Research and analysis

Spotlight on sexually transmitted infections in the South East: 2022 data

Updated 5 March 2024

Applies to England

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Summary

This report focusses on sexually transmitted infections (STIs) in the South East. HIV is reported on separately. Please access the UK Health Security Agency (UKHSA) report on STIs and screening for chlamydia in England for a national perspective (1).

While this report primarily focuses on the trend between 2021 and 2022, some trends relative to 2019 or earlier are included to provide a comparison to sexual health service (SHS) provision and STI diagnoses prior to the COVID-19 pandemic. The numbers of consultations, sexual health screens and STI diagnoses in 2020 and 2021 were lower than preceding years and any trends in diagnoses between 2021 and 2022 must be interpreted in that context.

Sexually transmitted infections (STIs) represent a public health problem in the South East. Out of the 9 UKHSA regions it has the fourth lowest rate of new STIs in England.

More than 45,000 new STIs were diagnosed in South East residents in 2022 (45,214), representing a rate of 502 diagnoses per 100,000 population, lower than the rate in England (694 per 100,000). Rates by upper-tier local authority ranged from 260 new STI diagnoses per 100,000 population in West Berkshire to 1,145 new STI diagnoses per 100,000 population in Portsmouth.

The number of new STIs diagnosed in South East residents increased by 23% between 2021 and 2022. During this time period genital warts decreased by 11%, but rises were seen in the numbers of the other major STIs:

• gonorrhoea by 83%
• chlamydia by 24%
• genital herpes by 9%
• syphilis by 6%

The rise in gonorrhoea was particularly sharp in heterosexual men and women (121% rise) and in young people aged 15 to 24 years.

Compared to 2018, 19% fewer new STIs in the South East were diagnosed in 2022, however the numbers of syphilis (23% rise) and gonorrhoea (40% rise) diagnoses in 2022 now exceeds that observed in 2018.

Overall, there was an increase in the number of consultations delivered by SHSs in the South East in 2022 compared to 2021 (12% increase; from 509,172 to 570,059). Of all consultations in 2022:

• 313,712 (55%) were delivered face to face (compared to 80% in 2019)
• 33% (168,863) were delivered online (compared to 17% in 2019)
• 15% (86,671) were via telephone

Compared to 2021, rises were seen in 2022 in face-to-face (21% increase) and telephone consultations (7% increase), but the number of online consultations was similar.

STI testing (excluding chlamydia in under 25 year olds) in the South East in 2022 increased by 14% compared to 2021. However, 15% fewer tests overall were conducted in 2022 than prior to the COVID-19 pandemic in 2019. In 2022, testing in gay, bisexual and other men who have sex with men (GBMSM) was 24% higher than in 2019, while testing in heterosexual males was 30% lower and testing in females was 19% lower.

The STI test positivity in 2022 in the South East was 6.5%, a rise from 2021, and higher than that seen in the past 10 years.

UKHSA recommends that local areas should be working towards achieving a chlamydia detection rate no lower than 3,250 per 100,000 among females aged 15 to 24 years, and this is the detection rate indicator (DRI) in the Public Health Outcomes Framework (PHOF). In 2022, the chlamydia diagnosis rate among South East female residents aged 15 to 24 years was below this, at 1,375 per 100,000 residents.

Rates of new STIs are higher in men than women (515 and 457 per 100,000 residents, respectively).

GBMSM experience health inequalities related to STIs. Where gender and sexual orientation are known, GBMSM account for 23% of South East residents diagnosed with a new STI excluding chlamydia diagnoses reported via CTAD (77% of those diagnosed with syphilis and 47% of those diagnosed with gonorrhoea).

STIs disproportionately affect young people. South East residents aged between 15 and 24 years accounted for 48% of all new STI diagnoses in 2022. A steep decline (89% decrease) has been seen between 2018 and 2022 in genital warts diagnosis rates in females aged 15 to 19 years. This follows the introduction in 2008 of vaccination against Human papillomavirus (HPV), the virus which causes genital warts, for girls.

Black ethnic groups experience health inequalities related to STIs. Although only 2% of new STIs are in the black Caribbean ethnic group, it has the highest rate: 1,428 per 100,000, which is 4 times the rate seen in the white ethnic group. The rate of new STIs are also high in the black African ethnic group (1,085 per 100,000). The white ethnic group has the highest number of new STI diagnoses: 30,697 (83%).

Where country of birth was known, 82% of South East residents diagnosed with a new STI in 2022 (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

STI diagnoses are on the rise in the South East, with the number of syphilis and gonorrhoea diagnoses now exceeding the pre-pandemic level. STIs also continue to show marked geographic variation and disproportionately impact upon GBMSM, black ethnic groups, and young people.

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 who are at greatest risk.

Easy access to good quality sexual health care is important to control STIs. Following the disruptions in service delivery during the pandemic, the number of consultations at SHSs for South East residents has continued to rebound and in 2022 was higher than in 2019, with the largest proportional increase for GBMSM and lowest for heterosexual men. Considerable changes have occurred in how consultations are delivered over this period with an increase in online consultations, which now account for just under a third, and a reduction in face-to-face consultations. Service providers will be aware that the impact of changes in consultation medium differs by sexual orientation, and it will remain important to understand whether the changes in how people use services has affected the equity of access (3, 4).

There is a likely increase in transmission of STIs in the community. While the number of sexual health screens (for chlamydia, gonorrhoea, syphilis and HIV) rose in the South East between 2021 and 2022, the rise in STI diagnoses was larger than the rise in testing. The high and rising STI test positivity may reflect more targeted testing of people, but it is more likely to reflect an increase in transmission in the community.

The rise in gonorrhoea was particularly steep in heterosexual men and women, and while increases were seen in all age groups, the largest increase in rates was seen in young people aged 15 to 24 years. Improved testing alone cannot explain this increase. Increases were seen in all English regions, with the number diagnosed in England in 2022 being the largest annual number reported since records began.

The high rates of STIs among young people aged 15 to 24 years are likely to be due to greater rates of partner change (5). 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 (6, 7, 8). However, people need access to good quality age appropriate information beyond the school years, in order to address high risk behaviour.

Many areas in England continue to provide condom schemes which distribute condoms to young people (mostly under 20 years of age) and other groups most at risk through a variety of outlets (9) and condoms are provided free from sexual health clinics for all ages.

The National HPV Vaccination Programme introduced vaccination against Human papillomavirus (HPV), the virus which causes genital warts, for girls in 2008 and for boys in 2019. Prior to the pandemic the programme achieved high coverage in girls and was successful in producing a longer-term decline in genital warts in those aged 15 to 19 years from 2009 to 2020. However, vaccination was disrupted by the pandemic, with low coverage in 2019 to 2020, and the rate of genital warts diagnoses in females aged 15 to 19 years remained stable between 2020 and 2022. By 2021 to 22, HPV vaccination coverage had risen, but not to the levels seen prior to the pandemic. 

Also targeted at young people is the National Chlamydia Screening Programme (NCSP). In June 2021, the NCSP changed to focus on reducing reproductive harm of untreated infection primarily in young women (10). This led to a change in the recommended chlamydia DRI included in the Public Health Outcomes Framework (PHOF). Although the detection rate in the South East increased in 2022, it remained below the DRI, indicating that continued effort in this area is required.

In 2022, the population rates of STI diagnoses remained high among people of black ethnicity, but this varies within 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 (11).

Among GBMSM, diagnoses of STIs increased markedly in 2022. There is evidence of a rebound in sexual mixing among GBMSM between 2020 and 2021, and this is likely to have contributed to the large rise in STIs within this population in 2022 (12). The high and increasing 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 C.

As GBMSM continue to experience high rates of STIs they remain a priority for targeted STI prevention and health promotion beyond HIV prevention, including immunisation against hepatitis A, hepatitis B, HPV and mpox. Furthermore, to prevent Shigella infections, it remains important to promote messages designed for GBMSM regarding practicing good hygiene during and after sex (13).

There is a continued need to strengthen public health measures to reduce transmission of syphilis across the South East region. National clinical guidelines recommend frequent testing in high-risk GBMSM (14), but surveillance data has suggested that this is not uniformly carried out, especially in GBMSM living with HIV. There have also been concerns about poor knowledge and awareness of syphilis among GBMSM (15). The Syphilis Action Plan includes recommendations to address the increase in syphilis diagnoses in England (16).

The 2022 mpox outbreak predominantly affected GBMSM and SHSs were instrumental in responding, including delivering vaccination to protect high risk GBMSM. At the time of publication, vaccination was available in London for those eligible. 

Several established HIV prevention activities may also impact on wider STI control. The Department of Health and Social Care (DHSC) commissioned Terrence Higgins Trust to deliver the 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 whom there is a higher or emerging burden of infection (17).

UKHSA’s main messages

Commissioners and providers of SHSs have an important role in communicating messages about safer sexual behaviours and how to access services.

Main prevention messages

Using condoms consistently and correctly protects against HIV and other STIs such as chlamydia, gonorrhoea, and syphilis – condoms can also be used to 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 and ovaries, aged under 25 years who are sexually active should have a chlamydia test annually and on change of sexual partner
• gay, bisexual and other men who have sex with men (GBMSM) should have tests for HIV and STIs annually or every 3 months if having condomless sex with new or casual partners

HIV pre-exposure prophylaxis (PrEP) is available for free from specialist SHSs and can be used to reduce an individual’s risk of acquiring HIV.

HIV post-exposure prophylaxis (PEP) can be used to reduce the risk of acquiring HIV following some sexual exposures – PEP is available for free from most specialist SHSs and most emergency departments.

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 human papillomavirus (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 hepatitis A and hepatitis B vaccines from specialist SHSs – these vaccines are also available for other people at high risk of exposure to the viruses
• GBMSM aged 45 years and under can obtain the HPV vaccine from specialist SHSs

Specialist sexual health services are free and confidential and offer testing and treatment for HIV and STIs, condoms, vaccination, HIV PrEP and PEP:

• clinic-based services are commissioned for residents of all areas in England
• 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, NHS sexual health services 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, 2022

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 (502.1 per 100,000 population). The South East rate is the fourth lowest among the English regions in 2022.

Figure 2. Number of diagnoses of the 5 main STIs, South East residents, 2018 to 2022 (See caveat 1 below)

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 2018 to 2022. The highest number of diagnoses was in chlamydia. This was followed by gonorrhoea, genital warts, genital herpes and syphilis.

Figure 3. Diagnosis rates of the 5 main STIs, South East residents, 2018 to 2022 (See note 1 above)

Data sources: GUMCAD, CTAD

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 2018 to 2022. The highest rate of diagnosis is in chlamydia. This is followed by gonorrhoea, genital warts, genital herpes and syphilis.

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

note 1 above)

Diagnoses	2022	Percentage change 2018 to 2022	Percentage change 2021 to 2022
New STIs	45,214	-19%	23%
Syphilis	868	23%	6%
Gonorrhoea	7,252	40%	83%
Chlamydia	23,788	-12%	24%
Genital Herpes	3,499	-26%	9%
Genital Warts	3,844	-55%	-11%

Data sources: GUMCAD, CTAD

Table 1 shows a 19% decrease in new STIs from 2018 to 2022 and a 23% increase from 2021 to 2022. Between 2018 and 2022, syphilis and gonorrhoea increased, but genital warts, genital herpes and chlamydia decreased. From 2021 to 2022, there was very large increase in gonorrhoea (by 83%), and also increases in chlamydia, genital herpes and syphilis. During this time period there was a decline in genital warts.

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, 2022

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 (3,215 and 2,437 per 100,000 respectively). Rates were also high among females aged 15 to 19 years (1,884 per 100,000) and males aged 25 to 34 years (1,366 per 100,000).

Figure 5. Rates of gonorrhoea per 100,000 residents by age group (note 2) in the South East, 2018 to 2022 (See caveat 1 below)

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 2018 to 2022. Rates were highest among those aged 20 to 24 years and lowest among those aged 45 to 65 years. Rates increased two-fold from 2021 to 2022 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, 2018 to 2022

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 2018 to 2022, although the rate in females remained stable from 2020 to 2022.

Figure 7. Rates of new STIs by ethnic group per 100,000 residents in the South East, 2022

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 2022. It shows the rate of new STIs is significantly higher among the black Caribbean ethnic group (1,428 per 100,000) and the black African ethnic group (1,085 per 100,000) compared to the white (393 per 100,000) and other ethnic groups (425 per 100,000).

Table 2. Proportion of South East residents diagnosed with a new STI by ethnicity, 2022

Ethnic group	Number	Percentage excluding unknown
White	30,697	83%
Black Caribbean	579	2%
Black African	1,400	4%
All other ethnic groups combined	4,331	12%
Unknown	8,207

Data sources: GUMCAD, CTAD

Table 2 shows the number and proportion of South East residents diagnosed with a new STI by ethnicity in 2022. It shows that the number and proportion of new STIs were highest in the white ethnic group (30,697). Where ethnicity was known, the black African ethnic group made up 4% of the total, and the black Caribbean group made up 2%. As there were 8,207 new STI diagnoses with ethnicity data recorded as unknown, there is an opportunity to improve reporting of ethnicity.

Figure 8. Proportion of South East residents diagnosed with a new STI by world region of birth (note 3), 2022

Data sources: GUMCAD data only

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 2022. It shows that 82% of South East residents diagnosed with a new STI were born in the UK, 7% 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. Rates of new STIs per 100,000 residents by decile of deprivation (note 4) in South East residents, 2022

Data sources: GUMCAD, CTAD

Note 4: Deciles run from 1 to 10 in order of decreasing deprivation.

Figure 9 is a column chart which shows the new STI diagnosis rate by 100,000 population for each decile of deprivation in 2022. Deciles run from 1 to 10 in order of decreasing deprivation and are calculated at the level of lower super output area (LSOA) of residence, a unit of geography containing around 1,500 residents, across England. All new STI diagnoses in South East residents reported with an LSOA of residence code that could be linked to Index of Multiple Deprivation (IMD) data for 2019 are included. The rates are not adjusted for the underlying population demographics for example age distribution.

The chart shows that new STI diagnosis rates are highest in LSOAs which fall into the decile of highest deprivation (792 per 100,000 population) and then fall with each decile, reaching 326 for the decile of lowest deprivation.

Figure 10. Diagnoses of the 5 main STIs among heterosexual (note 5) men and women: South East residents, 2018 to 2022 (See caveat 1 below)

Data sources: GUMCAD data only

Note 5: 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 and exclude chlamydia diagnoses via online services. For women, both heterosexual and bisexual sexual orientations are included.

Figure 10 shows trendlines for the diagnosis of the 5 main STIs among heterosexuals from 2018 to 2022 in the South East. The steepest increase observed between 2021 and 2022 was of gonorrhoea 121% (1,572 diagnoses in 2021 to 3,478 diagnoses in 2022), followed by chlamydia (21% increase) and syphilis (14% increase). The highest fall in diagnoses was seen for genital warts (57% decrease) over the 5-year period. Genital herpes diagnoses were 29% lower than 5 years previous, but increased by 12% from 2021 to 2022.

Table 3. Percentage change in new STI diagnoses among heterosexual men (note 5) and women resident in the South East (See caveat 1 below)

Diagnoses	2022	Percentage change 2018 to 2022	Percentage change 2021 to 2022
New STIs	24,155	-35%	18%
Syphilis	177	17%	14%
Gonorrhoea	3,478	47%	121%
Chlamydia	9,822	-35%	21%
Genital Herpes	3,053	-29%	12%
Genital Warts	3,357	-57%	-9%

Data sources: GUMCAD data only

Table 3 shows the number of the main STI diagnoses among heterosexual men and women South East residents in 2022 and the percentage change since 2018 to 2022.

From 2018 to 2022, the percentage increase among heterosexuals was highest for gonorrhoea (47% increase) and the percentage decrease was greatest for genital warts (57% decrease). The percentage increase was also highest for gonorrhoea from 2021 to 2022 (121% increase) followed by chlamydia (21% increase) and syphilis (13% increase).

Figure 11a. Diagnoses of the 5 main STIs among GBMSM (note 6), South East residents, 2018 to 2022 (See caveat 1 below)

Data sources: GUMCAD data only

Note 6: 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 and exclude chlamydia diagnoses via online services.

Note 7: It is important to consider whether there have been any changes to testing or vaccination practices when interpreting increases or decreases in STIs because:

• increases in gonorrhoea may be due to the increased use of highly sensitive nucleic acid amplification tests (NAATs) and additional screening of extra-genital sites in GBMSM
• decreases in genital wart diagnoses may be due to the moderately protective effect of HPV-16/18 vaccination
• increases in genital herpes diagnoses may be due to the use of more sensitive NAATs

Figure 11a shows trend lines for diagnoses of the 5 main STIs in specialist sexual health clinics among GBMSM, from 2018 to 2022. Gonorrhoea and chlamydia diagnoses increased from 2020 to 2022. Over the 5 years from 2018 to 2022, syphilis diagnoses have increased slightly (by 18%), genital warts have more than halved and genital herpes has remained relatively stable.

Figure 11b. Diagnosis rates of the 5 main STIs among GBMSM (note 8), South East residents, 2018 to 2022 (See caveat 1 below)

Data sources: GUMCAD, CTAD

Note 8: 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 and exclude chlamydia diagnoses via online services. The denominators for rates are based on sexual orientation information collected by the 2021 census and for each region the same estimate has been used for all years in the chart.

(See note 7 above)

Figure 11b shows trend lines for the rate of diagnoses of the 5 main STIs in specialist sexual health clinics among GBMSM, from 2018 to 2022. The rate of gonorrhoea and chlamydia diagnoses increased from 2020 to 2022. Over the 5 years from 2018 to 2022, syphilis diagnoses rates have increased (by 18%), genital warts have more than halved and genital herpes has remained relatively stable.

Table 4. Percentage change in new STI diagnoses in GBMSM (See notes 6 and 7 above) resident in the South East (See caveat 1 below)

Diagnoses	2022	Percentage change 2018 to 2022	Percentage change 2021 to 2022
New STIs	7,378	10%	36%
Syphilis	623	18%	7%
Gonorrhoea	3,178	33%	54%
Chlamydia	2,443	19%	42%
Genital Herpes	170	-7%	18%
Genital Warts	206	-53%	-12%

Data sources: GUMCAD data only

(See notes 6 and 7 above)

Table 4 shows the number of the main STI diagnoses among GBMSM South East residents in 2022 and the percentage change from 2018 to 2022.

From 2018 to 2022, the percentage increase among GBMSM was highest for gonorrhoea (33% increase) and the percentage decrease was greatest for genital warts (53% decrease). The percentage increase from 2021 to 2022 was also highest for gonorrhoea (54% increase) followed by chlamydia (42% increase) and genital herpes (18% increase).

Figure 12a. Rate of new STI diagnoses per 100,000 population by upper-tier local authority of residence, South East residents, 2022

Data sources: GUMCAD, CTAD

Figure 12a 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 2022. It shows that the rate of new STIs for all ages was highest in Portsmouth (1,145). Three UTLA had rates above the England average (Portsmouth, Brighton and Hove and Southampton).

Figure 12b. Rate of new STI diagnoses (excluding chlamydia diagnoses in residents aged younger than 25 years) per 100,000 population by upper-tier local authority of residence, the South East, 2022

Data sources: GUMCAD, CTAD

Prior to 2023, this figure showed rates for the population aged 15 to 64 years, excluding chlamydia in those aged 15 to 24 years.

Figure 12b 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 2022. The rate of new STIs for all ages was highest in Brighton and Hove (954 per 100,000) and lowest in West Berkshire (161 per 100,000).

Figure 13. Chlamydia detection rate per 100,000 female residents aged 15 to 24 years by upper-tier local authority of residence, the South East, 2022

Data sources: GUMCAD, CTAD

Note 9: Prior to 2023, this figure showed rates for the whole population aged 15 to 24 years, regardless of gender.

Figure 13 is a bar chart showing the chlamydia detection rate per 100,000 female residents, aged 15 to 24 years in the South East by UTLA of residence in 2022. The chlamydia detection rate among 15 to 24 year old females was highest in Portsmouth residents (4,419 per 100,000) and lowest in West Sussex (893 per 100,000).

Figure 14. Rate of gonorrhoea diagnoses per 100,000 population by upper-tier local authority of residence, South East residents, 2022

Data sources: GUMCAD

Figure 14 is a bar chart showing the rate of gonorrhoea diagnoses per 100,000 population in South East residents by UTLA of residence in 2022. It shows the rate of gonorrhoea was highest among residents in Brighton and Hove (276 per 100,000) and lowest in West Berkshire (29 per 100,000). Three UTLAs had rates above the England average (Brighton and Hove, Portsmouth and Southampton).

Figure 15. Map of new STI rates per 100,000 residents by upper-tier local authority in the South East, 2022

Data sources: GUMCAD, CTAD. Map contains Ordnance Survey data (© Crown copyright and database right 2023) and National Statistics data (© Crown copyright and database right 2023)

Figure 15 shows a map of new STI rates per 100,000 residents by UTLA in 2022. The map shows that the rate of new STIs for all ages was highest in Portsmouth (1,145 per 100,000) and lowest in West Berkshire (260 per 100,000). Rates tended to be higher in denser urban areas.

Figure 16. Map of new STI rates per 100,000 residents by middle super output area (MSOA) in the South East, 2022

Figure 16 shows a map of new STI rates per 100,000 residents by middle super output area in 2022. The map shows that the rate of new STIs for all ages tended to be higher in denser urban areas.

Figure 17. STI testing rate (excluding chlamydia in under 25 year olds) per 100,000 population in South East residents aged 15 to 64 years, 2018 to 2022

Data sources: GUMCAD, CTAD

Figure 17 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 2018 to 2022. The STI testing rate in the South East increased in 2022, but remained lower than seen 5 years prior. The testing rate in the South East was consistently lower than the England rate.

Figure 18. STI testing positivity rate (note 10) (excluding chlamydia in under 25-year-olds) in South East residents, 2018 to 2022

Data sources: GUMCAD, CTAD

Note 10: 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 18 shows trend lines for the STI testing positivity rate (excluding chlamydia in those aged under 25 years) in South East and England residents from 2018 to 2022. Although there was an increase in the STI positivity rate in South East residents to 6.5% in 2022, the rate remains lower than the England rate over the 5 years.

Table 5. Number of diagnoses of new STIs by UKHSA region of residence, data source and data subset 2022

UKHSA region of residence	GUMCAD: specialist SHSs	GUMCAD: non-specialist SHSs (note 11)	CTAD (note 12)	Total
East Midlands	13,901	8,518	5,492	27,911
East of England	16,850	6,310	6,377	29,537
London	82,589	11,598	28,725	122,912
North East	10,605	1,687	3,387	15,679
North West	33,005	5,925	10,192	49,122
South East	32,427	2,699	10,088	45,214
South West	17,085	4,187	6,660	27,932
West Midlands	18,965	4,920	5,982	29,867
Yorkshire and Humber	20,361	3,283	9,734	33,378

Data sources: GUMCAD, CTAD

Note 11: Diagnoses from enhanced GPs reporting to GUMCAD are included in the ‘Non-specialist sexual health services (SHSs)’ total.

Note 12: Including site type 12 chlamydia from GUMCAD.

Table 5 shows the number of diagnoses of new STIs by UKHSA region of residence, data source and data subset in 2022. It shows that the South East had a total of 45,214 new STI diagnoses in 2022, 72% of which were made at specialist SHSs.

Table 6. Number of diagnoses of the 5 main STIs in the South East by STI, data source and data subset 2022

Five main STIs	GUMCAD: specialist SHSs	GUMCAD: non-specialist SHSs (See note 11 above)	CTAD (See note 12 above)	Total
Chlamydia	13,123	577	10,088	23,788
Gonorrhoea	5,601	1,651		7,252
Genital Warts	3,774	70		3,844
Genital Herpes	3,422	77		3,499
Syphilis	849	19		868

Data sources: GUMCAD, CTAD

Table 6 shows the number of diagnoses of the 5 main STIs in the South East by STI, data source and data subset in 2022. It shows the majority of the 5 main STIs were diagnosed in specialist SHSs.

Figure 19. Consultations by medium: South East residents, 2018 to 2022

Data sources: GUMCAD

Figure 19 is a bar chart that shows the number of sexual health service consultations in South East residents over the 5-year period from 2018 to 2022 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. Online consultations increased 10-fold over the 5 year period. In 2022, just over half of consultations in South East residents were face to face (55%), almost a third were online (30%) and around 15% were over the telephone.

Information on data sources

Find more information on local sexual health data sources in the UKHSA guide.

This report is based on data from the GUMCAD and CTAD surveillance systems published on 6 June 2023 (data to the end of calendar year 2022).

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 which 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.

CTAD does not collect information about sexual orientation or country of birth. Reports from CTAD are excluded from figures in this report which relate to analyses by sexual orientation or world region of birth.

New STIs

New STI diagnoses (caveat 1) comprise diagnoses of:

• chancroid
• Lymphogranuloma venereum (LGV)
• donovanosis
• chlamydia
• gonorrhoea (caveat 1)
• 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

Caveat 1: The 2022 STI Spotlight Report for the South East includes data for gonorrhoea diagnoses and new STI diagnoses in 2021 which was sourced from the 2021 STI Spotlight Report for this region (published 22 March 2023). Therefore, the associated data included in this report will differ from the equivalent data for the South East included in the 2022 Annual STI Data Tables and the Sexual and Reproductive Health Profiles (published 6 June 2023). No other regions or STI diagnoses are affected

Calculations

Confidence Intervals were calculated using Byar’s method.

ONS mid-year population estimates for 2021 were used as a denominator for rates (other than by ethnic group) for 2022. Population estimates for 2021 are used as the denominator for rates for 2022. ONS estimates of population by ethnic group for the year 2021 were used as a denominator for rates by ethnic group for 2022. This is the first time that new estimates of population by ethnic group have been available since 2011. This must be considered if comparing rates for 2022 in this report with rates by 2021 in last year’s report, as the rates in the last report used the 2011 estimates.

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, see the UKHSA guide.

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:

• 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

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