Official Statistics

Quality and methodology information and development plan for official statistics in development on sexually transmitted infections

Updated 17 July 2024

This report covers the following data from sexual health services (SHSs) in England:

• the gender identity of service users
• the number of recent sex partners reported by people being tested for sexually transmitted infections (STIs) or diagnosed with gonorrhoea or syphilis

These have been published as Official Statistics in Development with our existing Official Statistics on sexually transmitted infections and screening for chlamydia in England.

Quality summary

Accuracy and reliability

Accuracy is the proximity between an estimate and the unknown true value. Reliability is the closeness of early estimates to subsequent estimated values.

The accuracy of the statistics is largely dependent on the accuracy of the source data submitted by SHSs. As this is the first publication of these statistics, we are publishing them as provisional estimates to more widely engage with stakeholders to assess and, where necessary, improve the quality of the data.

The data used for these statistics are reported using the GUMCAD STI Surveillance System. GUMCAD is a pseudonymised and depersonalised data set of all face-to-face attendances, and remote (telephone and online) consultations at SHSs – this means that the data is depersonalised so it is not possible to identify individual people. STIs are not notifiable diseases, but reporting of GUMCAD is mandatory as specified in the Department of Health and Social Care’s SHS service specification.

The source data is based on the GUMCAD specification published in 2019 (commonly referred to as ‘GUMCADv3’) which included, for the first time, data items that help contextualise STI diagnoses by understanding risk behaviours, including the number of recent sex partners (in the 3 months prior to the SHS attendance), and gender identity. The implementation of GUMCADv3 at SHSs was paused due to disruptions to clinical service provision during the first year of the COVID-19 pandemic in 2020 to 2021; implementation resumed in 2022, and 2023 is the first calendar year for which most SHSs in England reported data on gender identity and recent sex partners to UKHSA.

Table 1. The number of sexual health services (SHSs) reporting STI surveillance data using the GUMCADv3 specification, England, 2023

Region	Number of SHSs	v3 implemented (n)	v3 implemented (%)
London	43	32	74
East of England	26	26	100
East Midlands	17	17	100
West Midlands	20	19	95
North East	15	15	100
North West	41	38	93
Yorkshire and the Humber	24	24	100
South East	37	37	100
South West	18	16	89
England	241	224	93

Source: Data from routine returns to the GUMCAD STI Surveillance System.

Notes:

1. GUMCADv3 is the current (April 2019) specification of the GUMCAD STI Surveillance System.
   
2. ‘Implemented’ is defined as the ability to record and report GUMCADv3 data to UKHSA.

We have assessed the source data on gender identity to be reasonably accurate based on comparisons to the proportions of transgender and gender diverse (a person whose gender identity is non-binary or identifies in any other way) people reported in Census 2021, but we recognise the high degree of uncertainty of the Census estimates. The Office for National Statistics (ONS) acknowledged that respondents to the Census may not have interpreted the question on gender identity as the ONS had intended, but this is based on self-completed data outside of a clinical setting. As the source data for these statistics is obtained from SHSs and is reported by sexual healthcare practitioners with relevant guidelines, there is a greater likelihood that the gender identity data in GUMCAD is reported as intended.

Table 2. Percentage of consultations at SHSs reporting STI surveillance data to ascertain gender identity, England, 2019 to 2023

Data item	2019	2020	2021	2022	2023
Gender	98.3	97.6	95.8	94.4	95.5
Gender at birth [note 1]	4.6	27	43.6	76	87.8

Source: Data from routine returns to the GUMCAD STI Surveillance System.

[Note 1] Annual improvements in data completeness for ‘gender at birth’ represent ongoing implementation of GUMCADv3 (the current (April 2019) specification of the GUMCAD STI Surveillance System) in a higher number of SHSs. GUMCADv3 implementation began in 2019 and was complete in 93% of SHSs by 2023.

Similarly, we have assessed the source data on sexual behaviour to be accurate based on comparisons to high-quality population-based National Surveys of Sexual Attitudes and Lifestyle data produced by University College London on the number of recent sex partners. While the source data is reported by all publicly commissioned SHSs in England, those providing an exclusively online service did not report any data on recent sex partners. As a result, the data published in these statistical products is restricted to SHSs providing face-to-face attendances – these represent 98% (235 of 241) of all reporters. Please refer to Table 3 for consultation numbers by medium (face-to-face, telephone or online).

As many providers prioritise face-to-face consultations for people at greater risk of STIs or HIV, this means that the distribution of recent sex partners may be skewed towards those reporting more partners. Some SHSs in London did not report GUMCADv3 data – this would, in turn, skew the distribution of recent sex partners towards those reporting fewer partners. We therefore cannot say with certainty whether the data published in this statistical product over or under estimates the number of people being tested or diagnosed with STIs reporting multiple recent sex partners.

Relevance

Relevance is the degree to which the statistics meet user needs in both coverage and content.

There is a clear need for timely, high-quality gender identity data from SHSs; this will help us assess the equity of sexual health provision in England for gender minorities. The data on the number of recent sex partners will provide essential information to understand patterns of risk behaviour among people attending SHSs, and how these vary between and within population sub-groups and by STI.

This is the first time these statistics have been published, and we aim to publish them annually. England has experienced rising rates of STIs since the early 2000s, with the largest annual number of diagnoses of gonorrhoea reported in 2023; however, there is a lack of national data on STI diagnoses by gender identity, or on the distribution of recent sex partners for people being tested for or diagnosed with STIs.

The target audience for these official statistics includes people in local public health teams and the providers and commissioners of SHSs in local authorities, as well as academic collaborators and third sector partners. We have used external stakeholder feedback to design the data collection, and the format of these statistical products.

Timeliness and punctuality

The statistics are published as provisional estimates. Provisional estimates are early estimates that we publish as soon as possible, allowing for production and quality assurance. This is because we want people to have the most up to date data available.

Provisional estimates may be revised in later publications, as the source data is updated and improved. This means that if you compare across publications, you may see that some figures have changed slightly from one publication to the next.

Because these are early estimates, there is a trade-off of timeliness against accuracy. GUMCADv3 data was reported by 93% of SHSs in England in 2023 – we did not wait for all SHSs to report this data before we produced the statistics (please see Table 1 in the ‘Accuracy and reliability’ section); doing so would mean that we would have needed to delay their publication.

Accessibility and clarity

Accessibility is the ease with which users can access the data, also reflecting the format in which the data is available and the availability of supporting information. Clarity refers to the quality and sufficiency of the metadata, illustrations and accompanying advice.

We currently publish these statistical products as part of this statistical release:

1. STIs and screening for chlamydia in England 2023 report.
2. STIs annual data.
3. STI in England slide set.
4. Quality and methodology information report.

The official statistics are made available in a range of media (such as HTML and OpenDocument Spreadsheet) which optimise accessibility across different devices (such as desktop computers and smart phones) and different operating systems (such as Microsoft and Apple). The content has also been designed in a way that it is accessible for users with visual impairments. For example, the data and data notes are presented in a way that is compatible with a data reader, and graphics are designed in a way that is accessible to people who are colour-blind (such as using sufficient contrast between colour gradients).

Please also review UKHSA’s HTML accessibility statement.

Comparability and coherence

Coherence is the degree to which data that is derived from different sources or methods, but refers to the same topic, is similar. Comparability is the degree to which data can be compared over time and domain.

Data included in the official STI and NCSP statistics has been collected in a consistent manner over time using surveillance data sets with approved Information Standards Notices from NHS England (formerly NHS Digital). GUMCAD data has been reported to UKHSA since 2008, and the first reports of gender identity and recent sex partner data were submitted in 2019. The data items used to assess gender identity were developed with external stakeholder input, and are also used for the HIV official statistics published by UKHSA. Similarly, the data used to monitor the number of recent sex partners is collected using a data item developed after extensive piloting at some SHS and with external stakeholder input – it also uses a 3 month lookback interval in keeping with relevant guidelines for SHSs.

The publication of this data as official statistics in development will help us further assess the quality of the data reported, and to prospectively assess its comparability over time.

Official statistics in development

These statistics are labelled as Official Statistics in Development (previously termed ‘experimental statistics’). Official statistics in development are developed under the guidance of the Head of Profession for Statistics. The goal is to develop statistics that can, in due course, be produced to the standards of the Code of Practice for Statistics. This statement provides further detail on the nature of the development and how we are continuing to assess these statistics against the Code of Practice.

These stats are published as official statistics in development because we know that some SHSs have not reported data on gender identity and recent sex partners.

Context and user need

These statistics report on the number of sex partners people report having in the past 3 months, as well as the self-reported gender identity of people accessing SHSs in England.

We already publish official statistics on STIs (tests and diagnoses) and sexual health services in England. The new data (in these official statistics in development) will improve the public health utility of the source data by improving our ability to assess equity of sexual health service provision, and trends in risk behaviours in people diagnosed with STIs. The statistics will help us better understand who is accessing SHSs and how to meet their needs.

Development plan

As covered above we have identified a need for the statistics to be published, but these are the reasons that we are not publishing as official statistics immediately.

We have identified some quality issues with the data. Firstly, all SHSs are not reporting GUMCADv3 data so the data on gender identity and sexual behaviour is incomplete. We are engaging with SHSs and SHS commissioners in local authorities to encourage the remaining 7% of SHSs to start submitting GUMCADv3 data to UKHSA. We conduct regular data quality meetings and webinars for both SHSs and commissioners to ensure they are aware of the necessity for reporting this data.

Secondly, data on the number of recent sex partners is currently not being reported by online services. As a result, the data published in these statistical products is restricted to SHSs providing face-to-face or telephone consultations – these represent 98% (235 of 241) of reporters. Please refer to Table 3 for consultation numbers by medium (face-to-face, telephone or online).

We are working with SHSs to improve the reporting of these data. We will use stakeholder feedback to update our clinical coding guidelines to improve its clarity and utility. We anticipate that data will become more complete and reliable over time, as more services capture and submit this data.

There is a lack of national data on STI diagnoses by gender identity, or on the distribution of recent sex partners for people being tested for or diagnosed with STIs.

To improve GUMCADv3 data quality reported by SHSs, we will incorporate behavioural and gender identity data into existing data reports (as standard) and we will develop a data quality scorecard to highlight data content and allow SHSs to easily monitor the quality of their own data submissions. We will also work closely with UKHSA’s regional network of sexual health facilitators (SHFs) to support the SHSs in their respective regions to improve data quality. In addition, we will also continue to hold data quality workshops with SHFs each autumn.

We anticipate that with an increase in the number of SHSs submitting the required information, the data will be of sufficient quality to be used in a more meaningful way and so be published with the STI and NCSP official statistics.

Data sources

Data on STI tests and diagnoses are submitted by all local authority commissioned sexual health services (SHSs) in England to UKHSA through the GUMCAD STI Surveillance System. GUMCAD was established in 2008 as an electronic surveillance system to collect pseudonymised, individual service user-level data from SHSs. The data set includes:

• STI tests and diagnoses
• demographic data including ethnicity, gender identity and sexual orientation
• sexual behaviour
• outcomes of partner notification and management
• provision of HIV pre-exposure prophylaxis (PrEP)

Services reporting to GUMCAD

The following SHSs report GUMCAD data to UKHSA each quarter:

• SHSs providing specialist (Level 3) and non-specialist (Level 2) STI-related care – these services may also provide SRH care as an integrated service
• online services providing non-specialist (Level 2) STI-related care

Details on the levels of sexual health service provision are provided in Appendix B of the British Association for Sexual Health and HIV’s Standards for the Management of STIs.

The following strengths of the data have been identified:

• GUMCADv3 data reporting to UKHSA is mandatory
• data validation rules (applied at the point of submission) ensure that all fields are completed properly
• additional data reviews, enhancement and quality assurance checks are carried out on a quarterly basis and for each annual official statistics release of STI and NCSP data

The following limitations of the data have been identified:

• GUMCAD data is only reported by SHSs – a small proportion of people are tested for STIs in GPs
• GUMCAD data is depersonalised so it is not possible to identify individual people – it is therefore not possible to link people’s records between different services within the data set, or to link people’s records between different data sets
• this data set does not collect data from private providers of sexual healthcare

Methods

These official statistics in development are produced using automated calculations in standard software packages (such as Stata, SQL, MS Access and MS Excel) which reduces the risk of human error via manual calculations. All calculations are independently verified via multiple quality assurance checks.

GUMCAD data goes through a rigorous data validation and evaluation process. The initial data submissions have automated data validation rules applied at point of submission (enforcing coding and formatting requirements) and are also subject to quarterly data enhancement routines and quality assurance checks (such as ensuring consistency in data trends).

The official statistics in development (the report, data tables, and slide set) are produced using automated calculations which are prepared and tested in advance. Additionally, the statistics are produced by a member of the GUMCAD team and are then independently validated by another member of the team to ensure the accuracy of calculations and the written text in the report. Any data queries that are raised via review are investigated and actioned appropriately – where data may be confirmed as correct or may require the addition of specific data notes or caveats to explain the data content. These quality assurance checks ensure that outputs are robust and reliable.

Related statistics

To our knowledge, there is no other national data on the number of transgender and non-binary people accessing SHSs in England for STI testing and treatment. However, UKSHA already publishes data on the number of transgender and gender diverse people attending HIV services in England. The Netherlands also publishes STI data with breakdowns by gender identity.

ONS has also published Census 2021 data on the number of people in England and Wales whose gender identity differs from the sex assigned at birth.

Similarly, we are not aware of national data on the distribution of recent sex partners among people attending SHS in England, but data on recent sex partners is regularly captured in surveys of the general population such as Natsal, or of specific populations such as the reducing inequalities in sexual health survey of gay, bisexual and other men who have sex with men (GBMSM).