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STIs are on the rise

How common are sexually transmitted infections?

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There has been much headline news making statements about the rise in cases of STIs in the UK over recent times. They include this one in the Mirror newspaper:

 “STIs are on the rise due to super-resistant gonorrhoea” 

and the claim made by the Mail Online:
 
“Cases of syphilis in Britain are at their highest since WWII with one patient diagnosed with an STI every 70 seconds”

A report from Public Health England published in 2019 indicates that the number of new STI diagnoses in 2018 had increased by 5% when compared with the figures for 2017 and the number of consultations carried out at all sexual health services had risen by 7%. It was suggested that the rise could be attributed to the incorrect use of condoms and an increase in testing facilities which would have allowed more cases to be detected, particularly among the more common infections.

In order to put these claims into perspective, it is necessary to ignore claims made by the press and investigate more closely the actual figures involved. We need to look at the common infections such as genital warts, chlamydia, gonorrhoea and syphilis and in particular look at antibiotic-resistant gonorrhoea. 

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Genital warts

Genital warts are caused by the human papillomavirus (HPV) which is potentially serious as it can cause cervical cancer. The HPV vaccination programme has led to a marked decline in the incidence of the infection with diagnoses in 15 - 17 year old girls, many of whom would have had the HPV vaccine, was 92% lower in 2018 than it was in 2014. Similarly, a decline of 92% of the incidence of HPV in boys of the same age indicating the herd immunity affected by the vaccination.

Chlamydia

Chlamydia is the most commonly diagnosed sexually transmitted infection and accounts for almost half of all new diagnoses, 218,095 in 2018. This infection most commonly affects 15 - 24 year olds and accounted for 60% of the new chlamydia cases in 2018 which was an increase of 2% between 2017and 2018. A screening programme called the National Chlamydia Screening Programme was formed to increase detection and reduce the incidence of chlamydia in this group by proactively offering to screen.

Gonorrhoea

Rather shockingly, in the PHE report, the diagnosis of cases of gonorrhoea rose by 26% from 2017 to 2018. In general, men who have sexual intercourse with men, this includes gay and bisexual men, are at higher risk of contracting gonorrhoea and represented almost half the diagnoses in this group.

Syphilis

The incidence of syphilis has also been increasing; it has more than doubled over the period from 2009 to 2018, from 2847 cases in 2009 to 7541 cases in 2018. Men who have sex with men accounted for 75% of these cases in 2018 and a syphilis action plan was launched with increased frequency of testing for this high risk group.

Antibiotic resistant gonorrhoea

Gonorrhoea has developed resistance to nearly all of the antibiotics used for its treatment. We are currently down to one last recommended and effective class of antibiotics, cephalosporins, to treat this common infection. It is, however, important to realise that gonorrhoea resistance is not new and the sequential use of antibiotics over time has repeatedly seen resistance to each antibiotic in turn emerge. However, it is the emergence of resistance to extended-spectrum cephalosporins (ESC). There are fears that it may become an untreatable ‘superbug’

Why is the rise in STI’s important?

Many healthcare professionals are concerned about the rise in STIs. The reason for this is that STI’s can pose a serious risk to health for both the person who is infected as well as their sexual partners. Many sexually transmitted infections can be symptom free and go undiagnosed for a prolonged period of time; during this period it is possible to infect multiple sexual partners without realising it as well as running the risk of developing serious long term complications from the infection. For example, undiagnosed chlamydia can lead to a person getting the pelvic inflammatory disease (PID) and in the long term becoming infertile. If it is diagnosed early enough a simple course on antibiotics will clear the infection up.

The moral of the story is that it is very important to take care of your sexual health; ensure you always use condoms (correctly) as protection and be tested regularly. This is important regardless of age and what type of sexual relationship you are in.

Conclusion

As with most things, lack of education surrounding an issue and insufficient funding for related services, testing and treatment in this case, will in some part be responsible for the problem expanding and becoming more widespread.

In order to support sexual health services, Public Health England has undertaken to work to reduce the transmission of STI’s in the community by doing the following:

  • Develop an action plan aimed at addressing and reducing the increasing cases of syphilis
  • Launch a sexual health campaign called Protect Against STIs which is particularly aimed towards promoting condom usage amongst 16 - 24 year olds
  • Furnish local authorities with necessary information on the usage of sexual health services including attendance, testing levels and general epidemiology (statistics on rises or drops in STI levels)
  • Respond to outbreaks in order to reduce the spread of infection
  • Offer advice and support for the development of national guidelines in sexual healthcare

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