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Syphilis Rates Increase in England

Reported cases of syphilis in England increased by more than 8% in 2021 compared with the previous year, new figures show.

Overall, diagnoses of new sexually transmitted infections (STIs) rose by 0.5% over the same time frame, according to data published by the UK Health Security Agency (UKHSA).

It identified young people, some Black ethnic groups, and gay, bisexual, and other men who have sex with men (GBMSM) as cohorts most likely to be impacted by STIs.

Sexual Health Service Consultations Increased

There was a total of 4,002,827 consultations at sexual health services (SHSs) last year, which was 15.7% up on 2020, and an increase of 3.9% since the last pre-pandemic year in 2019.

A total of 1,949,940 sexual health screens for chlamydia, gonorrhoea, syphilis, and human immunodeficiency virus (HIV) were carried out – an increase of 18.7% compared with 2020, but 13.2% down on the 2019 figure.

There were 311,604 diagnoses of new STIs among residents in England, similar to the previous year's figure of 309,921, and a decrease of 33.2% since 2019. But positive screening results for primary, secondary, and early latent syphilis increased from 6926 in 2020 to 7506 in 2021 – a rise of 8.37%.

There were 51,074 diagnoses of gonorrhoea reported in 2021 – a 1.7% year-on-year increase.

Groups Most At-risk from STIs

Diagnoses of gonorrhoea among the GBMSM population were up 9% in 2021 compared with the previous year, with chlamydia increasing by 5.5%, and infectious syphilis by 2.6%. The UKHSA said that the number of bacterial STI diagnoses in this cohort had showed a persistent upward trend between 2012 and 2019, before dropping in 2020, and that while increases might partly be explained by more testing, "it may also be attributed to ongoing high-risk sexual behaviour".

Of all ethnic groups, the population rates of STI diagnoses remained highest among people of Black ethnicity in 2021, with rates for chlamydia, gonorrhoea, herpes, and trichomoniasis the highest in those who identified as Black Caribbean a discrepancy most likely due to underlying socioeconomic factors. People of Black African ethnicity had relatively lower rates than other ethnic groups.

Young people aged 15 to 24 had the highest rates of the most common STIs, possibly driven by the frequency of new partners, the Agency reported. However, positive screening results for this group decreased by 5.8%, largely due to a 21.7% fall in first episode genital warts, a 7.4% drop in gonorrhoea, and a 5.1% reduction for chlamydia.

The National Chlamydia Screening Programme delivered 978,307 tests last year among young people aged 15 to 24, which was 4% more than in the previous year.

Responding to the figures, Ian Green, chief executive of the Terrence Higgins Trust, said that testing rates for STIs, as well as HIV, were "still lagging behind pre-COVID levels seen in 2019" and that "the already very limited capacity of sexual health services is being swallowed up by leading the country's monkeypox response, which is displacing HIV and STI testing". He called on the Government to demonstrate "a clear commitment to prioritising the nation's sexual health".

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