The prevalence of STIs and the effectiveness of STD testing clinics are important issues in UK healthcare. Recent data has shown that there is work to do in both areas. Public Health England issued a report in October 2016 outlining the impact of STIs and their increase in 2015. Overall, the total number of new STI diagnoses did decrease. This equated to a 3% decrease in around 435,000 cases, making London on-par with New York City’s STD rates.
This is largely due to a decrease in STD testing for genital warts, HPV, and chlamydia. However, there are concerns over the correlation between reduced accessibility to testing and positive diagnoses. Chlamydia remains a prominent issue in UK sexual health, and other STDs are on the rise.
What Is Going On With Chlamydia STD Testing In The UK? Is The Situation Getting Better Or Worse?
Chlamydia was the most common STI in England in 2015 with 200,288 diagnosed and 1.5 million tests carried out. 129,000 of those diagnoses were in patients between the ages of 15 and 24. STD testing was mostly seen in non-specialist SHCs. These clinics saw 576,089 tests and 59,848 diagnoses. This compares with 298,263 GP tests with 17,741 diagnoses and 17,374 pharmacy tests with 1,449 diagnosis.
On face value, the reports on chlamydia numbers seem favorable. There was a drop in cases, and this may suggest that sexually active adults are now better educated. However, chlamydia rates are still high. There are some that believe that diagnoses are down because partners are not coming in for tests.
The problem is that STD testing rates and accessibility of care can vary depending on location. 27% of young people took tests in London compared to 19% in the West Midlands. In the North West, non-specialist SHCs and community-based facilities were responsible for 71% of tests.
By comparison, 52% of London tests took place in specialist SHCs. London has the high-end facilities but not the local, community-based care. This is a problem when we consider the following STI issue.
Health Care Officials Are Now Worried About Much More Than Chlamydia As Gonorrhea Is On The Rise In London.
.Chlamydia was the most common, but the largest increases were for syphilis and gonorrhea. They rose by 20% and 11% respectively from the year before. That also means a 76% and 53% rise since 2012. There are two ways of looking at this. On the one hand, there is a rise in the number of people becoming infected for one reason or another.
On the other, there is also the fact that gonorrhea STI tests have become much more sensitive and reliable. This means that cases are now more easily detected when a negative result may once have registered.
Location plays a big part in the number of STI cases registered. The data for 2015 shows that London fairs the worst for gonorrhea. Public Health England created a map of the country with different colors to indicate rates of diagnoses per 100,000 people. The darker the red tone, the bigger the issue. It is unsurprising that cities and built-up areas are likely to have higher incidences.
The map is darker around London, Newcastle Liverpool, and Manchester. The alarming thing about London is the rate across all Local Authorities and the surrounding areas. The lowest rate for gonorrhea in the UK was 7.1 per 100,000 in Mid Suffolk. The highest was 834.7 per 100,000 in Lambeth, London. London is at great risk because of the high population density, wider demographic and increasing levels of socio-economic deprivation.
London Is Home To Sexually Active Men Of Many Sexual Identities, Ethnicities, And Socio-Economic Situations.
The concern is always strongest over the most high-risk groups. At the top of the list are MSMs – men who have sex with other men – and young people identifying as heterosexual. Men who have sex with men were responsible for 79% of syphilis diagnoses and 54% of gonorrhea diagnoses. 15% of these men (3,400 out of 22,408) were only infected in the pharynx. 25% of them, however, (5,570 out of 22,408) showed signs of infection in the rectum.
This is data is important when identifying the cause of a rise in these STI cases. This figure of 25% suggests that a large number of transmissions were the result of anal sex without a condom.
There is also the concern for ethnic minorities. The highest rates of diagnosis were not with MSMs but with black people in poor urban areas. This suggests not only a lack of access to STD testing but also a lack of education within this community.
What Can Learn From This Report? How Can STD Testing And Healthcare Provision Improve In London And The Wider Nation?
Improvements always come down to better education and greater accessibility to screening programs. Both are problematic in areas of great diversity and budget cuts. Education is important for all sexually active adults, not just teens in sex-ed classes. This means finding ways to reach out to at-risk groups in the right manner. Simple one-size-fits-all messages about condom use and regular testing aren’t enough.
Sexually active adults need to be aware of the risks specific to their demographic. There is also some concern over the speed of access to STD testing and partner notification. Are some STI cases down because people are not informed after their partner tests positive?
The MSM label is one that is essential due to the diversity of sexual identity in the country. There cannot be any assumption of men having sex with men being homosexual. MSMs are identifying as the heterosexual who are actively sleeping with people of different genders.
This means there is a need to deal with this group in an open, tolerant way. It also changes the way that we need to communicate safe sex messages.
Finally, there is the issue of accessibility to treatment options and STD testing facilities. There was a decrease of 7% in chlamydia diagnoses from community-based settings. The majority of diagnoses came from high-level SHCs. This means that while the top-level facilities are performing well, many people cannot access help at the lower level.
There is a lot that needs to change to improve figures for STI prevalence and positive diagnoses. Until then, those syphilis and gonorrhea figures may continue to rise while chlamydia goes unnoticed.