Research and analysis

HPR volume 9 issue 22: news (26 June)

Updated 29 December 2015

1. PHE publishes full annual STIs data for 2014

Public Health England (PHE) has released its annual data on sexually transmitted infections (STIs) in England [1,2] which are covered in depth in this issue of Health Protection Report.

The main review report, Sexually Transmitted Infections and Chlamydia Screening in England, 2014 [1,2], provides an overview of trends for the STIs of most concern in England: gonorrhoea, syphilis, genital herpes, chlamydia and genital warts. The latest data show that although the total of new STI diagnoses decreased by 0.3% overall in 2014, compared with 2013 (from 439,243 to 440,707), there were marked year-on-year increases in syphilis and gonorrhoea diagnoses (up 33% and 19%, respectively, compared with 2013) – particularly in men who have sex with men (among whom the new diagnoses increased 42% and 36%, respectively).

Chlamydia was the most commonly diagnosed STI in 2014, accounting for 47% (206,774 cases) of all diagnoses. The main STI report also presents data, covering 2012 to 2014, on genital Chlamydia Trachomatis tests and diagnoses among those most at risk – sexually active 15-to-24 year-olds. A separate report, Monitoring Rates of Chlamydia Re-testing within the English National Screening Programme in 2013 [3], comprises a set of baseline data against which hoped-for future improvements in the rate of re-testing can be compared; this represents a new strand of STI reporting from the National Chlamydia Screening Programme (NCSP).

A further new strand of PHE reporting contained in this issue of HPR concerns pelvic inflammatory disease (PID), which can be caused by untreated genital chlamydia and other STIs. Rates of Pelvic Inflammatory Disease (PID) in England (2000-2013) [4] indicates declining PID diagnosis rates in GP settings between 2000 and 2008, with rates remaining relatively stable from 2008 to 2011. These declines may reflect reducing risk due to increases in chlamydia screening and testing over the last decade, although further exploration of the contribution chlamydia screening has made is needed.

Also reported in this issue are latest data (to end-2014) on genital warts (GW) trends, providing further evidence of the unexpected moderate protective effect of the bivalent human papillomavirus (HPV) vaccine against genital warts [5]. These data indicate a 30.6% decrease in the GW incidence rate in females aged 15 to 19 years (from 685.8 to 75.7 per 100,000) – and of 9.6% for females aged 20 to 24 years (from 698.8 to 475.7 per 100,000). A decrease of 24.0% (from 274.0 to 208.1 per 100,000) was also seen in 15-to-19 year-old males – and 9.9% (from 849.6 to 765.3 per 100,000) for 20-to-24 year-old males – over the same time period, the potential causes of which are discussed.

The main STIs report [1] reiterates that health promotion and education to increase risk awareness and encourage safer sexual behaviour remain the cornerstones of STI prevention. The continuing increases in syphilis and gonorrhoea, it is noted, are likely due to ongoing high levels of unsafe sexual practices. This is especially found with MSM, among whom there is an increased incidence of hepatitis B and C, and of sexually transmissible enteric infections, such as Shigella spp.

1.1 References

1. PHE (2015). Sexually transmitted infections and chlamydia screening in England, 2014, HPR 9(22) Advance Access report, 23 June.
2. PHE press release: New STI figures show rapid increases among gay men, 23 June 2015.
3. PHE (June 2015). Monitoring rates of chlamydia re-testing within the English National Screening Programme in 2013, HPR 9(22) Advance Access report, 23 June.
4. PHE (June 2015). Rates of Pelvic Inflammatory Disease (PID) in England, 2000–2013, HPR 9(22) Advance Access report, 23 June.
5. PHE (June 2015). Continuing trend of declining genital warts diagnoses in young women in England: update to end 2014, HPR 9(22): news (see below).

2. Continuing trend of declining genital warts diagnoses in young women in England: update to end-2014

Genital warts (GW) diagnoses in genitourinary medicine (GUM) clinics among 15-to-19 year-old females declined by 33.2% between 2009 and 2014. A smaller reduction of 25.8% has also been seen in 15-to-19 year-old males.

The UK was the first country in the world to introduce a national HPV vaccination programme using the bivalent HPV 16/18 vaccine. The programme began in September 2008 and use of the bivalent vaccine continued until September 2012. At this time it was replaced by the quadrivalent vaccine, which also includes HPV types 6 and 11, providing protection against GW [1]. The target group for the routine vaccination programme is 12-to-13 year-old females and uptake has been high. No reduction in genital warts was expected during the first years of the programme due to the initial choice of a bivalent vaccine.

Data for 2009 to 2014 from the GUM clinic activity dataset (GUMCADv2), submitted by GUM and integrated GUM/sexual and reproductive health clinics in England, were reviewed. There has been a marked decrease of 30.6% (from 685.8 to 475.7 per 100,000) in the rate of GW diagnoses in females aged 15-to-19 years and of 9.6% (from 698.8 to 631.8 per 100,000) for females aged 20-to-24 years. A decrease of 24.0% (from 274.0 to 208.1 per 100,000) was seen for 15-to-19 year-old males and 9.9% (from 849.6 to 765.3 per 100,000) for 20-to-24 year-old males over the same time period. The greatest declines were seen among 15, 16, 17 and 18 year-old females (50.9%, 46.7%, 37.4% and 29.7% respectively) who would have been eligible for vaccination in school (with reported vaccination coverage >70%) [2,3,4]. The percentage declines lessen with increasing age, as does the estimated vaccine coverage. In females above the age eligible for HPV immunisation, and males of the same age, diagnoses rates showed no similar declines.

Several factors that might be contributing to these declines, such as changing risk behaviours or different patterns of attendance at GUM or integrated GUM/SRH clinics have been explored elsewhere [5]. However, the pattern of declines by age and gender seem to suggest a moderately protective effect of the bivalent vaccine against genital warts [6].

2.1 Reference

1. MHRA. Human papillomavirus (HPV) immunisation programme: first-year safety review.
2. DH (2012). Annual HPV vaccine coverage in England in 2010 to 2011.
3. DH (2012). Annual HPV vaccine coverage in England in 2011 to 2012.
4. PHE (2013). Annual HPV vaccine coverage 2012 to 2013: by PCT and SHA.
5. PHE (2014). Declines in genital warts since start of the HPV immunisation programme, HPR 8(24).
6. Howell-Jones R, Soldan K, Wetten S, Mesher D, Williams T, Gill ON, et al (2013). Declining genital warts in young women in England associated with HPV 16/18 vaccination: an ecological study. J Infect Dis. 1; 208(9): 1397-403.