Reducing sexually transmitted infections

Context

Sexually transmitted infections (STIs) can affect personal wellbeing, mental health and relationships. They can also lead to serious health problems including pelvic inflammatory disease, ectopic pregnancy and infertility. The rates of STIs are highest in young people aged 15 to 24; people from a Black family background; and gay, bisexual and other men who have sex with men.

In 2020, there were 3,482,700 consultations at sexual health services and 317,901 diagnoses of new STIs in England. This was a decrease of 10% and 32%, respectively, compared with 2019, but this largely reflects the rapid reconfiguration of sexual health service delivery in response to the COVID‑19 pandemic. But the number of internet consultations doubled from 511,979 to 1,062,157 over the same period. Sexual health services carried out 1,649,429 sexual health screens (tests for chlamydia, gonorrhoea, syphilis or HIV) in 2020, a 25% decrease compared with 2019.

New HIV diagnoses have declined over the past decade, with a substantial decrease during 2019 (4,139 cases, a 10% fall from 4,580 in 2018). This recent reduction has been mostly driven by fewer HIV diagnoses among gay and bisexual men, which have decreased by 47% since 2014. There is also an ongoing human papillomavirus (HPV) vaccination programme for gay, bisexual and other men who have sex with men. The vaccine is recommended for all men up to and including the age of 45 who have sex with men.

Social and sexual networking apps have made it easier to buy recreational drugs. People who use drugs during sex are more likely to report unsafe sexual behaviours than those who do not.

Mycoplasma genitalium is being increasingly recognised as a public health concern because of its relatively high prevalence (1% to 2% of the general population) and high levels of antimicrobial resistance, along with already recognised drug-resistant gonorrhoea.

Sexually transmitted infections are a major public health concern and are costly to healthcare services. Although the COVID‑19 pandemic has reduced the diagnosis rates of STIs, this has coincided with a decrease in sexual health screening caused by the disruption to service provision. The overall trends continue to rise. Together with new evidence identified, this highlights the need for an updated guideline on this topic.