Sexually transmitted infections – trends and challenges 25th June 2019 Dr Sarah Edwards Consultant in Sexual Health

Trends in STIs

Notes: Total number of STI diagnoses: England, 2009-2018 In 2018, the total number of new diagnoses of STIs in specialist and non-specialist sexual health services (SHS) was 447,694. Compared to 2017, the total number of new STIs diagnosed in 2018 increased by 5.4% (from 424,724). Total diagnoses increased by 4.7% in specialist services (331,920 to 347,589) and increased by 7.9% in non-specialist services (92,804 to 100,105). Some STIs also experienced notable changes in reported diagnosis counts between 2017 and 2018:  a 26% increase in gonorrhoea diagnoses (from 44,812 to 56,259)  a 5% increase in syphilis diagnoses (from 7,149 to 7,541)  a 7% increase in other new STI diagnoses (from 23,283 to 24,828)  a 3% decrease in genital warts (from 59,178 to 57,318) – a continuing decline from previous years. More detail can be found in the 2018 Health Protection Report on Sexually Transmitted Infections and Chlamydia Screening in England, available on: https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables 3

Notes: Rates of chlamydia diagnoses by gender & age: England, 2018 Young adults have the highest rates of new STIs. In men, rates of new STI diagnoses are highest in 20-29 year olds, and in women rates are highest in 15-24 year olds. Rates are higher in older men than in older women. 4

Notes: Number of STI diagnoses among men: England, 2009-2018 Following a steady annual increase in the number of gonorrhoea diagnoses in men between 2008 and 2015, diagnoses decreased sharply between 2015 and 2016. However, diagnoses increased by 21% between 2016 and 2017 (27,348 to 33,168) and have increased again by 24% between 2017 and 2018 (33,168 to 41,190). Diagnoses of anogenital warts in men decreased by 1% from 2017 to 2018 (33,363 to 33,161), a continuation of the 7% decrease from 2016 and 2017 (35,734 to 33,363). There has been an increase in syphilis diagnoses, particularly in the last five years. Between 2017 and 2018, syphilis diagnoses among men increased 4% (6,697 to 6954). 5

Notes: Number of STI diagnoses among women: England, 2009-2018 The number of anogenital herpes (first episode) diagnoses in women increased steadily between 2008 and 2013, but has shown signs of levelling off in recent years. Gonorrhoea diagnoses have increased rapidly between 2016 and 2017 (a 26% increase from 9,211 to 11,571) and again by 29% from 2017 to 2018 (11,571 to 14,931). There has been a general decline in the number of anogenital warts diagnoses in women since 2008- diagnoses decreased by 7% between 2017 and 2018 (25,737 to 24,013) 6

Notes: Rates of new STI diagnoses by LA of residence: England, 2018 In 2018, rates of new STIs by Local Authority ranged from 184.7 to 3,457.3 per 100,000 population. Rates were highest among residents of urban areas, particularly in London. This largely reflects the areas of higher deprivation and the distribution of the core groups of the population who are at greatest risk of infection. 7

Notes: Number of gonorrhoea diagnoses by gender: England, 2009-2018 After an increase in annual number of gonorrhoea diagnoses between 2010 and 2015, gonorrhoea diagnoses fell by 12% between 2015 and 2016 (41,369 to 36,559). However, diagnoses increased by 54% between 2016 and 2018 (to 56,121). 73% of diagnoses in 2018 were in men, and diagnoses in men increased by 24% between 2017 and 2018 (33,168 to 41,190) whereas diagnoses in women increased by 29% (11,571 to 14,931). 9

Gonorrhoea diagnostic rate / 100,000 Suffolk

Notes: Number of syphilis diagnoses by gender: England, 2009-2018 Syphilis diagnoses have increased markedly in men in recent years; by 124% between 2013 and 2018 (3,345 to 7,504). However, between 2017 and 2018 diagnoses increased by 5% which is the smallest increase year on year since 2012. Diagnoses in women continue to be in much lower numbers, with 550 diagnoses in 2018. 11

Syphilis diagnostic rate / 100,000 Suffolk

Syphilis is on the rise in the east of England Posted on February 21, 2019 In the east of England there were 301 diagnoses of syphilis in 2017. This is an 11% increase from 2016 and an 82% increase over the last 5 years. · New social media campaign launches across the region to raise awareness #syphilisbanana Public Health England (PHE) in partnership with the 12 local authorities across the region and the Terrence Higgins Trust (THT) have today launched a social media campaign aimed at raising awareness of the rise in syphilis. .

Challenges

Sexual health House of Commons Health and Social Care Committee Fourteenth Report of Session 2017–19 Report, together with formal minutes relating to the report

Challenges Funding and commissioning Service delivery Prevention Workforce

Funding and commissioning Inadequate funding Complexity and fragmentation Local variation Length of contracts

Local authority spending on sexual health has decreased

Funding and commissioning Inadequate funding Complexity and fragmentation Local variation Length of contracts

Service delivery Quality of care Accessibility Testing and screening PrEP

Notes: Rates of STI diagnoses by index of multiple deprivation (IMD) quintile: England, 2018 Rates of STI diagnoses were highest among those living in the most deprived areas of England. Please note that 2018 data will not be comparable with the 2017 slideset where CTAD returns were included and higher rates of chlamydia and NewSTIs were observed. 21

Testing and screening Antibiotic resistance Mycoplasma genitalium Cervical screening

Prevention Major hit from funding reductions Behavioural trends Apps Condomless sex Chemsex Education

Workforce Morale: British Association of Sexual Health and HIV describe staff morale as at “breaking point”. Of respondents to their 2018 members survey, 81% reported that staff morale had decreased within their service in the past year with 49% reporting that staff morale had greatly decreased. Recruitment: GUM training 12/46 posts filled this year

Where next? Success stories Recommendations of Health Select Committee

Success stories

Notes: Number of anogenital warts (first episode) diagnoses by gender: England, 2009-2018 In 2018, there were just over 57,000 diagnoses of anogenital warts, of which 58% were in men. Between 2017 and 2018, diagnoses of anogenital warts decreased by 0.6% in men and by 7% in women. Most of this decline has occurred since 2013. 27

HIV testing coverage, total (%) Suffolk

Recommendations of Health Select Committee

“Some areas have managed to negotiate their way around the bureaucratic obstacles and work more effectively together. This needs to happen everywhere in order to put patients first, and more should be done to make joint working easier”