Significant worsening of sexual health in England in 2011: gay men and young heterosexual adults had high rates of STIs

There has been a significant worsening in the sexual health of gay and other men who have sex with men in England, new surveillance data released by the Health Protection Agency shows. 

Infections also remained high among heterosexual young people, aged between 15 and 24.   

Overall, there was a 2% increase in the number of reported sexually transmitted infections in 2011 compared to 2010. But cases of gonorrhoea and syphilis were up by 25 and 10% respectively. 

Although the increase in diagnoses is partly attributed to improved testing and surveillance, doctors believe that high rates of unprotected sex are leading to the continued transmission of sexually transmitted infections.

Investigators from the HPA are especially concerned about the 25% increase in gonorrhoea diagnoses. The infection is becoming increasingly difficult to treat due to the emergence of strains which are resistant to antibiotics.

Analysis of longer-term trends showed that rates of syphilis, genital herpes and genital warts have all increased significantly since 2002. This year’s increase follows a modest fall in the number of infections diagnosed in 2010.

As in previous years, gay and other men who have sex with men had high rates of sexually transmitted infections. Three-quarters of syphilis cases in 2011 were in this group, as were 50% of gonorrhoea diagnoses.

The number of gonorrhoea cases in gay and bisexual men increased by 61% compared to 2010, chlamydia by 48%, genital herpes by a third, syphilis by over a quarter and genital warts by 23%.

A substantial proportion of gonorrhoea cases in this population involved extragenital sites. Some 16% of infections were in the throat, with 20% located in the rectum. The authors believe that these figures are likely to represent an underestimate.

Several factors appear to have contributed to the upsurge of diagnoses in gay men. The large increase in gonorrhoea is partly attributed to improved testing and surveillance. Highly sensitive nucleic acid amplification tests (NAATs) are now used to diagnose infections. Reporting of sexual orientation has also improved.

However, investigators are convinced that the increase is at least partly due to ongoing high rates of unprotected sex. The researchers highlight the continuing LGV epidemic continues in older HIV-positive gay and bisexual men and recent outbreaks of Shigella.

Younger heterosexual people also had high rates of infections. Overall, two-thirds of chlamydia diagnoses involving heterosexuals involved patients aged between 15 and 24. This age group also accounted for 57% of gonorrhoea and 56% of genital wart diagnoses.

The only apparent good news in the report was a 2% fall in cases of chlamydia. However, the investigators believe that was simply due to a decline in the number of young people being screened.

Inner London had the highest overall rates of sexually transmitted infections. Investigators believe this is due to the concentration of at-risk populations in this area.

Doctors are especially alarmed by the large increase in gonorrhoea diagnoses: “The emergence of decreased susceptibility to frontline antimicrobials used for treating gonorrhoea and depletion of effective treatment options suggest that the prospect of untreatable gonorrhoea is a real threat.”

They recommend that sexual health prevention campaigns and services should continue to be focused towards high-risk populations.

“Health promotion and education remain the cornerstones of STI prevention, through improving awareness and encouraging safer sexual behaviour,” write the investigators. “Men who have sex with men having unprotected sex with casual or new partners should have an HIV/STI screen at least annually, and every three months if changing partners regularly. Consistent condom use, reducing the number of sexual partners and the avoidance of overlapping sexual relationships all reduce the risk of being infected with an STI.”