Research and analysis

Spotlight on sexually transmitted infections in the North West: 2022 data

Updated 5 March 2024

Applies to England

Your feedback

Take our survey to share what you find valuable and what we can improve in these reports.

Take the survey

Summary

While this report primarily focuses on the trend between 2021 and 2022, some trends relative to 2019 or earlier are included to provide a comparison to sexual health service provision and sexually transmitted infection (STI) diagnoses prior to the COVID-19 pandemic. For England, the numbers of consultations, sexual health screens and STI diagnoses in 2020 and 2021 are lower than preceding years and any trends in diagnoses between 2021 and 2022 must be interpreted in that context.

STIs represent an important public health problem in the North West. Out of all the UK Health Security Agency (UKHSA)’s regions it has the second highest rate of new STIs in England.

New STI diagnoses

A total of 49,122 new STIs were diagnosed in North West residents in 2022, representing a rate of 662 diagnoses per 100,000 population (Figure 1). Rates by upper-tier local authority ranged from 264 new STI diagnoses per 100,000 population in Westmorland and Furness to 1,514 new STI diagnoses per 100,000 population in Liverpool (Figure 12a) .

The number of new STIs diagnosed in North West residents increased by 35% between 2021 and 2022 but declined by 12% compared to 2018 (Table 1). Increases were seen in the numbers of most of the 5 major STIs compared to 2021:

• syphilis increased by 15%
• gonorrhoea by 93%
• chlamydia by 33%
• genital herpes by 21%

Genital warts decreased by 8% (Figure 2, Table 1). However, only gonorrhoea and syphilis diagnoses increased compared to 2018 (by 64% and 6% respectively). The most commonly diagnosed STIs among residents of the North West in 2022 were:

• chlamydia (54% of all new STI diagnoses)
• gonorrhoea (20%)
• first-episode genital herpes (6%)
• first episode genital warts (6%) (Figure 2)

UKHSA recommends that local areas should be working towards achieving a chlamydia detection rate no lower than 3,250 per 100,000 among individuals aged 15 to 24 years and this rate in females only is an indicator in the Public Health Outcomes Framework (1). In 2022, the chlamydia detection rate among females (aged 15 to 24 years) resident in the North West was 2,262 per 100,000 residents. The rate of new STI diagnoses was similar in men and women (583 and 580 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 24% (6,878 out of 28,157) of North West residents diagnosed with a new STI excluding chlamydia diagnoses reported via CTAD (80% (622 out of 778) of those diagnosed with syphilis and 40% (3,243 out of 8,207) of those diagnosed with gonorrhoea).

STIs disproportionately affect young people. North West residents aged between 15 and 24 years accounted for 50% of all new STI diagnoses in 2022. A steep decline (93% decrease) has been seen between 2018 and 2022 in genital warts diagnosis rates in females aged 15 to 19 (14.7 compared to 215.0 per 100,000 population). This follows the introduction in 2008 of vaccination against Human papillomavirus (HPV), the virus which causes genital warts, for females aged 12 to 13 years. A decline of 86% was seen in young men of the same age over the same period (18.2 versus 126.1 cases per 100,000 population), suggesting a combination of substantial herd and direct protection within this age group overall (2).

The white ethnic group has the highest number of new STI diagnoses: 34,277 (86%) (Table 2). Although only 1% of new STIs are among people of black Caribbean ethnicity, they have the highest rate: 1,890 per 100,000, which is 4 times the rate seen in the white ethnic group (Figure 7). Where country of birth was known, 88% of North West residents diagnosed with a new STI in 2022 (excluding chlamydia diagnoses reported via CTAD) were UK-born (Figure 8). The rate of new STI diagnoses was significantly higher among the 4 most deprived socioeconomic groups and rose with increasing level of deprivation (745 to 808 diagnoses per 100 000 in the 4 most deprived deciles compared to 338 per 100 000 in the least deprived decile) (Figure 9).

STI consultations and screens

The number of consultations delivered by sexual health services (clinic-based and online) for residents of the North West in 2022 (452,819) was 8% lower than in 2021 (491,142) and 11% lower than in 2019 (507,068) (Figure 18). Of all consultations to residents of the North West in 2022, 70% (316,780) were delivered face to face, 16% (70,458) via the internet and 14% (65,571) via telephone (Figure 18). There was a small increase in the number of face-to-face consultations (311,508 to 316,780) and online consultations (64,074 to 70,458) delivered in 2022 compared to 2021 and a larger reduction in the number of telephone consultations (115,560 to 65,581) (Figure 18). The reduction in telephone consultations is unsurprising and likely reflects the change in provision as services continued to recover from COVID-19. During the COVID-19 pandemic, many clinics introduced an initial telephone triage to manage the number of people attending in person. This practice has now ended.

The number of sexual health screens (diagnostic tests for one or more of chlamydia, gonorrhoea, syphilis, and HIV) carried out for residents of the North West was 2% higher in 2022 (197,615) compared to 2021 (193,038) but was 13% lower compared to 2019 (227,568). In England, the increase in number of screens was larger, rising by 13% in 2022 compared to 2021. The comparatively lower number of screens in the North West in 2022 can partially be explained by known issues with quality and completeness of data reported to GUMCAD by some providers. In addition, changes to how screening tests are recorded in 2022 (from one code for a sexual health screen to the requirement to individually code a screen for each infection), confounds comparison to previous years as providers transition to using the new system.

Although the number of sexual health screens only increased by 2% from 2021 to 2022, the number of new STIs increased by 35% over the same period (from 36,399 diagnoses in 2021 to 49,122 in 2022). In addition to reflecting a true increase in STI transmission in the community, the increase in diagnoses of STIs relative to the number of sexual health screens may be influenced by more targeted testing of those more likely to have an STI.

The 10% decrease in new STIs among North West residents from 2019 to 2022 is similar to the 13% decrease in number of sexual health screens over the same time period. The reduction in screening from 2019 to 2022 may explain the comparable reduction in the number of new STI diagnoses.

Populations with greater sexual health needs

Young people aged 15 to 24 years

Young people experience the highest diagnosis rates of the most common STIs, and this may be due to higher rates of partner change among those aged 16 to 24 years (3). Young women may be more likely to be diagnosed with an STI due to disassortative sexual mixing by age and gender (4). Compared to 2021, the number of new STI diagnoses in 2022 among young people aged 15 to 24 years increased by 41% (17,427 to 24,577). There was a 133% increase in cases of gonorrhoea among this age group comparing 2022 (4,511) with 2021 (1,937); this is larger than the 91% increase for this age group observed for England overall. Further analysis conducted by UKHSA Field Service North West showed that this increase was predominantly seen among heterosexual people aged 15 to 24 years, while in previous years, a larger proportion of gonorrhoea infections were attributable to GBMSM.

Black ethnic groups

In the North West, there were only 1,574 diagnoses of new STIs among people of black ethnicity in 2022 (4% of the total number of new STI diagnoses) (Table 2). However, when accounting for the underlying population sizes, people of black ethnicity had significantly higher diagnosis rates compared to all other ethnic groups (Figure 7, Table 2). It should be noted that there is significant variation between black ethnic groups as well, as the rate of new STI diagnoses in 2022 was significantly higher among people in the black Caribbean ethnic group (1,890 cases per 100,000) compared to people in the black African ethnic group (856 per 100,000) (Figure 7). The ethnic disparity in STIs is likely reflective of underlying socio-economic factors and the role they play in the structural determinants of the health of this community (5).

GBMSM

In line with the recovery of SHS and increased STI testing in 2021 and 2022, there were increases in some bacterial STI diagnoses among GBMSM over this period (Figure 10, Table 3). From 2021 to 2022, diagnoses of gonorrhoea increased by 63% (1,994 to 3,243), chlamydia increased by 34% (1,534 to 2,050), and syphilis increased by 7% (579 to 622) (Table 3). There is evidence of a rebound in sexual mixing among GBMSM between 2020 and 2021, and this is likely to have contributed to the rise in STIs within this population in 2022 (6). Uptake of HIV pre-exposure prophylaxis (HIV PrEP) among residents of the North West increased in 2022, predominantly among GBMSM (7, 8). People who take HIV PREP are required to have quarterly STI screening as part of their care (9). Therefore, increased detections of STIs in GBMSM may partly be explained by increased testing (10). In addition, several large North West cities have invested in targeted HIV/STI prevention work with at-risk populations, potentially leading to increased testing and awareness of STIs.

Conclusions

Although new STI diagnoses in North West residents increased by 35% between 2021 and 2022, this represented a bounce back to pre-pandemic levels overall.

Gonorrhoea and syphilis diagnoses exceeded those reported in 2019. The increase in syphilis diagnoses reflected the national picture (a 15% increase compared to 2021), while the increase in gonorrhoea diagnoses was larger (93% from 2021 compared to 50% nationally), predominantly affecting young people aged 15 to 24.

The number of sexual health screens carried out in 2022 increased by 2% compared to 2021, yet the number of new STI diagnoses increased by 35%; this larger increase in diagnoses relative to screens may reflect more targeted testing of those more likely to have an STI or an increase in STI transmission in the community. New STI diagnoses were 10% lower than in 2019 which may reflect a 13% reduction in screening over this period.

The number of consultations delivered by sexual health services for North West residents declined compared to the previous 2 years. This was driven by a reduction in the number of telephone consultations (face-to-face and online consultations increased slightly) as service provision changed during recovery from the COVID-19 pandemic.

STIs disproportionately impact GBMSM, people of black Caribbean ethnicity and young people aged 15 to 24 years in the North West.

UKHSA’s main messages

Commissioners and providers of SHSs have an important role in communicating messages about safer sexual behaviours and how to access services. 

Main prevention messages

Using condoms consistently and correctly protects against HIV and other STIs such as chlamydia, gonorrhoea, and syphilis – condoms can also be used to 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 and ovaries, aged under 25 years who are sexually active should have a chlamydia test annually and on change of sexual partner
• gay, bisexual and other men who have sex with men (GBMSM) should have tests for HIV and STIs annually or every 3 months if having condomless sex with new or casual partners

HIV pre-exposure prophylaxis (PrEP) is available for free from specialist SHSs and can be used to reduce an individual’s risk of acquiring HIV.

HIV post-exposure prophylaxis (PEP) can be used to reduce the risk of acquiring HIV following some sexual exposures – PEP is available for free from most specialist SHSs and most emergency departments.

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

• GBMSM can obtain the hepatitis A and hepatitis B vaccines from specialist SHSs – these vaccines are also available for other people at high risk of exposure to the viruses
• GBMSM aged up to and including 45 years can obtain the HPV vaccine from specialist SHSs

Specialist sexual health services are free and confidential and offer testing and treatment for HIV and STIs, condoms, vaccination, HIV PrEP and PEP:

• clinic-based services are commissioned for residents of all areas in England
• 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, NHS.UK 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, 2022

Data sources: GUMCAD STI surveillance system (GUMCAD), CTAD

Figure 1 is a bar chart showing that the rate of new STI diagnoses per 100,000 in the North West (661.8) was the second highest in England, with London having the highest rate (1,397.3).

Figure 2. Number of diagnoses of the 5 main STIs, North West residents, 2018 to 2022

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.

Figure 2 shows trend lines of the number of diagnoses of syphilis, gonorrhoea, chlamydia, genital herpes, and genital warts for North West residents from 2018 to 2022. Chlamydia has consistently had the highest number of diagnoses. The figure shows that chlamydia has been increasing since 2020, with 26,374 diagnoses in 2022. A similar trend has been seen for gonorrhoea, increasing to 9,840 diagnoses in 2022. The number of diagnoses of syphilis, genital herpes, and genital warts are smaller in comparison to chlamydia and gonorrhoea and therefore the trend is difficult to see due to the scale used for this figure. Diagnoses of genital warts and genital herpes declined by 59% and 28% respectively between 2018 and 2022, while diagnoses of syphilis increased by 6%.

Figure 3. Diagnosis rates of the 5 main STIs, North West residents, 2018 to 2022

Data sources: GUMCAD, CTAD

(See note 1 above)

Figure 3 shows trend lines of diagnosis rates of syphilis, gonorrhoea, chlamydia, genital herpes, and genital warts for North West residents from 2018 to 2022. It displays the same trends as Figure 2.

Table 1. Percentage change in new STI diagnoses, North West residents

Diagnoses	2022	Percentage change 2018 to 2022	Percentage change 2021 to 2022
New STIs	49,122	-12%	35%
Syphilis	943	6%	15%
Gonorrhoea	9,840	64%	93%
Chlamydia	26,374	-10%	33%
Genital herpes	3,139	-28%	21%
Genital warts	3,051	-59%	-8%

Data sources: GUMCAD, CTAD

See note 1 above.

Table 1 shows that chlamydia was the most commonly diagnosed STI among North West residents in 2022 with 26,374 diagnoses. The largest percentage increase from 2021 to 2022 was seen in gonorrhoea diagnoses which increased by 93%. The only percentage decrease from 2021 to 2022 was seen in genital wart diagnoses which fell by 8%.

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 North West, 2022

Data sources: GUMCAD, CTAD

Figure 4 is a bar chart showing rates of new STI diagnoses in North West residents by gender and age group. The highest rates are seen in women aged 20 to 24.

Figure 5. Rates of gonorrhoea per 100,000 residents by age group (note 2) in the North West, 2018 to 2022

Data sources: GUMCAD

Note 2: Age-specific rates are shown for those aged 15 to 64 years only.

Figure 5 is a line graph showing rates of gonorrhoea in North West residents by age group from 2018 to 2022. The rate is consistently highest in those aged 20 to 24. Rates in all age groups have increased since 2020, with large increases seen in those 15 to 19, 20 to 24, and 25 to 34 from 2021 to 2022.

Figure 6. Rates of genital warts per 100,000 residents aged 15 to 19 years by gender in the North West, 2018 to 2022

Data sources: GUMCAD

Figure 6 is a line graph showing rates of genital warts among North West residents aged 15 to 19 from 2018 to 2022 by gender. It illustrates that rates in both males and females have fallen since 2018, with the rate of decrease being higher among females. Rates are now similar among males and females at 18.2 and 14.7 cases per 100,000 respectively in 2022.

Figure 7. Rates of new STIs by ethnic group per 100,000 residents in the North West, 2022

Data sources: GUMCAD, CTAD

Figure 7 is a bar chart showing rates of new STI diagnoses in 2022 among North West residents by ethnic group. It shows that the rate of new STI diagnoses was significantly higher among people in the black Caribbean ethnic group (1,890.3 cases per 100,000) compared to people in the black African ethnic group (856.2 per 100,000), white ethnic group (540.0 per 100,000), and all other ethnic groups (444.9 per 100,000).

Table 2. Proportion of North West residents diagnosed with a new STI by ethnicity, 2022

Ethnic group	Number	Percentage excluding unknown
White	34,277	86%
Black Caribbean	490	1%
Black African	1,084	3%
All other ethnic groups combined	4,082	10%
Unknown	9,189

Data sources: GUMCAD, CTAD

Table 2 shows that the highest number of new STI diagnoses was in people in the white ethnic group (34,277), representing 86% of all new STI diagnoses. The remaining diagnoses were among people in the black Caribbean ethnic group (1% of total), black African ethnic group (3%), and all other ethnic groups combined (10%).

Figure 8. Proportion of North West residents diagnosed with a new STI by world region of birth (note 3), 2022

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.

Figure 8 is a bar chart showing the proportion of North West residents diagnosed with a new STI in 2022 by world region of birth. It shows that people born in the UK constitute the highest proportion at 88%, with the next highest being people born in the European Union (excluding the UK) at 4%.

Figure 9. Rates of new STIs per 100,000 residents by decile of deprivation (note 4) in the North West, 2022

Data sources: GUMCAD, CTAD

Note 4: Deciles run from 1 to 10 in order of decreasing deprivation (1 is the most deprived and 10 is the least).

Figure 9 is a bar chart displaying the rate of new STI diagnoses in 2022 per 100,000 North West residents by decile of deprivation. Decile 1 is the most deprived while decile 10 is the least deprived. It shows that the rate of new STI diagnoses is similar across those in the deciles 1 to 4 (the 4 most deprived deciles) and is significantly higher in comparison to all other deciles. Across deciles 4 to 10 (the 7 least deprived deciles), the rate of new STI diagnoses generally increases with increased deprivation (from 338 to 808 diagnoses per 100,000 residents in decile 10 and 4, respectively).

Figure 10. Diagnoses of the 5 main STIs among GBMSM (note 5), North West residents, 2018 to 2022

Data sources: GUMCAD data only

Note 5: 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 and exclude chlamydia diagnoses via online services.

Note 6: It is important to consider whether there have been any changes to testing or vaccination practices when interpreting increases or decreases in STIs. Increases in gonorrhoea may be due to the increased use of highly sensitive nucleic acid amplification tests (NAATs) and additional screening of extra-genital sites in GBMSM. Decreases in genital wart diagnoses may be due to the moderately protective effect of HPV-16/18 vaccination. Increases in genital herpes diagnoses may be due to the use of more sensitive NAATs.

Figure 10 is a line graph showing the number of diagnoses of syphilis, gonorrhoea, chlamydia, genital herpes, and genital warts among GBMSM North West residents from 2018 to 2022. It shows increases in syphilis, gonorrhoea, and chlamydia since 2020. The number of diagnoses of genital herpes and genital warts have remained similar since 2020.

Figure 11. Diagnosis rates of the 5 main STIs among GBMSM (note 7), North West residents, 2018 to 2022

Data sources: GUMCAD, CTAD

Note 7: 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 and exclude chlamydia diagnoses via online services. The denominators for rates are based on sexual orientation information collected by the 2021 census and for each region the same estimate has been used for all years in the chart.

See note 6 above.

Figure 11 is a line graph showing the rates of diagnoses of syphilis, gonorrhoea, chlamydia, genital herpes, and genital warts per 100,000 GBMSM North West residents from 2018 to 2022. It displays the same trends as Figure 10.

Table 3. Percentage change in new STI diagnoses in GBMSM (see note 7 above) resident in the North West

Diagnoses	2022	Percentage change 2018 to 2022	Percentage change 2021 to 2022
New STIs	6,878	12%	41%
Syphilis	622	7%	7%
Gonorrhoea	3,243	42%	63%
Chlamydia	2,050	22%	34%
Genital herpes	149	-20%	48%
Genital warts	170	-58%	-4%

Data sources: GUMCAD data only

See note 6 above.

Table 3 shows the number of diagnoses of syphilis, gonorrhoea, chlamydia, genital herpes, and genital warts among GBMSM North West residents in 2022. It shows gonorrhoea was the most common STI with 2,050 new diagnoses among GBMSM in 2022. The largest percentage increase from 2021 to 2022 was also seen in gonorrhoea, which increased by 63%. The only percentage decrease from 2021 to 2022 was seen in genital wart diagnoses which fell by 4%. The overall number of new STI diagnoses among GBMSM North West residents rose by 41% from 2021 to 2022.

Figure 12a. Rate of new STI diagnoses per 100,000 population by upper-tier local authority of residence, North West residents, 2022

Data sources: GUMCAD, CTAD

Figure 12a is a bar chart showing the rate of new STI diagnoses in 2022 among North West residents by upper-tier local authority, compared to the North West (662 diagnoses per 100,000) and England (694 diagnoses per 100,000) rates. The rates in local authorities ranged from 264 per 100,000 in Westmorland and Furness to 1,514 per 100,000 in Liverpool.

Figure 12b. Rate of new STI diagnoses (excluding chlamydia diagnoses in residents aged 24 years and under) per 100,000 population by upper-tier local authority of residence, the North West, 2022

Data sources: GUMCAD, CTAD

Note 8: Prior to 2023, this figure showed rates for the population aged 15 to 64 years, excluding chlamydia in those aged 15 to 24 years.

Figure 12b is a bar chart showing the rate of new STI diagnoses in 2022 among North West residents by upper-tier local authority, compared to the North West (427 diagnoses per 100,000) and England (480 diagnoses per 100,000) rates. The graph excludes chlamydia diagnoses in those aged 24 or younger. The rates in local authorities ranged from 162 per 100,000 in Westmorland and Furness to 950 per 100,000 in Manchester.

Figure 13. Chlamydia detection rate per 100,000 female residents aged 15 to 24 years by upper-tier local authority of residence, the North West, 2022

Data sources: GUMCAD, CTAD

Note 9: Prior to 2023, this figure showed rates for the whole population aged 15 to 24 years, regardless of gender.

Figure 13 is a bar chart showing the chlamydia detection rate in 2022 among female North West residents aged 15 to 24 by upper-tier local authority. It shows that the rate in Liverpool was significantly higher than all other local authorities with 4,528 chlamydia detections per 100,000. The lowest rate was in Cumberland with 1,281 detections per 100,000.

Figure 14. Rate of gonorrhoea diagnoses per 100,000 population by upper-tier local authority of residence, North West residents, 2022

Data sources: GUMCAD

Figure 14 is a bar chart showing the rate of gonorrhoea diagnoses in 2022 among North West residents by upper-tier local authority. It shows a large variation in the rate of gonorrhoea diagnoses from 33 per 100,000 in Westmorland and Furness to 312 per 100,000 in Liverpool.

Figure 15. Map of new STI rates per 100,000 residents by upper-tier local authority in the North West, 2022

Data sources: GUMCAD, CTAD. Contains Ordnance Survey data © Crown copyright and database right 2023. Contains National Statistics data © Crown copyright and database right 2023.

Figure 15 is a map of new STI rates in 2022 across the North West by local authority. In general, more urban areas of the North West had higher STI rates compared to more rural areas.

Figure 16. STI testing rate (excluding chlamydia in those aged 24 and under) per 100,000 population in North West residents aged 15 to 64 years, 2018 to 2022

Data sources: GUMCAD, CTAD

Figure 16 is a line graph showing the STI testing rate among North West and England residents aged 15 to 64 from 2018 to 2022. The graph excludes chlamydia diagnoses in those aged 24 and younger. The testing rate fell in both the North West and England in 2020 but has increased since. The testing rate in the North West remained lower than the rate in England throughout.

Figure 17. STI testing positivity rate (note 10) (excluding chlamydia in those aged 24 and under) in North West residents, 2018 to 2022

Data sources: GUMCAD, CTAD

Note 10: 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 24 and under), gonorrhoea, syphilis and HIV. Up to 2018 (data for 2017) it included all new STIs.

Figure 17 is a line graph showing STI positivity rate (excluding chlamydia in those aged under 25 years) in the North West and England residents from 2018 to 2022. It shows that the positivity rate was stable prior to 2021 (around 6 to 7%) but increased in both the North West and England in 2022. The positivity rate in the North West now exceeds that of England (9.2% compared to 7.6%). 

Table 4. Number of diagnoses of new STIs by UKHSA region of residence, data source and data subset 2022

UKHSA region of residence	GUMCAD: specialist SHSs	GUMCAD: non-specialist SHSs (note 11)	CTAD (note 12)	Total
East Midlands	13,901	8,518	5,492	27,911
East of England	16,850	6,310	6,377	29,537
London	82,589	11,598	28,725	122,912
North East	10,605	1,687	3,387	15,679
North West	33,005	5,925	10,192	49,122
South East	32,427	2,699	10,088	45,214
South West	17,085	4,187	6,660	27,932
West Midlands	18,965	4,920	5,982	29,867
Yorkshire and Humber	20,361	3,283	9,734	33,378

Data sources: GUMCAD, CTAD

Note 11: Diagnoses from enhanced GPs reporting to GUMCAD are included in the ‘Non-specialist sexual health services (SHSs)’ total.

Note 12: Including site type 12 chlamydia from GUMCAD.

Table 4 shows the number of diagnoses of new STIs in 2022 by UKHSA region of residence, data source, and data subset. It shows that the highest number of new STIs were diagnosed in London residents, with the majority of new STIs being diagnosed in specialist SHSs.

Table 5. Number of diagnoses of the 5 main STIs in the North West by STI, data source and data subset 2022

Five main STIs	GUMCAD: specialist SHSs	GUMCAD: non-specialist SHSs (see note 11 above)	CTAD (see (note 12 above)	Total
Syphilis	928	15		943
Gonorrhoea	8,392	1,448		9,840
Chlamydia	11,825	4,357	10,192	26,374
Genital herpes	3,091	48		3,139
Genital warts	3,018	33		3,051

Data sources: GUMCAD, CTAD

Table 5 shows the number of diagnoses of syphilis, gonorrhoea, chlamydia, genital herpes, and genital warts in 2022 in the North West by data source and data subset. It shows that the majority of new STIs are diagnosed in specialist SHSs.

Figure 18. Consultations by medium: North West residents, 2018 to 2022

Data sources: GUMCAD

Figure 18 is a bar chart showing consultations in the North West by medium (face-to-face, online or telephone) from 2018 to 2022. It shows that the number of face-to-face consultations has decreased from almost 499,368 in 2019 to 316,780 in 2022. Inversely, online and telephone consultations have increased from 3,673 to 70,458 and from 4,027 to 65,581 respectively. The change in medium is the result of increased access to online and telephone consultations since the COVID-19 pandemic.

Information on data sources

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

This report is based on data from the GUMCAD and CTAD surveillance systems published on 6 June 2023 (data to the end of calendar year 2022).

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.

CTAD does not collect information about sexual orientation or country of birth. Reports from CTAD are excluded from figures in this report which relate to analyses by sexual orientation or world region of birth.

New STIs

New STI diagnoses comprise diagnoses of:

• 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.

ONS mid-year population estimates for 2021 were used as a denominator for rates (other than by ethnic group) for 2022. Population estimates for 2021 are used as the denominator for rates for 2022. ONS estimates of population by ethnic group for the year 2021 were used as a denominator for rates by ethnic group for 2022. This is the first time that new estimates of population by ethnic group have been available since 2011. This must be considered if comparing rates for 2022 in this report with rates by 2021 in last year’s report, as the rates in the last report used the 2011 estimates.

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.

For more information on local sexual health data sources, see the UKHSA guide.

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 North West, contact fes.northwest@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 fes.northwest@ukhsa.gov.uk

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

Acknowledgements

Prepared by Field Service North West.

We would like to thank:

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

References

1. UK Health Security Agency. Standards. English National Chlamydia Screening Programme 2022

2. Migchelsen SJ and others. ‘Sexually transmitted infections and screening for chlamydia in England, 2022’ UKHSA 2023

3. Mercer CH and others. ‘Changes in sexual attitudes and lifestyles in Britain through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal)’ Lancet 2013: volume 382, issue 9,907, pages 1,781-94

4. Geary RS and others. ‘Sexual mixing in opposite-sex partnerships in Britain and its implications for STI risk: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)’ International Journal of Epidemiology 2019: volume 48, issue 1, pages 228-242

5. Bardsley M and others. ‘Improving our understanding of the disproportionate incidence of STIs in heterosexual-identifying people of black Caribbean heritage: findings from a longitudinal study of sexual health clinic attendees in England’ Sexually Transmitted Infections 2022: volume 98, issue 1, pages 23-31

6. Brown JR and others. ‘Sexual behaviour, STI and HIV testing and testing need among gay, bisexual and other men who have sex with men recruited for online surveys pre/post-COVID-19 restrictions in the UK’ Sexually Transmitted Infections 2023: volume 99, issue 7, pages 467-473

7. Office for Health Improvement and Disparities. Sexual and Reproductive Health Profiles

8. UKHSA. Pre-exposure prophylaxis (PrEP) need and use at specialist sexual health services, by demographic group: England, 2021 to 2022

9. British HIV Association. BHIVA/BASHH guidelines on the use of HIV pre-exposure prophylaxis (PrEP) 2018

10. Traeger M, Cornelisse V, Asselin J and others. ‘Association of HIV Preexposure Prophylaxis with Incidence of sexually transmitted infections among individuals at high risk of HIV infection’ Journal of the American Medical Association 2019: volume 321, issue 14, pages 1,380-1,390