and HIV. Up to 2018 (data for 2017), it included all new STIs.

Figure 16 shows trend lines for the STI testing positivity rate (excluding chlamydia in those aged under 25 years) in South East and England residents from 2017 to 2021. It shows the STI testing positivity rate in the South East was lower than the England rate over the 5 years.

Table 4. Number of diagnoses of new STIs by UKHSA region of residence, data source and data subset 2021

UKHSA region of residence	GUMCAD specialist SHSs	GUMCAD non-specialist SHSs [note 6]	CTAD [note 7]	Total
East Midlands	10,622	6,275	3,974	20,871
East of England	15,809	4,238	5,608	25,655
London	69,545	8,162	23,792	101,499
North East	7,495	1,580	2,718	11,793
North West	23,693	3,789	7,954	35,436
South East	26,578	1,960	8,287	36,825
South West	13,797	2,444	4,782	21,023
West Midlands	16,890	3,867	4,804	25,561
Yorkshire and Humber	16,031	2,050	7,724	25,805

Data sources: GUMCAD, CTAD

[note 6] Diagnoses from enhanced GPs reporting to GUMCAD are included in the ‘non-specialist sexual health services’ total.

[note 7] Including site type 12 chlamydia from GUMCAD.

Table 4 shows the number of diagnoses of new STIs by UKHSA region of residence, data source and data subset in 2021. It shows that the South East had a total of 36,825 new STI diagnoses in 2021, 72% of which were made at specialist SHSs.

Table 5. Number of diagnoses of the 5 main STIs in the South East by STI, data source and data subset 2021

5 main STIs	GUMCAD specialist SHSs	GUMCAD non-specialist SHSs [note 8]	CTAD [note 9]	Total
Syphilis	805	12		817
Gonorrhoea	3,041	930		3,971
Chlamydia	10,202	748	8,287	19,237
Genital herpes	3,152	49		3,201
Genital warts	4,289	41		4,330

Data sources: GUMCAD, CTAD

[note 8] Diagnoses from enhanced GPs reporting to GUMCAD are included in the ‘non-specialist sexual health services’ total.

[note 9] Including site type 12 chlamydia from GUMCAD.

Table 5 shows the number of diagnoses of the 5 main STIs in the South East by STI, data source and data subset in 2021. It shows the majority of the 5 main STIs were diagnosed in specialist SHSs.

Figure 17. Consultations by consultation medium: South East residents, 2017 to 2021

Data source: GUMCAD, CTAD

Figure 17 is a bar chart that shows the number of consultations in South East residents attending SHSs (levels 2 or 3) over the 5 year period from 2017 to 2021 by the medium of consultation. It shows that the number of consultations which took place over the telephone trebled in 2020, the first year of the COVID-19 pandemic, compared to 2019 and doubled again in 2021, compared to 2020. Face-to-face and online consultations continued to account for the majority of consultations. In 2021, just over half of consultations in South East residents were face to face, a third were online and around a sixth were over the telephone.

Information on data sources

Find more information on local sexual health data sources on GOV.UK.

These figures are based on data from the GUMCAD and CTAD surveillance systems published on 4 October 2022 (data to the end of calendar year 2021).

GUMCAD surveillance system

This disaggregate reporting system collects information about attendances and diagnoses at specialist (level 3) and non-specialist (level 2) sexual health services. Information about the patient’s area of residence is collected along with demographic data and other variables. GUMCAD superseded the earlier KC60 system and can provide data from 2009 onwards. GUMCAD is the main source of data for this report.

Due to limits on how much personally identifiable information sexual health clinics are able to share, it is not possible to deduplicate between different clinics. There is a possibility that some patients may be counted more than once if they are diagnosed with the same infection (for infection specific analyses) or a new STI of any type (for new STI analyses) at different clinics during the same calendar year.

CTAD surveillance system

CTAD collects data on all NHS and local authority or NHS-commissioned chlamydia testing carried out in England. CTAD is comprised of all chlamydia (NAATs) tests for all ages (with the exception of conjunctival samples), from all venues and for all reasons. CTAD enables unified, comprehensive reporting of all chlamydia data, to effectively monitor the impact of the NCSP through estimation of the coverage of population screening, proportion of all tests that are positive and detection rates.

For services that report to GUMCAD and for which CTAD does not receive data on the patient’s area of residence (for example, SHSs), information about chlamydia diagnoses is sourced from GUMCAD data.

New STIs

New STI diagnoses comprise diagnoses of the following:

• chancroid
• lymphogranuloma venereum (LGV)
• donovanosis
• chlamydia
• gonorrhoea
• genital herpes (first episode)
• HIV (acute and AIDS defining)
• molluscum contagiosum
• non-specific genital infection (NSGI)
• non-specific pelvic inflammatory disease (PID) and epididymitis
• chlamydial PID and epididymitis (presented in chlamydia total)
• gonococcal PID and epididymitis (presented in gonorrhoea total)
• scabies
• pediculosis pubis
• syphilis (primary, secondary and early latent)
• trichomoniasis and genital warts (first episode)
• mycoplasma genitalium
• Shigella

Calculations

Confidence Intervals were calculated using Byar’s method.

Office of National Statistics (ONS) mid-year population estimates for 2020 were used as a denominator for rates for 2021. ONS ceased producing estimates of population by ethnicity in 2011. Estimates for that year were used as a denominator for rates for 2021.

Further information

As of 2020, all analyses for this report include data from non-specialist (level 2) SHSs and enhanced GP services as well as specialist (level 3) SHSs.

For further information, access the online Sexual and Reproductive Health Profiles.

For more information on local sexual health data sources on GOV.UK.

Local authorities have access to the Summary Profile of Local Authority Sexual Health (SPLASH) Reports (accessible from the Sexual and Reproductive Health Profiles) and the SPLASH supplement reports via the HIV and STI Data exchange.

For an annual epidemiological spotlight on HIV in the South East, contact [email protected].

About the Field Service

The Field Service was established in 2018 as a national service comprising geographically dispersed multi-disciplinary teams integrating expertise in Field Epidemiology, Real-time Syndromic Surveillance, Public Health Microbiology and Food, Water and Environmental Microbiology to strengthen the surveillance, intelligence and response functions of UKHSA.

You can contact your local Field Service team at [email protected].

If you have any comments or feedback regarding this report or the Field Service, contact [email protected].

Acknowledgements

We would like to thank the following:

• local SHSs for supplying the SHS data
• local laboratories for supplying the CTAD data
• UKHSA Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division for collection, analysis and distribution of data

References

1. UKHSA. ‘Sexually transmitted infections and screening for chlamydia in England, 2021’ October 2022 (accessed 22 February 2023)

2. UKHSA. ‘Mpox (monkeypox) outbreak: epidemiological overview, 20 December 2022’ (accessed 22 February 2023)

3. Mitchell KR, Shimonovich M, Bosó Pérez R, Dema E, Clifton S, Riddell J and others. ‘Initial Impacts of COVID-19 on sex life and relationship quality in steady relationships in Britain: Findings from a large, quasi-representative Survey (Natsal-COVID)’ The Journal of Sex Research March 2022: pages 1 to 12 (accessed 11 August 2022)

4. Howarth A, Saunders J, Reid D, Kelly I, Wayal S, Weatherburn P, Hughes G and Mercer C. ‘Stay at home’: Exploring the impact of the COVID-19 public health response on sexual behaviour and health service use among men who have sex with men: findings from a large online survey in the United Kingdom’ Sexually Transmitted Infections July 2022: pages 346 to 352 (accessed 11 August 2022)

5. Dema E, Gibbs J, Clifton S and others. ‘Initial impacts of COVID-19 on sexual and reproductive health service use and unmet need in Britain: findings from a large, quasi-representative survey (Natsal-COVID)’ The Lancet Public Health January 2022: volume 7, pages e36 to e47

6. Sonnenberg P, Menezes D, Freeman L and others. ‘Intimate physical contact between people from different households during the COVID-19 pandemic: a mixed-methods study from a large, quasi-representative survey (Natsal-Covid)’ British Medical Journal Open February 2022: volume 12, issue 2 (accessed 11 August 2022)

7. Ratna N, Dema E, Conolly A, and others. ‘O16 ethnic variations in sexual risk behaviour, sexual health service use and unmet need during the first year of the COVID-19 pandemic: an analysis of population-based survey and surveillance data’ Sexually Transmitted Infections 2022: volume 98, pages A8 to A9 (accessed 11 August 2022)

8. Sumray K, Lloyd KC, Estcourt CS, Burns F and Gibbs J. ‘Access to, usage and clinical outcomes of, online postal sexually transmitted infection services: a scoping review’ Sexually Transmitted Infections June 2022: pages 1 to 8 (accessed 11 August 2022)

9. Mercer CH and others. ‘Changes in sexual attitudes and lifestyles in Britain through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal)’ The Lancet 2013: volume 382, issue 9,907, pages 1,781 to 1,794

10. Macdowall W, Jones KG, Tanton C, Clifton S, Copas AJ, Mercer CH and others. ‘Associations between source of information about sex and sexual health outcomes in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)’. British Medical Journal Open 2015: volume 5, issue 3: e007837

11. Sex Education Forum ‘Sex and Relationship Education (SRE) – the evidence’. 2015 (accessed 24 December 2021)

12. Department for Education. ‘Policy statement: relationships education, relationships and sex education, and personal, social, health and economic education’ 2017

13. Ratna N, A N, Hadley A, Brigstock-Barron O. ‘Condom distribution schemes in England 2015 to 2016’ PHE 2017 (accessed 1 December 2021)

14. National Chlamydia Screening Programme ‘NCSP: programme overview’ (accessed 31 January 2023)

15. Clutterbuck D, and others. ‘2016 United Kingdom national guideline on the sexual health care of men who have sex with men’ International Journal of STD and AIDS 2018: page 95646241774689

16. Datta J, and others. ‘Awareness of and attitudes to sexually transmissible infections among gay men and other men who have sex with men in England: a qualitative study’ Sexual Health 2019: volume 16, issue 1, pages 18 to 24

17. Public Health England (PHE) ‘Addressing the increase in syphilis in England: PHE Action Plan’ June 2019 (accessed 31 January 2023)

18. UKHSA. ‘UK strategy for mpox control, 2022 to 2023’ December 2022 (accessed 31 January 2023)

19. Bardsley M, Wayal S, Blomquist P, Mohammed H, Mercer CH, Hughes G. ‘Improving our understanding of the disproportionate incidence of STIs in heterosexual-identifying people of black Caribbean heritage: findings from a longitudinal study of sexual health clinic attendees in England’ Sexually Transmitted Infections 2022: volume 98, pages 23 to 31 (accessed 17 August 2022)

20. ‘HIV prevention England’ (accessed 1 December 2021)