Safe sex an elusive target; STIs continue to rise in England

The incidence of sexually transmitted infections (STIs) in England continues to go up, according to a new report released by Public Health England (PHE). The currently reported increase of 5% from 2017 brings the figure to almost 450,000 cases. Consultations at sexual health services went up by 7%, to over 3,500,000.

Safe sex message. Image Credit: keko64 / Shutterstock
Safe sex message. Image Credit: keko64 / Shutterstock

The failure to curb the increase in STI incidence is attributed to the lack of consistent and correct condom use during sex with a casual or new partner, as well as better detection rates following higher rates of testing.

The PHE’s Head of STI Surveillance, Gwenda Hughes, noted: “The rise in sexually transmitted infections is concerning. STIs can pose serious consequences to health – both your own and that of current and future sexual partners. No matter what age you are, or what type of relationship you are in, it’s important to look after your sexual health.”

Common STIs

Gonorrhea showed the largest jump of 26% because of new cases among homosexual, bisexual and other men who have sex with men (MSM), with 50% of over 56,000 cases occurring in this group. Compared to the 16,000 cases in 2009, this reflects an almost 250% increase in the disease, making this the highest count in 40 years. This is an alarming trend, as shown by the three cases of multi-drug resistant gonorrhea reported in 2018.

Syphilis has also more than doubled over just ten years, from about 2,900 cases in 2009 to over 7,500 in 2018. Again, MSMs figure prominently in this condition, accounting for 75% of cases in 2018. PHE’s Syphilis Action Plan is meant to counter this increase, and is based on higher testing rates among high-risk MSM, and among patients who have been treated for syphilis; BASHH standard partner notification; and  excellent antenatal testing coverage.

Chlamydia was the most common diagnosis, with over 205,000 cases, comprising about half of new STIs (6% up from 2017). 60% of new cases occurred in young people between 15 and 24 years. Despite the pro-active testing being offered under the National Chlamydia Screening program to young people, testing fell by 22% since 2014 but with more tests returning positive (10%), the disease is still rising.

First-time genital warts accounted for 13% of new STIs. The HPV vaccination program, which offers the quadrivalent HPV vaccine to most girls between 12 and 13 years of age, has achieved good herd protection, as suggested by the 92% decrease in genital warts in girls 15 to 17 years old compared to 2014, and an 82% decrease in heterosexual boys.

STIs continue to hit young people (15 to 24 years), MSM, and black minorities. While STIs increased by 2% and 1% among heterosexual women and men, respectively, the rise was 16% and 17% among women who had sex with women (WSW) and MSM respectively.

These groups likely have higher rates of sex with new partners without condoms. The practice of combining recreational drug use with sexual activity, called chemsex, is suspected to be responsible for high-risk behavior in some MSM.

Among people over 24 years, STI incidence is far lower but rising. The largest proportional increase in gonorrhea (42%) and chlamydia (24%) was in those over 65 years, though absolute numbers are low.

Curbing STI increases

Many STIs don’t cause symptoms, and are easily passed on to others unknowingly. PHE recommends regular annual screening for STI, including HIV, with or without signs of infection, for all sexually active people who change partners or have casual sex without condom protection. If under 25 years, chlamydia testing is advised annually and when they change partners.

For MSM, testing should be done every three months if they have unprotected sex with new or casual partners.

About 2 million screening tests for STIs were carried out in 2018. Sexual health clinics offer access to anyone at risk of an STI. More and more, people are using eSexual Health Services (eSHSs). This makes personal visits to the clinic unnecessary, with the tests being ordered online, taken at home, and posted to the testing laboratory. The results will be received through a phone call, text or post. 14% of chlamydia diagnoses among 15-24 year olds were made this way.

Relationship and sex education (RSE) in secondary schools is important to prevent new STIs among young people.

Other PHE initiatives for sexual health include:

  • A Protect Against STIs campaign promoting condom use to 16-24 year olds
  • Providing data on the activity of local sexual health services to local authorities
  • Containing outbreaks and incidents successfully
  • Advisory help to develop national guidelines in this area
Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.

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