Research and analysis

Spotlight on sexually transmitted infections in the East Midlands: 2021 data

Updated 1 September 2023

Summary

Sexually transmitted infections (STIs) represent an important public health problem in the East Midlands. Out of all the UK Health Security Agency (UKHSA)’s regions it has the median rate of new STIs in England.

20,871 new STIs were diagnosed in East Midlands residents in 2021, representing a rate of 429 diagnoses per 100,000 population. Rates by upper tier local authority (UTLA) ranged from 262 new STI diagnoses per 100,000 population in Rutland to 937 new STI diagnoses per 100,000 population in Nottingham.

The number of new STIs diagnosed in East Midlands residents increased by 4% between 2020 and 2021. Increases were seen in the numbers of most of the 5 major STIs:

• syphilis (21%)
• chlamydia (2%)
• genital herpes (6%)
• genital warts (11%)

Gonorrhoea decreased by 4%.

UKHSA recommends that local areas should be working towards achieving a chlamydia detection rate of at least 2,300 per 100,000 among individuals aged 15 to 24 years and this is an indicator in the Public Health Outcomes Framework (PHOF). In 2021, the chlamydia diagnosis rate among East Midlands residents aged 15 to 24 years was 1,370 per 100,000 residents. Rates of new STIs vary somewhat between men and women (370 and 439 per 100,000 residents, respectively).

Where gender and sexual orientation are known, gay, bisexual and other men who have sex with men (GBMSM) account for 15% of East Midlands residents diagnosed with a new STI excluding chlamydia diagnoses reported via Chlamydia Surveillance System (CTAD) (69% of those diagnosed with syphilis and 34% of those diagnosed with gonorrhoea).

STIs disproportionately affect young people. East Midlands residents aged between 15 and 24 years accounted for 54% of all new STI diagnoses in 2021. A steep decline (96% decrease) has been seen between 2017 and 2021 in genital warts diagnosis rates in females aged 15 to 19 years. This follows the introduction of vaccination against human papillomavirus (HPV), the virus which causes genital warts, for females in 2008 and males in 2019.

The white ethnic group has the highest number of new STI diagnoses: 14,430 (81%). Although only 2% of new STIs are in the black Caribbean ethnic group, they have the second highest rate: 1,473 per 100,000, which is 4 times the rate seen in the white ethnic group. Where country of birth was known, 85% of East Midlands residents diagnosed with a new STI in 2021 (excluding chlamydia diagnoses reported via CTAD) were UK-born.

Conclusions

Following the disruptions in service delivery during the first year of the COVID-19 pandemic, the number of consultations at sexual health services (SHSs) increased between 2020 and 2021 and now exceeds the number reported in 2019. This provides evidence of a recovery in service provision, after the lifting of COVID-19 restrictions in the summer of 2021, partially driven by the continued widespread provision of online consultations. The number of sexual health screens (for chlamydia, gonorrhoea, syphilis and HIV) in England also increased between 2020 and 2021, although the number of STI diagnoses remained stable. The increase in sexual health screens may be a result of built-up demand for SHSs as well as a return to pre-COVID-19 pandemic levels of social and sexual mixing and the substantial number of tests being accessed through online services (1 to 4). It will remain important to continue to monitor and understand whether these changes have affected equity of access to SHSs (5, 6).

Chlamydia continues to account for the majority of STI diagnoses made in 2021, a large proportion of which are related to the National Chlamydia Screening Programme (NCSP). Screening rates for chlamydia have recovered gradually since the pandemic, with an increasing proportion of tests and diagnoses being made via internet services.

Although overall STI diagnoses rates remained similar between 2020 and 2021, there was an increase in bacterial STI diagnoses among GBMSM. STIs continue to show geographic and socioeconomic variation and disproportionately impact GBMSM, people of black Caribbean ethnicity, and young people aged 15 to 24 years.

UKHSA’s main messages

Providers and commissioners have an important role in communicating messages about safer sexual behaviours and how to access services.

Important prevention messages

Using condoms consistently and correctly protects against HIV and other STIs such as chlamydia, gonorrhoea, and syphilis, and can prevent unplanned pregnancy.

Regular screening for STIs and HIV is essential to maintain good sexual health. Everyone should have an STI screen, including an HIV test, on at least an annual basis if having condomless sex with new or casual partners.

In addition:

• women and other people with a womb or ovaries aged under 25 years who are sexually active should have a chlamydia test annually and on change of sexual partner
• GBMSM should have an annual test for HIV and STIs or every 3 months if having condomless sex with new or casual partners

HIV pre-exposure prophylaxis (PrEP) can also be used to provide protection to people at risk of HIV while HIV post-exposure prophylaxis (PEP) can be used after condomless sex if someone has potentially been exposed to HIV, to reduce the risk of contracting HIV. Both of these can be obtained from specialist SHSs.

People living with diagnosed HIV who are on treatment and have an undetectable viral load are unable to pass on the infection to others during sex. This is known as ‘Undetectable = Untransmittable’ or ‘U=U’.

Vaccination against mpox (monkeypox) virus, HPV, hepatitis A and hepatitis B will protect against disease caused by these viruses and prevent the spread of these infections:

• GBMSM can obtain the mpox, hepatitis A and hepatitis B vaccines from specialist sexual health services; these vaccines are also available for other people at high risk of exposure to the viruses
• GBMSM aged 45 years and under, can also obtain the HPV vaccine from specialist SHSs

SHSs are free and confidential and offer testing and treatment for HIV and STIs, condoms, vaccination, HIV PrEP, and PEP:

• online self-sampling for HIV and STIs is widely available
• information and advice about sexual health including how to access services is available at Sexwise and from the national sexual health helpline on 0300 123 7123

Charts, tables and maps

Figure 1. New STI diagnosis rates by UKHSA region of residence, England, 2021

Data sources: GUMCAD STI Surveillance System (GUMCAD), CTAD

20,871 new STIs were diagnosed in East Midlands residents in 2021, representing a rate of 429 diagnoses per 100,000 population. Compared to other regions, the East Midlands region had the median rate of new STI diagnoses in England.

Figure 2. Number of diagnoses of the 5 main STIs, East Midlands residents, 2017 to 2021

Data sources: GUMCAD, CTAD

[note 1] Any increase in gonorrhoea diagnoses may be due to the increased use of highly sensitive nucleic acid amplification tests (NAATs) and additional screening of extra-genital sites in GBMSM. Any decrease in genital wart diagnoses may be due to a moderately protective effect of HPV-16/18 vaccination. Any increase in genital herpes diagnoses may be due to the use of more sensitive NAATs. Increases or decreases may also reflect changes in testing practices.

Between 2017 and 2021, chlamydia accounted for the highest number of new diagnoses although the number of diagnoses fell significantly in 2020. The number of diagnoses of most STIs increased between 2020 and 2021, apart from gonorrhoea, which fell slightly.

Figure 3. Diagnosis rates of the 5 main STIs, East Midlands residents, 2017 to 2021

Data sources: GUMCAD, CTAD

See [note 1] above.

Similar to the number of new diagnoses, the diagnosis rate was highest for chlamydia than for other infections. The rate of diagnoses for genital warts decreased each year between 2017 and 2020 but increased slightly between 2020 and 2021. The rate of gonorrhoea diagnoses increased each year until 2019 before it fell in 2020 and slightly in 2021, but remained higher than the rate in 2017.

Table 1. Percentage change in new STI diagnoses, East Midlands residents

Diagnoses	2021	Percentage change 2017 to 2021	Percentage change 2020 to 2021
New STIs	20,871	-29%	4%
Syphilis	283	-4%	21%
Gonorrhoea	2,440	8%	-4%
Chlamydia	12,439	-24%	2%
Genital herpes	1,585	-32%	6%
Genital warts	2,029	-54%	11%

Data sources: GUMCAD, CTAD

See [note 1] above.

Between 2017 and 2021, diagnoses of gonorrhoea increased while the number of diagnoses for all other infections fell. Conversely between 2020 and 2021, the number of diagnoses of all infections (apart from gonorrhoea) increased.

Figure 4. Rates of new STIs per 100,000 residents by age group (for those aged 15 to 64 years only) and gender in the East Midlands, 2021

Data sources: GUMCAD, CTAD

The rate of new STIs per 100,000 is highest in individuals aged 20 to 24 years. In those aged 25 years and under, the rate is higher among females, but in those aged 25 and over, males have a higher rate of new infections.

Figure 5. Rates of gonorrhoea per 100,000 residents by age group [note 2] in the East Midlands, 2017 to 2021

Data sources: GUMCAD

[note 2]Age-specific rates are shown for those aged 15 to 64 years only.

Individuals aged 20 to 24 years old have the highest rate of gonorrhoea. All age groups apart from those aged 15 to 19 years and those aged 25 to 34 years have a slightly higher rate in 2021 than they did in 2017.

Figure 6. Rates of genital warts per 100,000 residents aged 15 to 19 years by gender in the East Midlands, 2017 to 2021

Data sources: GUMCAD

Rates of genital warts have fallen in both males and females each year since 2017. Females had a significantly higher rate than males in 2017 but rates are now more similar in males and females.

Figure 7. Rates of new STIs by ethnic group per 100,000 residents in the East Midlands, 2021

Data sources: GUMCAD, CTAD

The rate of diagnoses of new STIs is significantly higher for black African and black Caribbean individuals than other ethnic groups.

Table 2. Proportion of East Midlands residents diagnosed with a new STI by ethnicity, 2021

Ethnic group	Number	Percentage excluding unknown
White	14,430	81%
Black Caribbean	426	2%
Black African	806	4%
All other ethnic groups combined	2,259	13%
Unknown	2,950

Data sources: GUMCAD, CTAD

The highest number of new STI diagnoses are in white individuals, who account for 81% of diagnoses where ethnic group is known.

Figure 8. Proportions of East Midlands residents diagnosed with a new STI by world region of birth [note 3], 2021

Data sources: GUMCAD data only

[note 3] Data on country of birth is not collected by CTAD. All information about world region of birth is based on diagnoses made in specialist and non-specialist services which report to GUMCAD.

The majority (85%) of new STI diagnoses occur in individuals born in the UK.

Figure 9. Diagnoses of the 5 main STIs among GBMSM [note 4], East Midlands residents, 2017 to 2021

Data sources: GUMCAD data only

See [note 1] above.

[note 4] Data on sexual orientation is not collected by CTAD. All information about GBMSM is based on diagnoses made in specialist and non-specialist services which report to GUMCAD.

GUMCAD started in 2009. Reporting of sexual orientation is less likely to be complete for earlier years, so rises seen may be partly artefactual.

Within specialist and non-specialist services, the highest number of diagnoses among GBMSM were of gonorrhoea and chlamydia. The number of diagnoses of gonorrhoea and chlamydia increased each year between 2017 and 2019 before falling in 2020. Between 2020 and 2021, gonorrhoea increased slightly, while chlamydia remained relatively stable.

Table 3. Percentage change in new STI diagnoses in GBMSM resident in the East Midlands

Diagnoses	2021	Percentage change 2017 to 2021	Percentage change 2020 to 2021
New STIs	1,543	-15%	4%
Syphilis	171	-9%	19%
Gonorrhoea	747	26%	8%
Chlamydia	797	45%	13%
Genital herpes	40	-37%	-2%
Genital warts	74	-54%	-22%

Data sources: GUMCAD data only

See [note 4] above.

Between 2017 and 2021 gonorrhoea diagnoses in GBMSM increased by 26% and chlamydia by 45%. Between 2020 and 2021, syphilis diagnoses increased by 19%.

Figure 10a. Rate of new STI diagnoses per 100,000 population among East Midlands residents by upper tier local authority of residence, 2021

Data sources: GUMCAD, CTAD

Nottingham and Derby had the highest rate of new STI diagnoses in 2021 and were significantly higher than the England rate. The rate of diagnoses in Leicester was similar to the national rate, while other UTLAs had lower rates.

Figure 10b. Rate of new STI diagnoses (excluding chlamydia diagnoses in people aged 15 to 24 years) per 100,000 population aged 15 to 64 years among East Midlands residents by upper tier local authority of residence, 2021

Data sources: GUMCAD, CTAD

When chlamydia diagnoses in people aged 15 to 24 years are excluded, the 3 UTLAs with the highest rates of new STI diagnoses are still Nottingham, Derby and Leicester.

Figure 11. Chlamydia detection rate per 100,000 population aged 15 to 24 years in East Midlands residents by upper tier local authority of residence, 2021

Data sources: GUMCAD, CTAD

In the East Midlands, Nottingham had the highest chlamydia detection rate among those aged 15 to 24 years. The detection rate in all local authorities was below the rate in the PHOF that local areas should be working to (2,300 per 100,000).

Figure 12. Rate of gonorrhoea diagnoses per 100,000 population in East Midlands residents by upper tier local authority of residence, 2021

Data sources: GUMCAD

Nottingham had the highest rate of gonorrhoea diagnoses among UTLAs in the East Midlands.

Figure 13. Map of new STI rates per 100,000 residents by upper tier local authority in the East Midlands, 2021

Data sources: GUMCAD, CTAD. Map contains Ordnance Survey data (© Crown copyright and database right 2021) and National Statistics data © Crown copyright and database right 2021)

The map shows that Nottingham, Derby and Leicester had the highest rates of new STI diagnoses in the East Midlands.

Figure 14. STI testing rate (excluding chlamydia in those aged under 25 years) per 100,000 population in East Midlands residents aged 15 to 64 years, 2017 to 2021

Data sources: GUMCAD, CTAD

STI testing rate in the East Midlands and nationally increased each year between 2017 and 2019. Testing rates fell in 2020 due to disruption to SHSs caused by the COVID-19 pandemic. In 2021, the testing rate increased from the previous year, but remained below the rate in 2019 for both the East Midlands and England. The testing rate in the East Midlands is consistently lower than the national average.

Figure 15. STI testing positivity rate [note 5] (excluding chlamydia in those aged under 25 years) in East Midlands residents, 2017 to 2021

Data sources: GUMCAD, CTAD

[note 5] The numerator for the STI testing positivity rate now only includes infections which are also included in the denominator. These are chlamydia (excluding diagnoses in those aged under 25 years), gonorrhoea, syphilis and HIV. Up to 2018 (data for 2017) it included all new STIs.

The STI testing positivity rate in the East Midlands in 2021 was slightly lower than the national rate (5.0% compared to 6.0%).

Table 4. Number of diagnoses of new STIs by UKHSA region of residence, data source and data subset 2021

UKHSA region of residence	GUMCAD specialist SHSs	GUMCAD non-specialist SHSs [note 6]	CTAD [note 7]	Total
East Midlands	10,622	6,275	3,974	20,871
East of England	15,809	4,238	5,608	25,655
London	69,545	8,162	23,792	101,499
North East	7,495	1,580	2,718	11,793
North West	23,693	3,789	7,954	35,436
South East	26,578	1,960	8,287	36,825
South West	13,797	2,444	4,782	21,023
West Midlands	16,890	3,867	4,804	25,561
Yorkshire and Humber	16,031	2,050	7,724	25,805

Data sources: GUMCAD, CTAD

[note 6] Diagnoses from enhanced GPs reporting to GUMCAD are included in the ‘non-specialist SHSs’ total.

[note 7] Including site type 12 chlamydia from GUMCAD.

Only the North East had a lower number of new STIs diagnoses in 2021 than the East Midlands. In all regions, the majority of new STIs were diagnosed in specialist SHSs, although in the East Midlands a significant proportion of new STIS were diagnosed in non-specialist SHSs.

Table 5. Number of diagnoses of the 5 main STIs in the East Midlands by STI, data source and data subset 2021

5 main STIs	GUMCAD specialist SHSs	GUMCAD non-specialist SHSs [note 8]	CTAD [note 9]	Total
Syphilis	277	6		283
Gonorrhoea	1,439	1,001		2,440
Chlamydia	3,395	5,070	3,974	12,439
Genital herpes	1,523	62		1,585
Genital warts	1,947	82		2,029

Data sources: GUMCAD, CTAD

[note 8] Diagnoses from enhanced GPs reporting to GUMCAD are included in the ‘non-specialist SHSs’ total.

[note 9] Including site type 12 chlamydia from GUMCAD.

In the East Midlands a significant number of gonorrhea and chlamydia diagnoses are made in non-specialist SHSs.

Information on data sources

Find more information on local sexual health data sources on GOV.UK.

These figures are based on data from the GUMCAD and CTAD surveillance systems published on 4 October 2022 (data to the end of calendar year 2021).

GUMCAD surveillance system

This disaggregate reporting system collects information about attendances and diagnoses at specialist (level 3) and non-specialist (level 2) sexual health services. Information about the patient’s area of residence is collected along with demographic data and other variables. GUMCAD superseded the earlier KC60 system and can provide data from 2009 onwards. GUMCAD is the main source of data for this report.

Due to limits on how much personally identifiable information sexual health clinics are able to share, it is not possible to deduplicate between different clinics. There is a possibility that some patients may be counted more than once if they are diagnosed with the same infection (for infection specific analyses) or a new STI of any type (for new STI analyses) at different clinics during the same calendar year.

CTAD surveillance system

CTAD collects data on all NHS and local authority or NHS-commissioned chlamydia testing carried out in England. CTAD is comprised of all chlamydia (NAATs) tests for all ages (with the exception of conjunctival samples), from all venues and for all reasons. CTAD enables unified, comprehensive reporting of all chlamydia data, to effectively monitor the impact of the NCSP through estimation of the coverage of population screening, proportion of all tests that are positive and detection rates.

For services which report to GUMCAD and for which CTAD does not receive data on the patient’s area of residence (for example, SHSs), information about chlamydia diagnoses is sourced from GUMCAD data.

New STIs

New STI diagnoses comprise diagnoses of the following:

• chancroid
• lymphogranuloma venereum (LGV)
• donovanosis
• chlamydia
• gonorrhoea
• genital herpes (first episode)
• HIV (acute and AIDS defining)
• molluscum contagiosum
• non-specific genital infection (NSGI)
• non-specific pelvic inflammatory disease (PID) and epididymitis
• chlamydial PID and epididymitis (presented in chlamydia total)
• gonococcal PID and epididymitis (presented in gonorrhoea total)
• scabies
• pediculosis pubis
• syphilis (primary, secondary and early latent)
• trichomoniasis and genital warts (first episode)
• mycoplasma genitalium
• shigella

Calculations

Confidence Intervals were calculated using Byar’s method.

Office of National Statistics (ONS) mid-year population estimates for 2020 were used as a denominator for rates for 2021. ONS ceased producing estimates of population by ethnicity in 2011. Estimates for that year were used as a denominator for rates for 2021.

Further information

As of 2020, all analyses for this report include data from non-specialist (level 2) SHSs and enhanced GP services as well as specialist (level 3) SHSs.

For further information, access the online Sexual and Reproductive Health Profiles.

Find more information on local sexual health data sources on GOV.UK.

Local authorities have access to the Summary Profile of Local Authority Sexual Health (SPLASH) Reports (accessible from the Sexual and Reproductive Health Profiles) and the SPLASH supplement reports via the HIV and STI Data exchange.

For an annual epidemiological spotlight on HIV in the East Midlands, contact fsmidlands@ukhsa.gov.uk.

About the Field Service

The Field Service was established in 2018 as a national service comprising geographically dispersed multi-disciplinary teams integrating expertise in Field Epidemiology, Real-time Syndromic Surveillance, Public Health Microbiology and Food, Water and Environmental Microbiology to strengthen the surveillance, intelligence and response functions of UKHSA.

You can contact your local Field Service team at fsmidlands@ukhsa.gov.uk

If you have any comments or feedback regarding this report or the Field Service, contact josh.forde@ukhsa.gov.uk

Acknowledgements

We would like to thank:

• local SHSs for supplying the SHS data
• local laboratories for supplying the CTAD data
• UKHSA Blood Safety, Hepatitis, STI and HIV Division for collection, analysis and distribution of data

References

1. Mitchell KR, Shimonovich M, Bosó Pérez R, Dema E, Clifton S, Riddell J and others. ‘Initial Impacts of COVID-19 on sex life and relationship quality in steady relationships in Britain: Findings from a large, quasi-representative Survey (Natsal- COVID)’ The Journal of Sex Research. March 2022: pages 1 to 12 (accessed 11 August 2022

2. Howarth A, Saunders J, Reid D, Kelly I, Wayal S, Weatherburn P, Hughes G, and Mercer C. ‘Stay at home ….: Exploring the impact of the COVID-19 public health response on sexual behaviour and health service use among men who have sex with men: findings from a large online survey in the United Kingdom’ Sexually Transmitted Infections. July 2022: pages 346 to 352 (accessed 11 August 2022)

3. Dema E, Gibbs J, Clifton S and others. ‘Initial impacts of COVID-19 on sexual and reproductive health service use and unmet need in Britain: findings from a large, quasirepresentative survey (Natsal-COVID)’ The Lancet Public Health. January 2022: volume 7, pages e36 to e47

4. Sonnenberg P, Menezes D, Freeman L and others. ‘Intimate physical contact between people from different households during the COVID-19 pandemic: a mixed-methods study from a large, quasi-representative survey (Natsal-Covid)’ British Medical Journal Open. February 2022: volume 12, issue 2 (accessed 11 August 2022)

5. Ratna N, Dema E, Conolly A, and others. ‘O16 Ethnic variations in sexual risk behaviour, sexual health service use and unmet need during the first year of the COVID-19 pandemic: an analysis of population-based survey and surveillance data’ Sexually Transmitted Infections. 2022: volume 98, pages A8 to A9 (accessed 11 August 2022)

6. Sumray K, Lloyd KC, Estcourt CS, Burns F and Gibbs J. ‘Access to, usage and clinical outcomes of, online postal sexually transmitted infection services: a scoping review’ Sexually Transmitted Infections. June 2022: pages 1 to 8 (accessed 11 August 2022)