Research and analysis

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

Updated 8 August 2024

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 (SHS) 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.

Out of the 9 UK Health Security Agency (UKHSA) regions, the South West has the second lowest rate of new STIs in England. However, STIs represent an important public health problem in the South West.

In 2022, 27,932 new STIs were diagnosed in South West residents, representing a rate of 489 diagnoses per 100,000 population. Rates by upper tier local authority (UTLA) ranged from 322 new STI diagnoses per 100,000 population in North Somerset to 838 in the City of Bristol.

The number of new STIs diagnosed in South West residents increased by 33% between 2021 and 2022. Increases were seen in the numbers of most of the 5 major STIs:

• syphilis increased by 32%
• gonorrhoea by 166%
• chlamydia by 39%
• genital herpes by 6%

Genital warts decreased by 14%. In 2022, infectious syphilis diagnoses reached the largest number reported nationally since 1948, and gonorrhoea diagnoses reached the largest number reported nationally since records began (1).

The UKHSA recommends that local areas should be working towards achieving a chlamydia detection rate no lower than 2,300 per 100,000 among individuals aged 15 to 24 years, and this is an indicator in the Public Health Outcomes Framework. In 2022, the chlamydia diagnosis rate among South West residents aged 15 to 24 years was 1,567 per 100,000 residents.

Where gender and sexual orientation are known, gay, bisexual and other men who have sex with men (GBMSM) account for 19% of South West residents diagnosed with a new STI (excluding chlamydia diagnoses reported via the Chlamydia Surveillance System (CTAD)), including 78% of those diagnosed with syphilis and 41% of those diagnosed with gonorrhoea.

Rates of new STIs vary somewhat between men and women (429 and 454 per 100,000 residents, respectively). 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 (2). Young women may be more likely to diagnosed with an STI due to disassortative sexual mixing by age and gender (3). South West residents aged between 15 and 24 years accounted for 55% of all new STI diagnoses in 2022. A steep decline (91% decrease) has been seen between 2018 and 2022 in genital warts diagnosis rates in females aged 15 to 19. This follows the introduction in 2008 of vaccination of girls against Human papillomavirus (HPV), the virus which causes genital warts.

The greatest proportion of new STI diagnoses was observed in members of the white ethnic group: 21,716 (90%). Although constituting only 1% of new diagnoses, black Caribbeans were disproportionately more likely to be diagnosed with a new STI in 2022, with a rate of 1,465 per 100,000 residents in comparison to black African (833), white (409), and other (529) residents.

The relative decrease in new diagnoses between 2019 and 2022 was also greater for white (−23%) than black Caribbean (−19%), black African (−16%), and other (−8%) groups. In 2022, people of black Caribbean ethnicity had the highest national diagnosis rates of:

• chlamydia
• gonorrhoea
• infectious syphilis
• trichomoniasis
• genital herpes

People of black African ethnicity had relatively lower rates of STIs (4). The ethnic disparity in STIs is likely influenced by underlying socio-economic factors and the role they play in the structural determinants of the health of this community (5).

Where country of birth was known, 87% of South West residents diagnosed with a new STI in 2022 (excluding chlamydia diagnoses reported via CTAD) were UK-born. The rate of new STIs across the South-West was highest in areas in the most deprived decile in 2022 (707 per 100,000), with a trend of decreasing rates with lower deprivation.

Conclusion

Following the disruptions in service delivery during the first year of the COVID-19 pandemic, the number of consultations (all types) at SHSs increased in 2022 compared to 2021 and 2019 (4). 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 (diagnostic tests for 1 or more of chlamydia, gonorrhoea, syphilis and HIV) in England increased in 2022 compared to 2021, as did the number of new STI diagnoses between the same time period (4). The larger increase in diagnoses relative to sexual health screens may reflect more targeted testing of those more likely to have an STI, or an increase in STI transmission in the community.

The most commonly diagnosed STIs in England in 2022 were:

• chlamydia (51% of all new STI diagnoses)
• gonorrhoea (21%)
• first episode genital warts (7%)
• first episode genital herpes (6%)(1)

The greatest increase was in the number of gonorrhoea diagnoses (increase of 50%, from 54,961 to 82,592), with the largest increase among young people (4).

There was an increase in bacterial STI diagnoses among GBMSM, in keeping with the recovery of SHS provision and increased STI testing in 2021 and 2022 (4). 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 (4).

Across England, there have also been increases among GBMSM in less frequently reported STIs such as lymphogranuloma venereum (LGV) (82.8%, 570 in 2021 to 1,042 in 2022) (6). In 2022, there has been a national increase in cases of shigellosis, including several outbreaks of extensively drug-resistant Shigella sonnei and S. flexneri (7). 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 (8).

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 include:

• 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 – and 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
  • 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 and 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 and hepatitis B 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 SHSs 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, CTAD

Figure 1 is a bar chart showing the rate of new STI diagnoses per 100,000 population by UKHSA region of residence. In 2022, the South West had the second lowest rate (488.9 per 100,000) in England, while London had the highest rate (1,397.3 per 100,000 population).

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

Data sources: GUMCAD, CTAD

Note: 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 the trendlines for the number of diagnoses for the 5 main STIs amongst South West residents from 2018 to 2022.

Chlamydia remained the most frequently diagnosed STI, although the number of new chlamydia diagnoses has decreased from 2018 (18,542) to 2022 (15,314), a large increase was seen between 2021 (10,981) and 2022.

Syphilis remained the least frequently diagnosed STI, and the number of new diagnoses has decreased between 2018 (400) and 2022 (347).

Between 2018 and 2022, the number of new genital herpes diagnoses decreased (2,858 to 2,086) and the number of new genital warts diagnoses decreased (5,409 to 2,376).

The number of new gonorrhoea diagnoses increased from 2,499 to 4,185 between 2018 and 2022.

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

Data sources: GUMCAD, CTAD.

See notes for Figure 2.

Figure 3 shows trendlines for diagnosis rates per 100,000 population for the 5 main STIs among South West residents from 2018 to 2022. Diagnosis rates increased for gonorrhoea between 2018 to 2022 in the South West (44.6 to 73.3 per 100,000).

For all other STIs, diagnosis rates decreased in the South West between 2018 and 2022:

• syphilis (7.1 to 6.1 per 100,000),
• genital herpes (51.0 to 36.5 per 100,000)
• genital warts (96.6 to 41.6 per 100,000)
• chlamydia (331.1 to 268.1 per 100,000): although there was a large increase observed between 2021 (192.2 per 100,000) and 2022

Chlamydia diagnosis rates remained higher than the other STIs, while syphilis remained the lowest over the 5 years.

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

Data sources: GUMCAD, CTAD.

Diagnoses	2022	Percentage change 2018 to 2022	Percentage change 2021 to 2022
New STIs	27,932	−22%	33%
Syphilis	347	−13%	32%
Gonorrhoea	4,185	67%	166%
Chlamydia	15,314	−17%	39%
Genital herpes	2,086	−27%	6%
Genital warts	2,376	−56%	−14%

See notes for Figure 2

Table 1 shows the percentage change in new STI diagnoses in South West residents. In 2022, 27,932 new STI diagnoses were made, which is 33% greater than in 2021 and 22% lower than in 2018.

The number of gonorrhoea diagnoses made in 2022 increased from that made in 2021 and in 2018.

The number of syphilis, chlamydia and genital herpes diagnoses made in 2022, increased from that made in 2021 but decreased from the number made in 2018.

The number of genital warts diagnoses made in 2022 decreased from that made in 2021 and 2018.

The biggest increase in the number of diagnoses made between 2018 and 2021 and between 2021 and 2022 was in gonorrhoea (67% and 166% increase respectively).

The biggest decrease in the number of diagnoses made between 2018 and 2022 and between 2021 and 2022 was in genital warts (56% and 14% decrease respectively).

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 South West, 2022

Data sources: GUMCAD, CTAD.

Figure 4 is a bar chart showing the rates of new STIs per 100,000 population in South West residents, aged 15 to 64, in 2022, by age group and gender. The highest rates for new STIs were in females aged 20 to 24 years (3,237.9 per 100,000) followed by males in the same age group (2298.0 per 100,000).

The lowest rates for new STIs were in those aged 45 to 64 years for both genders (156.0 per 100,000 and 65.1 per 100,000, for males and females, respectively).

Figure 5. Rates of gonorrhoea per 100,000 residents by age group in the South West, 2018 to 2022

Data sources: GUMCAD.

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

Figure 5 shows trend lines for rates of gonorrhoea per 100,000 population by age group in the South West from 2018 to 2022.

Gonorrhoea rates remained consistently higher in those aged 20 to 24 years (197.2 to 416.1 per 100,000), and lowest in those aged 45 to 64 years (21.1 to 24.7 per 100,000).

From 2018 to 2022, overall rates of gonorrhoea increased in all age groups.

Gonorrhoea rates were highest in 2022 across all age groups, the highest being in those aged 20 to 24 years old (416.1 per 100,000), apart from in 35 to 44 year olds, in whom rates peaked in 2019.

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

Data sources: GUMCAD.

Figure 6 shows trend lines for the rate of genital warts per 100,000 population of South West residents aged 15 to 19 years by gender from 2018 to 2022.

Rates of genital warts decreased from 2018 to 2022 in both males (116.9 to 10.0 per 100,000) and females (213.4 to 18.4 per 100,000).

Rates have historically been higher in females, however, from 2020 onwards the difference in rates between genders has decreased substantially.

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

Data sources: GUMCAD, CTAD.

Figure 7 is a bar chart showing the rates of new STIs by ethnic group in the South West in 2022 per 100,000 residents.

The highest rate in 2022 was seen in the black Caribbean ethnic group (1,464.9 (95% Confidence interval (CI): 1,289.3 to 1,657.8) per 100,000), followed by the black African ethnic group (833.3 (95% CI: 749.6 to 923.9) per 100,000), all other ethnic groups combined (528.5 (95% CI: 504.0 to 553.8)) and then those from a white ethnic group (409.0 (95% CI: 403.6 to 414.5) per 100,000).

The number of diagnoses in black Caribbean and black African ethnic groups is very small (see Table 2), with large confidence intervals for the rates.

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

Data sources: GUMCAD, CTAD.

Ethnic group	Number	Percentage excluding unknown
White	21,716	90%
Black Caribbean	251	1%
Black African	361	1%
All other ethnic groups combined	1,749	7%
Unknown	3,855

Table 2 shows the number and proportion of South West residents diagnosed with a new STI by ethnic group in 2022.

The white ethnic group made up the greatest proportion of new STI diagnoses (90%), even though those of white ethnicity accounted for the lowest rate (Figure 7), whereas black Caribbean and black African ethnic groups only accounted for 1% of cases, respectively.

All other ethnic groups combined accounted for 7% of new STI diagnoses in 2022.

Figure 8. Proportions of South West residents diagnosed with a new STI by world region of birth, 2022

Data sources: GUMCAD data only.

Note: 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 South West residents diagnosed with a new STI by world region of birth in 2022.

UK-born cases constitute the highest proportion of South West residents diagnosed with a new STI (87%), followed by EU-born cases excluding the UK (6%).

The smallest proportions of new STI diagnoses were those born in Sub-Saharan Africa, Caribbean, and Central and South America, which only accounted for 2% of cases, respectively.

Cases born in all other countries accounted for 4% of total cases.

Figure 9. Rates of new STIs per 100,000 residents by decile of deprivation in the South West, 2022

Data sources: GUMCAD, CTAD.

Note: Deciles run from 1 to 10 in order of decreasing deprivation.

Figure 9 is a bar chart showing the rate of new STIs per 100,000 of South West residents by IMD decile of deprivation, in 2022.

The rate of new STIs was highest in decile 1 (707 per 100,000) and decile 2 (706 per 100,00), which constitute the most deprived areas in the South West.

The rate generally decreased as deprivation decreased; the lowest rate (331 per 100,000) was found in the least deprived areas.

Figure 10. Diagnoses of the 5 main STIs among GBMSM, South West residents, 2018 to 2022

Data sources: GUMCAD data only.

Note: 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. 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 shows trend lines for the number of diagnoses of the 5 main STIs among GBMSM in South West residents from 2018 to 2022.

Gonorrhoea and chlamydia remained the most frequently diagnosed STIs among GBMSM from 2018 to 2022. Between 2018 and 2022, there was an overall decrease in STIs among GBMSM, with the exception of gonorrhoea diagnoses which increased (1,052 in 2018 to 1,488 in 2022).

The number of syphilis and genital herpes diagnoses peaked in 2018 while that for chlamydia and genital warts peaked in 2019. Between 2021 and 2022, increases were seen across all STIs. In 2022, gonorrhoea had the highest number of diagnoses while genital herpes had the lowest (76).

Figure 11. Diagnosis rates of the 5 main STIs among GBMSM [note 1], South West residents, 2018 to 2022

Data sources: GUMCAD.

[note 1] 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.

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 11 shows trend lines for the rate of the 5 main STIs per 100,000 among GBMSM in South West residents, from 2018 to 2022. Between 2018 and 2022, there was an overall decrease in STI rates among GBMSM, with the exception of gonorrhoea which increased (1,524.6 per 100,000 in 2018 to 2,156.5 per 100,000 in 2022).

Increases  were also seen in syphilis and chlamydia rates between 2021 and 2022 while rates of genital herpes and warts remained fairly constant.

Table 3. Percentage change in new STI diagnoses in GBMSM [note 1] resident in the South West

Data source: GUMCAD data only.

Diagnoses	2022	Percentage change 2018 to 2022	Percentage change 2021 to 2022
New STIs	2,901	−9%	62%
Syphilis	214	−30%	35%
Gonorrhoea	1,488	41%	122%
Chlamydia	721	−24%	42%
Genital herpes	76	−25%	9%
Genital warts	129	−42%	8%

See notes for Figure 11

Table 3 shows the number of new STI diagnoses in 2022, as well as the percentage change from 2018 and 2021 to 2022, in GBMSM residents in the South West.

In 2022, there were 2,901 new STI diagnoses made among GBMSM, a 9% decrease from 2018 and a 62% increase from 2021. Except for gonorrhoea diagnoses which increased by 41%, the number of diagnoses of the other main STIs in GBMSM decreased in 2022 compared to 2018.

The largest decrease was seen in genital warts (42% decrease) and the smallest decrease was seen in chlamydia (24% decrease).

The number of diagnoses of all 5 main STIs increased between 2021 and 2022 with the largest increases seen in gonorrhoea (122%) followed by chlamydia (42%).

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

Data sources: GUMCAD, CTAD.

Figure 12a is a bar chart showing the rate of new STI diagnoses per 100,000 population among South West residents by UTLA of residence in 2022.

The UTLA of the City of Bristol had the highest rate (838 (95% CI: 812 to 865) per 100,000), which was higher than the rate for England (694 per 100,000).

Bournemouth, Christchurch and Poole also had a rate that was higher than England in 2022 (744 (95% CI: 718 to 771) per 100,000).

All other UTLAs were below the rate for England.

Torbay (668 (95% CI: 626 to 713) per 100,000) and Swindon (561 (95% CI: 531 to 592) per 100,000) had the 3rd and 4th highest rates.

North Somerset had the lowest rate of new STI diagnoses in the South West in 2022 (322 (95% CI: 299 to 347) per 100,000).

Figure 12b: Rate of new STI diagnoses (excluding chlamydia diagnoses in residents aged over 25) per 100,000 population by UTLA of residence, the South West, 2022

Data sources: GUMCAD, CTAD.

Note: 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 (excluding chlamydia diagnoses in residents aged over 25 years) per 100,000 population among 15 to 64 year old South West residents by UTLA of residence in 2022.

The UTLA of the City of Bristol had the highest rate (586 per 100,000), which was also the only UTLA where the rate was higher than the rate for England (480 per 100,000). The next highest rates were in:

• Swindon (414 per 100,000)
• Bournemouth, Christchurch and Poole (357 per 100,000)
• Torbay (353 per 100,000)

The lowest rate in the South West was in Cornwall and the Isles of Scilly (181 per 100,000).

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

Data sources: GUMCAD, CTAD.

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

Figure 12b is a bar chart showing the chlamydia detection rate per 100,000 female South West residents aged 15 to 24 years by UTLA of residence in 2022.

The Torbay UTLA had the highest rate (3,460 per 100,000), followed by:

• Bournemouth, Christchurch and Poole (2,923 per 100,000)
• Devon (2,514 per 100,000)
• Cornwall and the Isles of Scilly (2,115 per 100,000).

The lowest rate in the South West was in Plymouth (980 per 100,000).

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

Data sources: GUMCAD.

Figure 14 is a bar chart showing the rate of gonorrhoea diagnoses per 100,000 population in South West residents by UTLA in 2022.

The highest rate of gonorrhoea was found in the City of Bristol (143 (95% CI: 132 to 154) per 100,000) followed by Bournemouth, Christchurch, and Poole (124 (95% CI: 113 to 135) per 100,000) and Devon (78 (95% CI: 72 to 85) per 100,000).

The lowest rates of gonorrhoea diagnoses were found in North Somerset (46 (95% CI: 37 to 56) per 100,000) followed by Wiltshire (48 (95% CI: 42 to 55) per 100,000).

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

Data sources: GUMCAD, CTAD.

Figure 15 is a map of rates of all new STIs per 100,000 residents of the South West by UTLA in 2022.

The following 6 UTLAs exhibited a rate of new STI diagnoses higher than 500 new diagnoses per 100,000 population:

• the City of Bristol (838.0 per 100,000)
• Bournemouth, Christchurch, and Poole (744.0 per 100,000)
• Torbay (668.4 per 100,000)
• Swindon (560.9 per 100,000)
• Bath and North East Somerset (541.0 per 100,000)
• Devon (514.6 per 100,000)

Figure 16. STI testing rate (excluding chlamydia in under 25 year olds) per 100,000 population in South West residents aged 15 to 64 years, 2018 to 2022

Data sources: GUMCAD, CTAD.

Figure 16 shows trend lines for STI testing rates per 100,000 residents in the South West aged 15 to 64 years, from 2018 to 2022 (excluding chlamydia in people aged under 25 years).

Between 2018 and 2022, the testing rate in the South West, has been consistently lower than the testing rate for England.

A marginal increase in testing rates between 2018 and 2022 has been seen across both the South West (2,688.6 to 2,691.6) and England (3,616.0 to 3,856.1).

Testing rates peaked in 2019 and then decreased in 2020 for both the South West and England.

Figure 17. STI testing positivity rate (excluding chlamydia in under 25 year olds) in South West residents, 2018 to 2022

Data sources: GUMCAD, CTAD.

Note: 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.

Figure 17 shows trend lines for STI testing positivity rates in South West residents from 2018 to 2022 (excluding chlamydia in those aged under 25 years).

Between 2018 and 2022, the STI testing positivity rate has been consistently lower in the South West compared to England.

An increase in the STI testing positivity rate between 2018 and 2022 was seen across both the South West (4.8 to 5.6 per 100,000) and England (6.6 to 7.6 per 100,000), peaking in 2022 for both.

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

Data sources: GUMCAD, CTAD.

UKHSA region of residence	Specialist SHSs (GUMCAD)	Non-specialist SHSs (GUMCAD) [note 2]	CTAD [note 3]	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

[Note 2] Diagnoses from enhanced GPs reporting to GUMCAD are included in the ‘Non-specialist SHSs’ total.

[Note 3] Including site type 12 chlamydia from GUMCAD.

Table 4 shows the number of new STI diagnoses by UKHSA region of residence, data source and data subset (specialist or non-specialist SHS) in 2022.

The highest total number of new STI diagnoses was in London (122,912) and the lowest was in the North East (15,679).

In the South West, there were 21,272 diagnoses recorded in GUMCAD in 2022, 17,085 from specialist SHSs and 4,187 through non-specialist SHSs, and 6,660 diagnoses recorded in CTAD.

Across all regions, higher numbers of diagnoses came from specialist SHSs.

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

Data sources: GUMCAD, CTAD.

5 main STIs	Specialist SHSs (GUMCAD)	Non-specialist SHSs (GUMCAD [note 2]	CTAD [note 3]	Total
Syphilis	347	0		347
Gonorrhoea	2,862	1,323		4,185
Chlamydia	5,820	2,834	6,660	15,314
Genital herpes	2,077	9		2,086
Genital warts	2,370	6		2,376

[Note 2] Diagnoses from enhanced GPs reporting to GUMCAD are included in the ‘Non-specialist SHSs’ total.

[Note 3] Including site type 12 chlamydia from GUMCAD.

Table 5 shows the number of diagnoses of the 5 main STIs in the South West in 2022, by data source and data subset.

The highest number of diagnoses of gonorrhoea, genital herpes, and genital warts in 2022 were made by at specialist SHSs.

CTAD is a surveillance system only used for chlamydia and had a higher number of diagnoses than recorded by specialist SHSs in GUMCAD in the South West.

Syphilis was diagnosed exclusively through specialist SHSs.

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

Data source: GUMCAD.

Figure 18 is a bar chart showing the number of consultations by medium in South West residents between 2018 and 2022. In 2022, the number of face-to-face consultations (143,158) were greater than online (122,893) or telephone (42,870) consultations.

Between 2018 and 2022, the number of face-to-face consultations decreased (222,438 to 143,158), while the number of online and telephone consultations increased (29,778 to 122,893 and 94    to 42,870 respectively).

Information on data sources

Find more information on local sexual health data sources in the UKHSA guide.

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) SHSs. 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 the following:

• chancroid
• 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.

The Office for National Statistics (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 South West, contact FES.SouthWest@ukhsa.go.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.SouthWest@ukhsa.go.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 the following:

• 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

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