Guidance

Public health guidance for sexually transmitted infection testing in prisons

Published 7 October 2026

Applies to England

Who this guidance is for

This guidance outlines the recommended process for the prevention, diagnosis and management of sexually transmitted infections (STIs) through opt-out testing for syphilis, chlamydia and gonorrhoea as part of the reception screening in adult prisons.

This guidance is targeted at:

• healthcare teams in prisons
• NHS commissioners
• governors and directors (for information)
• health protection teams (HPTs) (for information)
• community sexual health services (for information)
• Local Authority public health (for information)

This guidance applies to adult male and female prisons in England (hereafter: prisons) and is in line with NHS England (NHSE) service specifications.

Key messages

Opt-out sexually transmitted infection (STI) testing for chlamydia, gonorrhoea and syphilis should routinely be offered to all individuals entering prison as part of the reception screening process in line with the service specification.

Opt-out STI testing should be integrated into the current opt-out blood-borne virus (BBV) testing programme (HIV, Hepatitis B, Hepatitis C) where appropriate.

Prison healthcare services should offer a range of testing to increase uptake as well as establish and maintain an effective process for confirmatory testing where appropriate.

For testing which requires laboratory processes, prisons should maintain an effective agreement with a nominated accredited laboratory to ensure timely and accurate testing of samples, and prompt communication of test results. Where possible, prisons should use local laboratories to support timely processing and reporting of results.

Prison healthcare services, alongside commissioners and integrated care boards (ICBs), must establish and maintain clear referral pathways to specialist sexual health services to ensure that patients with STIs receive timely treatment. This could include agreed access to community services with local authorities, shared care arrangements or a commissioned in-reach service.

Background

STIs, including syphilis, chlamydia and gonorrhoea, remain a significant public health concern. These infections are both preventable and treatable, yet undiagnosed cases continue to drive avoidable ill health and ongoing transmission. More information on the differences between the infections can be found in Appendix 1. As prisons are closely connected to the wider community, effective STI prevention, testing, and treatment in custody are essential to protecting population health.

A recent report published by the Chief Medical Officer for England showed that women in prison are disproportionately affected by STIs, most notably syphilis. The report recommends that UKHSA and NHS England consider the feasibility of universal opt-out STI testing for chlamydia, syphilis, trichomoniasis and gonorrhoea for all women entering prison.

Ensuring timely access to STI testing and high quality, equivalent treatment services is a core requirement for prison healthcare services. Early diagnoses and evidence-based care can reduce transmission, improve health outcomes and reduce health inequalities.

Commissioning sexual health services in prisons

This document reflects the commissioning arrangements in place at the time of publication. It is recognised that commissioning arrangements for healthcare services in prisons will change, and this guidance will be reviewed and updated as necessary to reflect those changes.

People in prison are entitled to sexual healthcare that is equivalent to that available in the community. This should also be in line with the British Association for Sexual Health and HIV (BASHH) prisons standards.

NHSE-commissioned primary care services in prisons provide level 1 and 2 sexual health services. At the time of writing these services are commissioned through regional Health and Justice NHSE commissioners with oversight from the NHSE National Health and Justice team.

Specialist level 3 sexual health services (L3 SHS) are commissioned by regional NHSE Health and Justice commissioners based on local need and are typically provided by local NHS sexual health clinics or other specialist providers.  These services should be accessible to all prisoners with an identified need. To support timely access to care, robust and clearly defined referral pathways must be in place between prison healthcare services and L3 SHS providers.

Roles and responsibilities

For information regarding roles and responsibilities in relation to managing cases and outbreaks of STIs, please refer to the management of incidents and outbreaks of infectious disease in secure settings.

UKHSA

UKHSA Regional HPTs are responsible for providing specialist support to prevent and reduce the impact of infectious diseases and environmental hazards, including STIs. They manage outbreaks, conduct surveillance, and advise local partners on health protection. Find your local HPT here.

NHSE

NHSE is responsible for commissioning sexual healthcare in prisons. Level 1 and 2 sexual health services are covered under the primary care specification set out by the national NHS Health and Justice team. Access to consultant-led L3 SHS should also be made available. Clear pathways based on identified need within the prison should be developed with commissioners and ICBs.

Prison healthcare teams

Prison healthcare teams are responsible for implementing this guidance, including completing the actions set out below. Prison healthcare teams should develop pathways for prisoners to access specialist L3 SHS. Healthcare teams should also encourage uptake of training opportunities in relation to testing and sexual health.

Eligibility criteria

STI testing should be offered to all individuals on an opt-out basis as part of primary or secondary health screening, unless:

• they are currently being treated for the STI. For example, an individual receiving treatment for syphilis should not be retested for syphilis but should continue to be offered testing for chlamydia and gonorrhoea
• the individual has completed opt-out STI testing as part of the prison reception process within the previous 3 months

Repeat STI testing should be offered where a clinical or sexual health risk assessment indicates a risk of incident infection or reinfection, including new or ongoing sexual risk behaviours, known exposure to an STI, or the development of symptoms suggestive of an STI. Repeat testing should also be available on request for any individual who wishes to be re-screened.

Public health actions

The actions set out below relate specifically to the delivery of opt‑out STI screening and do not represent the full range of sexual health assessments and interventions that should be undertaken on entry. For comprehensive requirements relating to sexual health, refer to the NHSE health and justice primary care specification and the Prison Standards BASHH.

STI testing

Testing and any subsequent treatment for STIs must be offered to all eligible (see eligibility criteria above) individuals and should include syphilis screening using an enzyme immunoassay (EIA) or chemiluminescent immunoassay (CLIA), syphilis confirmatory testing where necessary (see below) as well as chlamydia and gonorrhoea testing.

STI testing must be offered as part of either the primary or secondary health screen depending on local processes. Settings should deliver testing at the most appropriate opportunity to maximise uptake. Individuals transferring from another prison should not routinely be re-offered STI screening if they have completed opt-out screening within the previous 3 months. Testing should only be offered again within 3 months where there are symptoms suggestive of an STI, reported exposure or other risk of infection since the previous test, or where the outcome of the previous screening is unknown. Repeat screening should be offered to those that wish to be re-screened. Optimal timing may vary depending on the prison category, patterns of new receptions, and the individual’s wellbeing. A flexible, person-centred, trauma-informed approach should be adopted to achieve the highest possible testing rates and to maximise health outcomes.

An opt‑out approach must be used to normalise STI testing and to reduce associated stigma. As such, opt-out STI testing should be offered at the same time as the already established opt-out BBV testing. Where possible, samples should be tested for multiple pathogens, for example, dried blood spot testing for HIV, hepatitis C, hepatitis B and syphilis.

Opt-out STI reception testing should be offered alongside individuals information about the full range of sexual healthcare services available in the prison, health promotion, and preventative and harm reduction-based interventions. It should also be clear whether the prison has a dedicated clinic for sexual health, delivered by the prison healthcare service and / or an external provider of specialist sexual healthcare.

Additional diagnostic and follow-up testing

Individuals with a positive STI test result may require additional investigations in accordance with national clinical guidelines and local protocols. Examples include syphilis treponemal and non-treponemal testing, gonorrhoea culture and test of cure following a positive gonorrhoea NAAT result, and lymphogranuloma venereum (LGV) testing in individuals with chlamydia infection where risk factors or clinical features suggest LGV. Commissioners and settings must ensure that follow-up testing is available to support appropriate follow-up and treatment.

Related actions

Laboratory pathways

Each healthcare team should have a clearly defined and effective pathway in place with the laboratory responsible for processing tests where needed (for example, chlamydia and gonorrhoea testing using a first-catch urine sample in men or self-collected vaginal swab testing in women, and syphilis confirmatory testing using a venous blood sample). This should be underpinned by a formal partnership arrangement with a shared and explicit understanding of testing processes, including the submission of samples, agreed turnaround times for results, and the mechanisms for communicating results back to the service as well as to individuals who may have since left the setting. These arrangements should be routinely monitored and documented to ensure consistency, quality and reliability. Where possible, local laboratories should be used to help build a relationship between the healthcare team and those processing tests, and to speed up the testing process.

Testing models and local considerations

The choice of testing model, whether that is point-of-care testing, dried blood spot test, or another platform, may vary between establishments, reflecting local operational factors such as the type of establishment, volume of new receptions and the wider clinical context.

It is considered good practice for healthcare teams not to rely exclusively on a single testing approach. Providing a range of testing options is essential to meet the diverse needs and circumstances of people in custody, maximise engagement, and support timely diagnosis.

For example, please see expedited syphilis guidance here Guidance on expedited syphilis testing and treatment for inclusion health groups - GOV.UK.

Recording results 

All reception screening information, including results relating to STI testing, must be recorded accurately on the Health and Justice Information System (HJIS) and in full compliance with the National Clinical Template. This requirement applies to every stage of the STI testing pathway, from initial offer through to results and follow-up. Healthcare teams should refer to the HJIS Clinical Template User Guides for detailed instructions, which can be found on the Learning Management System (LMS), on the correct use of the national STI templates and to ensure that all relevant clinical information is recorded consistently and to the required standard.

Treatment and referral pathways

Treatment and management of STIs should be in accordance with BASHH 2019 Standards for the Management of STIs, ensuring that relevant expertise is included where appropriate, and should be based on the differing levels of sexual health service as outlined in the Integrated sexual health service specification. Individuals requiring specialist sexual healthcare, for example treatment of gonorrhoea or syphilis, should be referred to a level 3 specialist sexual health service. Care may be provided through the specialist sexual health service via in-reach (if commissioned) or at an external clinic, or within the prison on a shared care basis. Prison healthcare services can independently offer treatment for uncomplicated infections such as chlamydia.

Each prison setting should have robust referral pathways to NHS England-commissioned L3 SHS to ensure that individuals in custody have access to consultant-led genitourinary medicine (GUM) care. Access may be provided through direct in-reach services or through agreed shared-care arrangements with local authority-commissioned community sexual health services, where appropriate.

Prison healthcare teams should ensure continuity of care for prisoners leaving prison, especially for those on long-term treatments. This should include appropriate arrangements for ongoing treatment and follow-up in the community. Services such as RECONNECT should be considered if there is a sexual health need after leaving prison.