Tackling the rise in sexually transmitted infections

female gpThe number of sexually transmitted infections (STIs) has reached record levels, with almost half a million new cases diagnosed in the UK last year.

The 482,696 new STI diagnoses represent an increase of almost 12,000 more cases from the 2008 figures, and continues the steady upward trend seen over the last decade, according to figures published last month by the Health Protection Agency (HPA).

Chlamydia remains the most common STI with 217,570 confirmed cases in 2009, an increase of 7 per cent on the 2008 figures.

The number of cases of gonorrhoea has increased by 6 per cent, and genital herpes by 5 per cent, over the same period.

But there is some good news, with rates of syphilis falling by 1 per cent and genital warts diagnoses down slightly by 0.3 per cent.

This year - and for the first time - the figures are broken down by local area of residence rather than clinic attended, to help Primary Care Trusts (PCTs) and local authorities achieve a greater understanding of the sexual health profile of their population.

London has the highest rates of STIs in the country, with 14 of the capital's PCTs featuring in the top 20 hotspots for STIs.

City and Hackney Teaching PCT has the highest rate of STIs in the country, closely followed by Lambeth and then Southwark.

Other PCTs and local authorities in the top 20 include Brighton and Hove City, Nottingham City, Manchester and Blackpool.

Several factors contribute to high concentrations of STIs, including social deprivation, risky sexual behaviour and proportion of young people in each area as they tend to have more infections than older people.

How NICE can help

Using NICE guidance on one to one interventions to reduce the transmission of STIs, especially among vulnerable and at risk groups, could help PCTs, particularly those in hotspot areas, develop more effective services to tackle the rise in STIs.

NICE recommends that health professionals, such as GPs and staff working in genito-urinary medicine (GUM) clinics, identify individuals at high risk of contracting STIs using their sexual history.

At-risk groups include men who have sex with men, people who have come from or who have visited areas of high HIV prevalence, and people with alcohol and drug problems.

Opportunities for risk assessment may arise during consultations on contraception, pregnancy or abortion, and when carrying out a cervical smear test, offering an STI test or providing travel immunisation. Risk assessment could also be carried out during routine care or when a new patient registers.

Health professionals should have one-to-one structured discussions with individuals at high risk of STIs, or arrange for these discussions to take place with a trained practitioner.

The discussions should be structured on the basis of behaviour change theories, and should last for at least 15-20 minutes.

Patients with an STI should be helped to get their partners tested and treated (partner notification), when necessary.

NICE also recommends that midwives and health visitors regularly visit vulnerable women aged under 18 who are pregnant or who are already mothers and discuss with them and their partner (where appropriate) how to prevent or get tested for STIs.

To help PCTs put these recommendations into practice; NICE has produced a suite of implementation tools. This includes a slide set outlining the key messages of the guidance and a costing report to help plan the delivery of services.

Professor Mike Kelly, Director of the Centre for Public Health at NICE says: "This guidance helps health professionals working in the NHS and others working with young people, to understand which one-to-one interventions are effective and how they should be used particularly with those at high risk.”

Young people most at-risk

8036107-article-young-femalesYoung people are particularly at-risk of developing STIs, which is why NICE recommends that one to one sexual health advice on how to prevent and/or get tested for STIs is given to vulnerable young people under the age of 18.

The latest HPA figures back this up showing that two thirds of new STIs diagnoses were in those under 25.

In women, 73 per cent of all new gonorrhoea diagnoses and 66 per cent of all new genital warts diagnoses were in the under 25s.

The majority of women diagnosed with chlamydia (88 per cent) were under the age of 25, partly due to the success of the National Chlamydia Screening Programme which targets this age group.

In men, over half of new STI diagnoses were in those aged under 25. They accounted for 41 per cent of male gonorrhoea diagnoses, 47 per cent of cases of male genital warts and 69 per cent of male Chlamydia diagnoses.

The figures also reveal that at least one in ten teenagers aged between 16 and 19 who are treated at a clinic for a STI will return within a year with another infection, and that high rates of STI diagnoses were found among men who have sex with men.

Dr Gwenda Hughes, Head of the HPA's STI section, says: "These latest figures show that poor sexual health is a serious problem among the UK's young adults and men who have sex with men.

"These figures also highlight the vulnerability of young women. Many studies have shown that young adults are more likely to have unsafe sex and often they lack the skills and confidence to negotiate safer sex."

16 September 2010

This page was last updated: 16 September 2010

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.