Research and analysis

Spotlight on sexually transmitted infections in the East Midlands: 2025 data

Updated 8 October 2026

Summary

While this report primarily focuses on the trend between 2024 and 2025, some trends relative to 2019 or earlier are included to provide a comparison to sexual health service provision and sexually transmitted infection (STI) diagnoses prior to the COVID-19 pandemic during 2020 and 2021. For England, the numbers of consultations, sexual health screens and STI diagnoses in 2020 and 2021 are lower than preceding years and any trends during periods which include those years must be interpreted in that context.

STIs represent an important public health problem in the East Midlands. Of all the UK Health Security Agency (UKHSA)’s regions it has the median rate of new STIs in England.

A total of 22,511 new STIs were diagnosed in the East Midlands population in 2025, a rate of 445 diagnoses per 100,000. Rates by upper tier local authority ranged from 287 new STI diagnoses per 100,000 in Rutland to 922 new STI diagnoses per 100,000 in Nottingham.

The number of new STIs diagnosed in the East Midlands population decreased by 9% between 2024 and 2025. Changes were seen in the numbers of the 5 main STIs: syphilis decreased by 8%, gonorrhoea decreased by 17%, chlamydia decreased by 7%, genital herpes decreased by 1% and genital warts decreased by 18%.

UKHSA recommends that local areas should be working towards achieving a chlamydia detection rate no lower than 3,250 per 100,000 among women aged 15 to 24 years and this is an indicator in the Public Health Outcomes Framework. In 2025, the chlamydia detection rate among East Midlands women aged 15 to 24 years was 1,689 per 100,000 compared to 1,846 per 100,000 in 2024.

Rates of new STIs vary slightly between men and women (434 and 427 per 100,000, respectively). Where gender and sexual orientation are known, gay, bisexual and other men who have sex with men (GBMSM) account for 15% of the East Midlands population diagnosed with a new STI excluding chlamydia diagnoses reported via CTAD (65% of those diagnosed with syphilis and 47% of those diagnosed with gonorrhoea).

STIs disproportionately affect young people. The East Midlands population aged between 15 and 24 years accounted for 48% of all new STI diagnoses in 2025. A steep decline has been seen in genital warts diagnosis rates in females aged 15 to 19 following the introduction in 2008 of vaccination against human papillomavirus (HPV), the virus which causes genital warts, for girls. Recent years have seen fluctuating rates though, with a 97% decrease in East Midlands from 2016 to 2025.

The White ethnic group has the highest number of new STI diagnoses: 14,395 (74%). Although 3% of new STIs are in the Black Caribbean ethnic group, they have the third highest rate: 1,751 per 100,000, which is 5.1 times the rate seen in the White ethnic group. Where country of birth was known, 81% of the East Midlands population diagnosed with a new STI in 2025 (excluding chlamydia diagnoses reported via CTAD) were UK-born. The rate of new STIs among people who lived in the most deprived areas (610 per 100,000) was 2 times higher than the rate for people who live in the least deprived areas (306 per 100,000).

Key findings

The number of new STI diagnoses in the East Midlands decreased by 9% between 2024 and 2025, although trends differed across infections and population groups. Demand for sexual health services continued to recover in 2025 following disruption associated with the COVID-19 pandemic, although patterns of service use remained different from those observed before 2020.

Despite declines in diagnosis rates, chlamydia remains the most important contributor to STI burden in the East Midlands and detection among young women remains below recommended levels.

Gonorrhoea diagnoses have declined since their 2023 peak but remain elevated compared with pre-pandemic levels, highlighting the need for continued surveillance and prevention activity.

Diagnoses of genital warts continued their long-term decline, especially among younger age groups, consistent with the sustained impact of the HPV vaccination programme. In contrast, genital herpes diagnoses recovered following the pandemic-related decline in 2020, although diagnosis numbers in 2025 remained below pre-pandemic levels.

While syphilis diagnoses declined slightly in 2025, the longer-term increase since 2016 indicates that syphilis remains an ongoing public health concern.

Overall, STI diagnoses and service use in the East Midlands in 2025 highlight continuing inequalities by age, ethnicity, deprivation and geography. Young adults, particularly those aged 20 to 24 years, people living in the most deprived communities, and some Black ethnic groups continued to experience a disproportionate burden of infection.

The observed inequalities by age, ethnicity, deprivation and geography support the use of risk-based approaches described within the STI Prioritisation Framework, ensuring that prevention, testing and treatment efforts are focused where they are most likely to reduce STI-related harms and improve sexual health outcomes.

Continued surveillance, targeted prevention, equitable access to testing and treatment, and the use of risk-based approaches remain important to reduce STI-related harms and address inequalities across the East Midlands.

Prevention messages

Sexual health clinics are free, confidential and available to everyone. They provide testing, post-exposure prophylaxis and treatment for STIs and HIV, as well as vaccination and contraception.

Using condoms consistently and correctly with new or casual partners protects against HIV and other STIs.

Testing is recommended if you have had sex without a condom with a new or casual partner in the last 3 months, or if a partner has tested positive for an STI. In addition:

• women and other people with a womb aged under 25 who are sexually active should have a chlamydia test after sex with a new partner or annually
• gay and bisexual men (GBMSM) with new or casual partners should test for HIV and STIs annually or every 3 months if having sex without condoms with new or casual partners

Prevention medications (known as pre- and post-exposure prophylaxis) can prevent HIV and some STIs:

• doxycycline post-exposure prophylaxis (doxyPEP) is recommended to people at risk of syphilis to reduce their chance of infection – doxyPEP is available at specialist sexual health clinics
• HIV pre-exposure prophylaxis (PrEP) reduces an individual’s risk of getting HIV – PrEP is available from specialist sexual health clinics
• HIV post-exposure prophylaxis (PEP) can be taken after sex to reduce the risk of getting HIV – PEP is available for free from most sexual health clinics and most emergency departments

Vaccination can prevent some STIs and blood-borne viruses:

• GBMSM can get the hepatitis A and hepatitis B vaccines from specialist sexual health clinics – these vaccines are also available for other people with a higher risk of exposure to these viruses
• GBMSM aged 45 years and younger can get the human papillomavirus (HPV) vaccine from specialist sexual health clinics – this protects against genital warts and some forms of cancer
• GBMSM who have a recently had multiple sexual partners or an STI and other people at higher risk are eligible for a meningococcal B disease vaccine (4CMenB) which can protect against gonorrhoea
• mpox vaccination is available for people at increased risk, including GBMSM who have recently had multiple sexual partners
• hepatitis B and HPV vaccines are also part of the routine childhood vaccination program – catch-up vaccines are available for people who missed them at school

STIs in East Midlands

Overview

Figure 1. New STI diagnosis rates by UKHSA region of residence, England, 2025

Data sources: GUMCAD, CTAD, ONS Census 2021 mid-year estimates.

In 2025, the rate of new STI diagnoses among residents of the East Midlands was 445 per 100,000 population. The East Midlands rate was lower than the rates recorded in London, the North West, the North East and Yorkshire and the Humber. It was higher than the rates in the East of England and the South West. London had the highest new STI diagnosis rate among the 9 UKHSA regions shown, while the South West had the lowest.

Figure 2. Number of diagnoses of the 5 main STIs (East Midlands, 2016 to 2025): A) all 5 STIs, B) excluding chlamydia (expanded scale)

Data sources: GUMCAD, CTAD.

Note: it is important to consider whether there have been any changes to testing practices when interpreting increases or decreases in chlamydia.

Figure 2 presents trends in diagnoses of the 5 main STIs in the East Midlands between 2016 and 2025. Chlamydia remained the most commonly diagnosed STI throughout the period, although diagnoses declined from 17,218 in 2016 to 13,095 in 2025. Genital warts diagnoses also decreased substantially over the period, while gonorrhoea and syphilis diagnoses increased overall. Genital herpes diagnoses remained broadly similar to 2016 levels by 2025.

All 5 STIs showed a decline in diagnoses in 2020, followed by differing post-pandemic trends. Gonorrhoea diagnoses increased from 1,940 in 2016 to 4,043 in 2019, before declining to 2,531 in 2020 and 2,435 in 2021. Diagnoses subsequently increased to a peak of 5,089 in 2023, before declining to 3,936 in 2024 and 2,933 in 2025. Despite these recent declines, gonorrhoea diagnoses remained higher in 2025 than in 2016. In contrast, genital warts experienced a sustained long-term decline, while syphilis diagnoses fluctuated but increased overall, from 267 diagnoses in 2016 to 346 in 2025.

Figure 2B excludes chlamydia and uses an expanded scale, highlighting the contrasting trends among the remaining 4 STIs more clearly. By 2025, gonorrhoea was the most commonly diagnosed of these 4 STIs, despite the decline from its 2023 peak. Genital herpes diagnoses remained comparatively stable over the longer term, while genital warts diagnoses were substantially lower than in 2016 and syphilis diagnoses remained higher than at the beginning of the period.

Changes in chlamydia diagnoses should be interpreted alongside changes in testing activity and service delivery. As chlamydia is often asymptomatic and control activity prioritises detection among young women, changes in diagnosis numbers may reflect changes in testing patterns as well as changes in infection burden.

Table 1. Percentage change in new STI diagnoses, East Midlands

Diagnosis	2019	2024	2025	Percentage change 2019 to 2025	Percentage change 2024 to 2025
Chlamydia	18,163	14,030	13,095	−28%	−7%
Genital Herpes	2,585	2,149	2,135	−17%	−1%
Genital Warts	3,653	1,733	1,425	−61%	−18%
Gonorrhoea	4,043	3,555	2,933	−27%	−17%
Syphilis	346	376	346	0%	−8%
Other	3,207	2,801	2,577	−20%	−8%
All new STIs	31,997	24,644	22,511	−30%	−9%

Data sources: GUMCAD, CTAD.

Note: see notes for Figure 2. See New STIS section for a list of diagnoses that are included in the other STIs.

Between 2019 and 2025, the number of new STI diagnoses in the East Midlands decreased by 30%, from 31,997 diagnoses to 22,511 diagnoses. Diagnoses also decreased between 2024 and 2025, falling by 9%, from 24,644 to 22,511 diagnoses. Trends varied by infection.

The long-term decline was driven largely by reductions in genital warts and chlamydia diagnoses. Genital warts showed the largest proportional decrease between 2019 and 2025, falling by 61%, from 3,653 to 1,425 diagnoses, while chlamydia decreased by 28%, from 18,163 to 13,095 diagnoses. Genital herpes decreased by 17%, from 2,585 to 2,135 diagnoses, and gonorrhoea decreased by 27%, from 4,043 to 2,933 diagnoses. In contrast, syphilis diagnoses were unchanged between 2019 and 2025, with 346 diagnoses recorded in both years.

Between 2024 and 2025, diagnoses decreased across each of the 5 main STIs. The largest proportional decrease was observed for genital warts (18%), followed by gonorrhoea (17%), syphilis (8%), chlamydia (7%) and genital herpes (1%). Overall, reductions in chlamydia and genital warts diagnoses were the principal contributors to the long-term decline in the number of new STI diagnoses in the East Midlands, while the most recent year showed a broader decline across all 5 main STIs.

Figure 3. Rates of new STIs per 100,000 by age group (for those aged 15 to 64 years only) and gender, East Midlands, 2025

Data sources: GUMCAD, CTAD, ONS Census 2021 mid-year estimates.

Rates of new STIs in the East Midlands in 2025 varied between males and females.
In 2025, rates of new STI diagnoses in the East Midlands were highest among people aged 20 to 24 years for both males and females. Females aged 20 to 24 years had the highest diagnosis rate overall, while males in the same age group had the second-highest rate. For both males and females, diagnosis rates declined with age for those aged 25 years and over.

The largest difference between the sexes was observed among those aged 15 to 19 years, with females in this age group recording substantially higher rates of new STI diagnoses than males.

Figure 4. Rates of new STIs per 100,000 by ethnic group, East Midlands, 2025

Data sources: GUMCAD, CTAD, ONS Census 2021.

Note: interpretation of differences in diagnosis rates by ethnic group should take account of demographic, socioeconomic and behavioural factors, as well as differences in healthcare access and STI testing patterns 

Substantial inequalities in rates of new STI diagnoses were observed between ethnic groups in the East Midlands in 2025. People in the All other Black ethnic groups combined category had the highest diagnosis rate (2,563 per 100,000 population), followed by people of Black African ethnicity (1,909 per 100,000) and Black Caribbean ethnicity (1,751 per 100,000).

People of Mixed or Multiple ethnic groups also experienced a comparatively high diagnosis rate (967 per 100,000 population). In contrast, substantially lower rates were observed among people from other ethnic groups (460 per 100,000), people of White ethnicity (344 per 100,000) and people of Asian or Asian British ethnicity (279 per 100,000).

These findings indicate marked variation in new STI diagnosis rates by ethnicity across the East Midlands.

Table 2. Percentage of new STI diagnoses by ethnic group, East Midlands, 2025

Ethnic group	Number	Percentage (excluding unknown)
Asian or Asian British	1,090	6%
Black African	1,587	8%
Black Caribbean	540	3%
All other Black ethnic groups combined	410	2%
Mixed or Multiple ethnic groups	1,134	6%
White	14,395	74%
Other ethnic groups	285	1%
Unknown	3,070

Data sources: GUMCAD, CTAD and ONS Census 2021.

While people of White ethnicity accounted for the greatest number of new STI diagnoses in the East Midlands in 2025 (14,395), important differences were observed between the number of diagnoses and diagnosis rates across ethnic groups.

Ethnicity was unknown for 3,070 diagnoses, and these diagnoses were excluded from the percentage distribution shown in the table.

Excluding diagnoses with unknown ethnicity, people of White ethnicity accounted for 74% of new STI diagnoses, followed by people of Black African ethnicity (8%), Asian or Asian British ethnicity (6%), and Mixed or Multiple ethnic groups (6%). However, as shown in Figure 4, diagnosis rates were substantially higher among some Black ethnic groups, highlighting marked inequalities in STI diagnosis rates by ethnicity across the East Midlands.

Figure 5. Percentage of new STI diagnoses by world region of birth [notes], East Midlands, 2025

Data source: GUMCAD data only.

Note 1: 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.

Note 2: the distribution of diagnoses by world region of birth should be interpreted with caution, as country of birth data is only available for diagnoses reported through GUMCAD and is not collected through CTAD. Consequently, these findings may not be representative of all new STI diagnoses in the East Midlands.

In 2025, 81% of people diagnosed with a new STI in the East Midlands who had a recorded world region of birth were born in the UK. People born in the European Union (EU), sub-Saharan Africa and other world regions each accounted for around 6% of diagnoses, while those born in the Caribbean, Central and South America accounted for 1%.

These findings indicate that while the majority of diagnoses were among UK-born individuals, a substantial minority occurred among people born outside the UK.

Figure 6. Rates of new STIs per 100,000 by decile of deprivation [note], East Midlands, 2025

Data sources: GUMCAD, CTAD, ONS Index of Multiple Deprivation and Census 2021 mid-year estimates.

Note: deciles run from 1 to 10 in order of decreasing deprivation, with 1 being the decile for the most deprived area. Deprivation is based on 2021 LSOAs – which is available for 96% of GUMCAD data reported in 2025

A clear deprivation gradient was observed in the East Midlands in 2025, with rates of new STI diagnoses generally decreasing as levels of deprivation decreased.

People living in the most deprived areas (decile 1) experienced the highest rate of new STI diagnoses, at 610 per 100,000 population, compared with 306 per 100,000 among those living in the least deprived areas (decile 10).

Overall, people living in the most deprived areas experienced approximately twice the rate of new STI diagnoses compared with those living in the least deprived areas. Rates were particularly high across the 3 most deprived deciles, at 610, 586 and 581 per 100,000 population in deciles 1, 2 and 3, respectively. Although some variation was observed between adjacent deprivation deciles, the overall pattern demonstrates a clear association between deprivation and STI diagnosis rates in the East Midlands.

Figure 7. Diagnoses of the 5 main STIs among GBMSM [note], East Midlands, 2016 to 2025

Data source: 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.

Where gender and sexual orientation are known, gay, bisexual and other men who have sex with men (GBMSM) accounted for 2,551 new STI diagnoses in the East Midlands in 2025. However, GBMSM accounted for a disproportionate share of some infections, particularly gonorrhoea and syphilis.

Among GBMSM in the East Midlands, gonorrhoea remained the most commonly diagnosed STI between 2016 and 2025. Diagnoses of gonorrhoea increased overall from 497 diagnoses in 2016 to 1,327 diagnoses in 2025, reaching their highest level in 2023. Chlamydia diagnoses also increased compared with 2016, from 482 diagnoses to 614 diagnoses in 2025, but remained below the peak observed in 2023.

Syphilis diagnoses increased overall during the study period, from 202 diagnoses in 2016 to 220 diagnoses in 2025, despite fluctuations between years. In contrast, genital warts diagnoses declined substantially, from 177 diagnoses in 2016 to 75 diagnoses in 2025, while genital herpes diagnoses remained relatively stable, increasing slightly from 63 to 67 diagnoses.

All 5 STIs showed reductions in diagnoses in 2020, followed by increases in subsequent years. The increase was most pronounced for gonorrhoea, while genital warts remained well below levels observed at the start of the study period.

Overall, gonorrhoea and chlamydia accounted for the greatest burden of STI diagnoses among GBMSM in the East Midlands. The substantial increase in gonorrhoea diagnoses over the study period, alongside the overall increase in syphilis diagnoses, highlights the continued importance of targeted prevention, testing and treatment interventions for this population.

Table 3. Percentage change in new STI diagnoses among GBMSM [note], East Midlands

Diagnosis	2019	2024	2025	Percentage change 2019 to 2025	Percentage change 2024 to 2025
Chlamydia	783	657	614	−22%	−7%
Genital herpes	54	93	67	24%	−28%
Genital warts	170	108	75	−56%	−31%
Gonorrhoea	1,022	1,331	1,327	30%	<0.5% change
Syphilis	239	238	220	−8%	−8%
Other	239	286	248	4%	−13%
All new STIs	2,507	2,713	2,551	2%	−6%

Data source: GUMCAD data only.

Note: see notes for Figure 7 (including asterisk). See New STIS section for a list of diagnoses that are included in the other STIs.

Trends in STI diagnoses among GBMSM differed between the longer-term (2019 to 2025) and most recent (2024 to 2025) periods. The total number of new STI diagnoses was 2% higher in 2025 than in 2019 but decreased by 6% compared with 2024. Gonorrhoea and genital herpes were the only main STIs to show long-term increases between 2019 and 2025, increasing by 30% and 24%, respectively. In contrast, diagnoses of chlamydia, genital warts and syphilis in 2025 remained below 2019 levels, decreasing by 22%, 56% and 8%, respectively.

The decrease in new STI diagnoses among GBMSM observed between 2024 and 2025 was seen across all 5 main STIs. The largest proportional decreases were in genital warts (31%) and genital herpes (28%), followed by syphilis (8%) and chlamydia (7%). Gonorrhoea diagnoses showed less than 0.5% change, decreasing slightly from 1,331 diagnoses in 2024 to 1,327 diagnoses in 2025.

Figure 8. Diagnoses of the 5 main STIs among heterosexual men and all women [note], East Midlands, 2016 to 2025

Data source: GUMCAD data only.

Note: data on sexual orientation is not collected by CTAD. All information here is based on diagnoses made in specialist and non-specialist services which report to GUMCAD and exclude chlamydia diagnoses via online services. Cases are defined here as GUMCAD records where gender is specified as male and sexual orientation is specified as heterosexual, or gender was specified as female, or gender was not specified but orientation was specified as heterosexual. GUMCAD records where sexual orientation was not specified for males or unknown gender individuals are excluded.

Among non-GBMSM in the East Midlands, chlamydia remained the most commonly diagnosed STI throughout 2016 to 2025, despite a substantial decline over the period. Chlamydia diagnoses fell from 14,514 diagnoses in 2016 to 7,375 diagnoses in 2025, with the sharpest reduction occurring between 2019 and 2020.

Genital warts and genital herpes diagnoses were also lower in 2025 than at the start of the study period, with genital warts showing the largest sustained decline. Gonorrhoea diagnoses fluctuated over the period, increasing after 2021 and peaking in 2023 before declining to 1,480 diagnoses in 2025.

In contrast, syphilis diagnoses increased overall between 2016 and 2025, from 80 diagnoses in 2016 to 118 diagnoses in 2025, despite remaining the least commonly diagnosed of the 5 main STIs.

Table 4. Percentage change in new STI diagnoses among heterosexual men and all women [note], East Midlands

Diagnosis	2019	2024	2025	Percentage change 2019 to 2025	Percentage change 2024 to 2025
Chlamydia	13,883	7,427	7,375	−47%	−1%
Genital herpes	2,515	2,017	2,026	−19%	<0.5% change
Genital warts	3,428	1,581	1,325	−61%	−16%
Gonorrhoea	2,930	2,105	1,480	−49%	−30%
Syphilis	96	120	118	23%	−2%
Other	2,930	2,471	2,283	−22%	−8%
All new STIs	25,782	15,721	14,607	−43%	−7%

Data source: GUMCAD data only.

Note: see notes for Figure 8 (including asterisk). See New STIS section for a list of diagnoses included in the other STIs.

Although the overall number of new STI diagnoses among heterosexual men and all women in the East Midlands remained substantially lower in 2025 than in 2019, diagnoses decreased further compared with 2024. Overall diagnoses fell by 43%, from 25,782 in 2019 to 14,607 in 2025, and decreased by 7% between 2024 and 2025.
Between 2019 and 2025, syphilis was the only STI to show an overall increase, rising by 23%, from 96 to 118 diagnoses, while genital warts experienced the largest decline, decreasing by 61%, from 3,428 to 1,325 diagnoses. Gonorrhoea decreased by 49%, chlamydia by 47%, and genital herpes by 19% over the same period.

Between 2024 and 2025, gonorrhoea showed the largest decline, decreasing by 30%, from 2,105 to 1,480 diagnoses, followed by genital warts, which decreased by 16%. Chlamydia decreased by 1% and syphilis by 2%, while genital herpes showed less than 0.5% change.

Figure 9. Rate of new STI diagnoses per 100,000 by upper tier local authority, East Midlands, 2025

Data source: GUMCAD, CTAD, ONS Census 2021 mid-year estimates.

In 2025, the rate of new STI diagnoses varied considerably across upper-tier local authorities in the East Midlands, ranging from 287 diagnoses per 100,000 population in Rutland to 922 per 100,000 in Nottingham. The regional rate was 445 diagnoses per 100,000 population.

Nottingham reported the highest rate in the region, at 922 diagnoses per 100,000 population, and was substantially above both the regional and England rates. Leicester (598 per 100,000) and Derby (573 per 100,000) also exceeded the England rate of 570 per 100,000. Lincolnshire (477 per 100,000) was above the regional rate but below the England rate.

The remaining local authorities recorded rates below the regional rate, ranging from 405 per 100,000 in West Northamptonshire to 287 per 100,000 in Rutland.

Figure 10. Rate of new STI diagnoses (excluding chlamydia diagnoses among people aged under 25 years [note]) per 100,000 by upper-tier local authority, East Midlands, 2025

Data sources: GUMCAD, CTAD, ONS Census 2021 mid-year estimates.

Note: chlamydia diagnoses in the target group for the National Chlamydia Screening Programme (those aged 15 to 24 years) are excluded as these diagnoses may reflect local implementation of screening.

The rate of new STI diagnoses among people aged under 25 years in the East Midlands varied markedly by upper-tier local authority in 2025, ranging from 179 diagnoses per 100,000 population in Rutland to 523 per 100,000 population in Nottingham.
Chlamydia diagnoses among those aged 15 to 24 years are excluded from these estimates because variation in local screening practices may influence diagnosis rates. The regional rate was 286 diagnoses per 100,000 population, substantially lower than the England rate of 441 per 100,000 population.

Nottingham reported the highest rate in the region, with 523 diagnoses per 100,000 population, and was the only upper-tier local authority to exceed the England rate. Derby (407 per 100,000) and Leicester (385 per 100,000) recorded the next highest rates, although both remained below the England rate.

In contrast, Leicestershire (191 per 100,000) and Rutland (179 per 100,000) recorded the lowest diagnosis rates in the region among people aged under 25.

Figure 11. Map of new STI rates per 100,000 by upper tier local authority, East Midlands, 2025

Data sources: GUMCAD, CTAD, ONS Census 2021 mid-year estimates.

The geographical distribution of new STI diagnosis rates across the East Midlands in 2025 shows substantial variation between upper-tier local authorities, with the highest rate observed in Nottingham (922 per 100,000 population). Leicester (598 per 100,000) and Derby (573 per 100,000) also recorded comparatively high rates, indicating a concentration of higher STI diagnosis rates within the region’s major urban areas.

Outside these areas, diagnosis rates were generally lower, with the lowest rates observed in Rutland (287 per 100,000), Leicestershire (315 per 100,000) and North Northamptonshire (345 per 100,000). Overall, the geographical pattern indicates higher STI diagnosis rates in the more urban areas of the East Midlands and lower rates across several of the surrounding county and less urban areas.

Figure 12. Map of new STI rates per 100,000 by middle super output area (MSOA21), East Midlands, 2025

Data sources: GUMCAD, CTAD, ONS Census 2021 mid-year estimates.

Analysis at the MSOA level demonstrates greater geographical variation in new STI diagnosis rates than is apparent from the upper-tier local authority summaries shown in Figure 11. Within local authorities, rates varied considerably between neighbourhoods, indicating that the burden of new STI diagnoses was not distributed evenly across the East Midlands.

The map shows localised areas with higher rates of new STI diagnoses across the region, alongside areas with substantially lower rates. This variation is evident both within and between upper-tier local authorities, with neighbouring MSOAs in some areas showing markedly different rates.

Figure 13. STI testing rate (excluding chlamydia in under-25-year-olds [note]) per 100,000, East Midlands, 2012 to 2025

Data sources: GUMCAD, CTAD, ONS Census 2021 mid-year estimates.

Note: chlamydia diagnoses in the target group for the National Chlamydia Screening Programme (those aged 15 to 24 years) are excluded as these diagnoses may reflect local implementation of screening.

STI testing rates in the East Midlands increased overall between 2012 and 2019, from 2,000 tests per 100,000 population in 2012, before declining sharply in 2020 and subsequently recovering. Testing rates increased between 2020 and 2023, reaching their highest level in 2023, before decreasing slightly in 2024 and 2025 to 2,902 tests per 100,000 population.

Throughout the period shown, STI testing rates in the East Midlands remained below those observed nationally. England followed a broadly similar temporal pattern, including a marked decline in 2020 and subsequent recovery. In 2025, the testing rate was 2,902 per 100,000 population in the East Midlands, compared with 4,012 per 100,000 population in England.

Overall, testing activity in the East Midlands has recovered substantially since the reduction observed in 2020. However, the regional testing rate remained below the England rate in 2025 and had declined from its 2023 peak.

Figure 14. STI testing positivity rate (excluding chlamydia in under-25-year-olds [note]), East Midlands, 2012 to 2025

Data sources: GUMCAD, CTAD.

Note: chlamydia diagnoses in the target group for the National Chlamydia Screening Programme (those aged 15 to 24 years) are excluded as these diagnoses may reflect local implementation of screening.

STI testing positivity in the East Midlands fluctuated over the period from 2012 to 2025. Positivity increased from 5% in 2012 to its highest level in 2019, before declining in 2020 and 2021. Following an increase in 2022 and 2023, positivity subsequently declined, reaching 5% in 2025.

Throughout most of the period, STI testing positivity in the East Midlands was lower than that observed nationally. In 2025, positivity was 5% in the East Midlands compared with 6% in England.

Taken together, Figures 13 and 14 show that the East Midlands had both a lower STI testing rate and lower testing positivity than England in 2025. This indicates that the regional difference is evident not only in the level of testing activity, but also in the proportion of tests resulting in an STI diagnosis.

Table 5. Number of diagnoses of new STIs by UKHSA region of residence, data source and Sexual Health Service Type, 2025

UKHSA region of residence	GUMCAD: specialist SHSs	GUMCAD: non-specialist SHSs [note]	CTAD	Total
East Midlands	13,724 (61%)	4,076 (18%)	4,711 (21%)	22,511
East of England	17,420 (68%)	2,042 (8%)	6,139 (24%)	25,601
London	79,241 (72%)	10,529 (10%)	19,826 (18%)	109,596
North East	9,111 (70%)	1,703 (13%)	2,264 (17%)	13,078
North West	31,340 (77%)	4,738 (12%)	4,816 (12%)	40,894
South East	28,757 (75%)	1,649 (4%)	7,914 (21%)	38,320
South West	14,333 (64%)	3,777 (17%)	4,360 (19%)	22,470
West Midlands	20,450 (74%)	4,133 (15%)	2,877 (10%)	27,460
Yorkshire and Humber	18,720 (72%)	1,636 (6%)	5,467 (21%)	25,823

Data sources: GUMCAD, CTAD.

Note: diagnoses from enhanced GPs reporting to GUMCAD are included in the ‘Non-specialist sexual health services (SHSs)’ total.

In 2025, there were 22,511 new STI diagnoses among East Midlands residents. The majority were reported through specialist sexual health services (SHSs), which accounted for 13,724 diagnoses (61%). A further 4,076 diagnoses (18%) were reported through non-specialist SHSs, while 4,711 diagnoses (21%) were identified through CTAD.

The East Midlands had the lowest proportion of diagnoses reported through specialist SHSs among the English regions shown, at 61%. This compared with 64% in the South West and 68% in the East of England, while the highest proportion was recorded in the North West at 77%.

Conversely, the East Midlands had the highest proportion of diagnoses reported through non-specialist SHSs, at 18%, followed by the South West at 17% and the West Midlands at 15%. The contribution of CTAD was also relatively high in the East Midlands, accounting for 21% of diagnoses, compared with 10% in the West Midlands and 12% in the North West.

Overall, although specialist SHSs remained the principal source of new STI diagnoses among East Midlands residents in 2025, the distribution across service types was more mixed than in most other English regions, with comparatively greater contributions from both non-specialist SHSs and CTAD.

Table 6. Number of diagnoses of the 5 main STIs by STI, data source and Sexual Health Service type, East Midlands, 2025

Five main STIs	GUMCAD: Specialist SHSs	GUMCAD: Non-specialist SHSs [note]	CTAD	Total
Chlamydia	5,099 (39%)	3,285 (25%)	4,711 (36%)	13,095
Genital Herpes	2,134 (100%)	1 (<1%)	-	2,135
Genital Warts	1,425 (100%)	0 (0%)	-	1,425
Gonorrhoea	2,149 (73%)	784 (27%)	-	2,933
Syphilis	346 (100%)	0 (0%)	-	346

Data sources: GUMCAD, CTAD.

Note: diagnoses from enhanced GPs reporting to GUMCAD are included in the ‘Non-specialist sexual health services (SHSs)’ total.

The setting in which diagnoses were made varied considerably by STI. Diagnoses of genital herpes, genital warts and syphilis were made almost exclusively in specialist sexual health services. All 346 syphilis diagnoses and all 1,425 genital warts diagnoses were reported through specialist SHSs, as were 2,134 of 2,135 genital herpes diagnoses.

Gonorrhoea diagnoses were reported through both specialist and non-specialist sexual health services. Of the 2,933 gonorrhoea diagnoses in 2025, 2,149 (73%) were reported through specialist SHSs and 784 (27%) through non-specialist SHSs.

Chlamydia showed the greatest variation in diagnostic setting. Of 13,095 diagnoses in 2025, 5,099 (39%) were reported through specialist SHSs, 3,285 (25%) through non-specialist SHSs and 4,711 (36%) through CTAD. Chlamydia therefore accounted for the largest contribution from non-specialist services among the 5 main STIs.

Overall, specialist SHSs remained the principal diagnostic setting for gonorrhoea, genital herpes, genital warts and syphilis, while chlamydia diagnoses were distributed more broadly across specialist SHSs, non-specialist SHSs and CTAD.

Figure 15. Consultations by service medium, East Midlands, 2016 to 2025

Data sources: GUMCAD, NHS Fingertips.

Patterns of sexual health service use in the East Midlands changed substantially between 2016 and 2025. While face-to-face consultations remained the most common form of contact throughout the period, online consultations increased markedly, particularly following 2020, and accounted for a substantially greater proportion of activity in 2025 than before the COVID-19 pandemic.

Face-to-face consultations fell from 215,792 in 2016 to 154,240 in 2025 and, despite recovering after the sharp decline in 2020, remained below pre-pandemic levels. In contrast, online consultations increased from 3 in 2016 to 94,802 in 2025, with the largest initial expansion occurring between 2019 and 2020. Telephone consultations also increased following 2020, reaching a peak of 21,363 in 2021 before declining to 14,413 in 2025.

Overall, the distribution of consultations by service medium in 2025 remained markedly different from that observed before 2020, with online provision accounting for a much greater component of sexual health service activity alongside face-to-face consultations.

Figure 16. All consultations by age group, East Midlands, 2016 to 2025

Data sources: GUMCAD, NHS Fingertips.

Consultation rates varied considerably by age group between 2016 and 2025. People aged 20 to 24 years consistently recorded the highest consultation rates throughout the period. In 2025, the rate among this age group was 6,370 consultations per 100,000 population, compared with 6,348 per 100,000 in 2016.

Different longer-term patterns were observed across the remaining age groups. Consultation rates increased among people aged 25 to 34 years, from 3,687 per 100,000 in 2016 to 4,585 per 100,000 in 2025, and among those aged 35 to 44 years, from 1,787 to 2,552 per 100,000. The rate among people aged 45 to 64 years also increased, from 606 to 827 per 100,000, although this age group consistently recorded the lowest consultation rate.

In contrast, consultation rates among people aged 15 to 19 years decreased overall, from 4,228 per 100,000 in 2016 to 3,151 per 100,000 in 2025. From 2021 onwards, consultation rates among people aged 25 to 34 years exceeded those among people aged 15 to 19 years, indicating a change in the age distribution of consultations compared with the earlier years of the study period.

Consultation rates declined across all age groups in 2020, followed by increases in 2021. Subsequent trends varied by age group, with rates among those aged 15 to 19 and 20 to 24 years declining from their post-2020 peaks, while rates among the older age groups remained above their 2016 levels in 2025.

Implications for prevention and control of sexually transmitted infections in the East Midlands

The findings in this report demonstrate that STI burden in the East Midlands continues to be concentrated within specific populations and communities. Young people, GBMSM, people living in the most deprived communities and some Black ethnic groups experience disproportionately high rates of STI diagnoses.

Diagnosis rates were particularly high among all other Black ethnic groups combined (2,563 per 100,000 population), people of Black African ethnicity (1,909 per 100,000) and people of Black Caribbean ethnicity (1,751 per 100,000), compared with 344 per 100,000 among people of White ethnicity.

The data also shows an association between deprivation and STI diagnosis rates in the East Midlands – residents of the most deprived communities experienced approximately twice the rate of new STI diagnoses compared with those living in the least deprived areas.

Although overall STI diagnosis rates in the East Midlands remain below the England average, there is substantial variation across the region, with the geographical analyses demonstrating concentrations of higher diagnosis rates within particular local authorities and neighbourhoods. Nottingham recorded the highest upper-tier local authority rate of new STI diagnoses at 922 per 100,000 population, while the MSOA analysis showed considerable variation within local authority areas. This pattern highlights the importance of targeted place-based approaches alongside interventions focused on populations experiencing the greatest burden of infection, inequalities and STI-related harms.

Testing activity has recovered following the COVID-19 pandemic and service delivery continues to evolve, with online consultations now accounting for a substantial proportion of sexual health activity. In the East Midlands, online consultations increased from 3 consultations in 2016 to 94,802 in 2025, although face-to-face consultations remained the most common consultation medium. Maintaining equitable access across both digital and face-to-face services will be important to avoid widening existing inequalities.

Reducing inequalities, harms and rates of STIs in the East Midlands will require a combination of behavioural, biomedical and service-based interventions. This includes targeted health promotion, vaccination programmes, partner notification, HIV PrEP and doxyPEP where indicated, and ensuring timely access to testing and treatment. These interventions should be informed by local epidemiology and the STI Prioritisation Framework, with the aim of reducing STI-related harm and narrowing health inequalities across the East Midlands.

The UKHSA STI Prioritisation Framework provides an evidence-based approach to identifying populations experiencing the greatest burden of STI-related harm and directing prevention and control activities accordingly.

The framework aims to shift the focus of STI control efforts towards reducing adverse health outcomes and addressing inequalities. It provides a clear template for prioritisation, within existing resources and commissioning arrangements. Organisations responsible for planning, commissioning and delivering sexual health services should consider how resources can be targeted to reduce adverse outcomes and address inequalities within existing commissioning arrangements.

For support with using the framework contact your regional Sexual Health Facilitator: Andy.Raynor@ukhsa.gov.uk

Chlamydia

Chlamydia remains the most commonly diagnosed STI in the East Midlands. As infection is frequently asymptomatic, diagnosis trends should be interpreted alongside changes in testing activity and service delivery.

In 2025, the chlamydia detection rate among women aged 15 to 24 years in the East Midlands was 1,689 diagnoses per 100,000 population, substantially below the UKHSA recommended detection rate of at least 3,250 per 100,000 population.

Early diagnosis and treatment remain important in preventing reproductive health complications and reducing onward transmission.

Figure 17. Number of chlamydia diagnoses, East Midlands, 2016 to 2025

Data sources: GUMCAD, CTAD.

Note: it is important to consider whether there have been any changes to testing practices when interpreting increases or decreases in chlamydia.

Chlamydia diagnoses in the East Midlands declined substantially between 2016 and 2025. The figure shows that diagnosis numbers remained relatively stable between 2016 and 2019 before declining markedly in 2020. Following this decline, diagnoses increased in 2021 and 2022 and then fell again between 2022 and 2025.

The number of diagnoses fell from 17,218 in 2016 to 13,095 in 2025, representing an overall reduction of 23.9% over the study period. Following the marked decline observed in 2020, diagnoses increased temporarily, reaching a post-pandemic peak in 2022, before declining again in subsequent years.

Between 2022 and 2025, chlamydia diagnoses declined each year. By 2025, diagnoses had fallen to 13,095, remaining below the levels recorded before 2020. Overall, despite the increase following the COVID-19 pandemic period, the long-term trend indicates a reduction in chlamydia diagnoses across the East Midlands.

Figure 18. Rates of chlamydia per 100,000 by age group (for those aged 15 to 64 years only), East Midlands, 2016 to 2025

Data sources: GUMCAD, CTAD, ONS Census 2021 mid-year estimates.

Rates of chlamydia diagnoses in the East Midlands declined across all age groups between 2016 and 2025, although people aged 20 to 24 years consistently recorded the highest rates throughout the study period.

In 2016, the highest rate was observed among people aged 20 to 24 years, at 2,264 diagnoses per 100,000 population. This was followed by those aged 15 to 19 years, at 1,761 per 100,000, people aged 25 to 34 years, at 635 per 100,000, and people aged 35 to 44 years, at 130 per 100,000. Rates were lowest among people aged 45 to 64 years, at 30 per 100,000.

The figure shows that rates declined across all age groups between 2019 and 2020. Although rates subsequently fluctuated, the ordering of age groups remained broadly unchanged, with higher rates observed among younger age groups throughout the study period.

By 2025, people aged 20 to 24 years continued to have the highest rate of chlamydia diagnoses, at 1,591 diagnoses per 100,000 population. Rates among those aged 15 to 19 years were 952 per 100,000, followed by people aged 25 to 34 years, at 511 per 100,000, those aged 35 to 44 years, at 180 per 100,000, and people aged 45 to 64 years, at 45 per 100,000.

Comparing 2016 and 2025, the largest absolute reduction in the rate of chlamydia diagnoses was observed among people aged 20 to 24 years, whose rate fell from 2,264 to 1,591 diagnoses per 100,000 population. Rates among people aged 15 to 19 years also declined substantially, from 1,761 to 952 per 100,000.

Figure 19. Rates of chlamydia per 100,000 by age group (for those aged 15 to 64 years only) and gender, East Midlands, 2025

Data sources: GUMCAD, CTAD, ONS Census 2021 mid-year estimates.

Note: male figures include trans men, and female figures include trans women. Rates are presented for people aged 15 to 64 years only.

Rates of chlamydia diagnoses in 2025 were highest among younger age groups for both males and females, particularly among those aged 20 to 24 years. Females aged 20 to 24 years had the highest diagnosis rate overall, followed by females aged 15 to 19 years, at just over 1,000 per 100,000 population.

Among males, the highest diagnosis rate was also observed in those aged 20 to 24 years, followed by those aged 15 to 19 years. Diagnosis rates declined with increasing age in both sexes, with the lowest rates observed among people aged 45 to 64 years.
Across all age groups, females had higher rates of chlamydia diagnoses than males. The difference between males and females was most pronounced among those aged 15 to 24 years, whereas rates were more similar in older age groups.

As with the overall age-specific pattern, the burden of chlamydia diagnoses remained concentrated among young people, particularly young women aged under 25 years.

Figure 20. Chlamydia detection rate per 100,000, females aged 15 to 24 years by upper tier local authority of residence, East Midlands, 2025

Data sources: GUMCAD, CTAD, ONS Census 2021 mid-year estimates.

Note: chlamydia detection rates among females aged 15 to 24 years are influenced by local patterns of testing and service provision, and variation between local authorities may reflect differences in screening activity as well as differences in the underlying burden of infection.

The chlamydia detection rate among females aged 15 to 24 years in the East Midlands varied considerably by upper-tier local authority in 2025, ranging from 1,187 to 2,458 diagnoses per 100,000 population.

The East Midlands regional detection rate was 1,689 diagnoses per 100,000 population, higher than the England rate of 1,348 per 100,000, but below the UKHSA recommended detection rate of at least 3,250 diagnoses per 100,000 population among females aged 15 to 24 years.

Substantial geographical variation was observed across the region. Lincolnshire recorded the highest detection rate, at 2,458 per 100,000, followed by Nottingham, at 2,151 per 100,000. Derby also had a rate above the regional average, at 1,737 per 100,000. In contrast, Rutland recorded the lowest rate, at 1,187 per 100,000.

Overall, although the East Midlands regional detection rate was higher than the England rate, no upper-tier local authority achieved the recommended detection rate of at least 3,250 per 100,000. The findings also demonstrate geographical variation in chlamydia detection rates across the East Midlands.

Gonorrhoea

Gonorrhoea remains a significant contributor to the burden of STIs in the East Midlands, particularly among younger adults and GBMSM. Ongoing surveillance is important given concerns regarding antimicrobial resistance and continuing transmission.

The introduction of the 4CMenB vaccination programme for people at increased risk of gonorrhoea represents an important addition to the range of interventions available for gonorrhoea prevention.

Figure 21. Number of gonorrhoea diagnoses, East Midlands, 2016 to 2025

Data source: GUMCAD.

In 2016, there were 1,940 gonorrhoea diagnoses in the East Midlands. The figure shows that diagnoses increased between 2016 and 2019, before declining in 2020. Diagnosis numbers subsequently increased again, reaching their highest level during the study period in 2023, before falling in 2024 and 2025.

By 2025, there were 2,933 gonorrhoea diagnoses in the East Midlands, an increase compared with 2016. The figure indicates that the number of diagnoses recorded in 2025 remained above the level observed at the beginning of the study period.

Overall, gonorrhoea diagnoses in the East Midlands were characterised by an upward trend between 2016 and 2025, despite fluctuations over time.

Figure 22. Rates of gonorrhoea per 100,000 by age group (for those aged 15 to 64 years only), East Midlands, 2016 to 2025

Data sources: GUMCAD, ONS Census 2021 mid-year estimates.

Rates of gonorrhoea varied by age group throughout the study period, with the highest rates consistently observed among people aged 20 to 24 years. The all-ages rate provides an overall measure of gonorrhoea diagnoses across the population aged 15 to 64 years.

In 2016, the rate of gonorrhoea diagnoses was highest among those aged 20 to 24 years, at 200 per 100,000 population, followed by those aged 25 to 34 years (104 per 100,000) and 15 to 19 years (93 per 100,000). Lower rates were recorded among people aged 35 to 44 years (38 per 100,000) and 45 to 64 years (14 per 100,000).

Rates increased across the younger age groups between 2016 and 2019, before declining in 2020 and 2021. Rates subsequently increased again, with particularly marked increases among those aged 20 to 24 years and 15 to 19 years between 2021 and 2022. Rates declined again following the peaks observed in 2022 and 2023.
By 2025, the highest rate remained among people aged 20 to 24 years, at 217 per 100,000 population. Rates were 144 per 100,000 among those aged 25 to 34 years, 90 per 100,000 among those aged 15 to 19 years, 80 per 100,000 among those aged 35 to 44 years, and 31 per 100,000 among those aged 45 to 64 years.

Overall, gonorrhoea diagnosis rates remained highest among people aged 20 to 24 years throughout 2016 to 2025 and lowest among those aged 45 to 64 years. Age-specific trends showed substantial variation over time, particularly among the younger age groups.

Figure 23. Rates of gonorrhoea per 100,000 by age group (for those aged 15 to 64 years only) and gender, East Midlands, 2025

Data sources: GUMCAD, ONS Census 2021 mid-year estimates.

Note: male figures include trans men, and female figures include trans women. Rates are presented for people aged 15 to 64 years only.

Rates of gonorrhoea diagnoses in the East Midlands in 2025 varied by both age group and gender. Among both males and females, the highest rates were observed among people aged 20 to 24 years, while substantially lower rates were observed among the older age groups.

For males, the rate was highest among those aged 20 to 24 years, followed by those aged 25 to 34 years. Rates were lower among males aged 35 to 44 years and 45 to 64 years. Among males aged 15 to 19 years, the rate was also lower than that observed among males aged 20 to 34 years.

A similar age pattern was observed among females, with the highest rate among those aged 20 to 24 years, followed by those aged 15 to 19 years. Rates were lower among females aged 25 to 34 years, with further reductions among those aged 35 to 44 years and 45 to 64 years.

Comparing genders within age groups, males had higher gonorrhoea diagnosis rates than females among those aged 20 to 24 years, 25 to 34 years, 35 to 44 years and 45 to 64 years. Among those aged 15 to 19 years, females had a higher rate than males. The greatest difference between males and females was observed among people aged 20 to 24 years.

Overall, gonorrhoea diagnosis rates in the East Midlands in 2025 were concentrated among younger age groups, particularly males aged 20 to 34 years, with substantially lower rates observed among older age groups.

Figure 24. Rate of gonorrhoea diagnoses per 100,000 by upper-tier local authority, East Midlands, 2025

Data sources: GUMCAD, ONS Census 2021 mid-year estimates.

Nottingham had the highest gonorrhoea diagnosis rate in the East Midlands, at 139 per 100,000 population, and was the only upper-tier local authority with a rate exceeding the England average of 109 per 100,000. Leicester (93 per 100,000) and Derby (69 per 100,000) also reported rates above the East Midlands regional average of 58 per 100,000.

Derbyshire, West Northamptonshire and Rutland each recorded rates of 58 per 100,000, equal to the regional average. Lower rates were observed in Nottinghamshire (48 per 100,000), Leicestershire (43 per 100,000), North Northamptonshire (42 per 100,000) and Lincolnshire (34 per 100,000).

Overall, rates varied substantially across the East Midlands, with Nottingham recording the highest rate and Lincolnshire the lowest. Most upper-tier local authorities recorded rates below the England average, while 4 of the 10 authorities had rates below the regional average.

Genital warts

Genital warts diagnoses have declined substantially over the past decade, consistent with the continuing population-level impact of the adolescent HPV vaccination programme. The greatest reductions have been observed among younger age groups, who have benefited most directly from the vaccination programme.

Maintaining high HPV vaccination uptake remains important to sustain these public health gains and reduce the burden of HPV-related disease.

Figure 25. Number of genital warts diagnoses, East Midlands, 2016 to 2025

Data source: GUMCAD.

Diagnoses of genital warts in the East Midlands declined substantially between 2016 and 2025. In 2016, there were 4,677 diagnoses, with numbers declining over subsequent years before decreasing sharply in 2020.

Following a small increase in 2021, the number of diagnoses declined over the subsequent years, with 1,425 diagnoses reported in 2025. This represents a reduction of 69.5% compared with 2016.

Although there was a small increase in diagnoses in 2021, levels remained considerably lower throughout 2022 to 2025 than those observed before 2020, indicating a sustained long-term decline in genital wart diagnoses across the East Midlands.

Figure 26. Rates of genital warts per 100,000 by age group (for those aged 15 to 64 years only), East Midlands, 2016 to 2025

Data sources: GUMCAD, ONS Census 2021 mid-year estimates.

Rates of genital warts declined across all age groups in the East Midlands between 2016 and 2025, although the magnitude of decline varied by age. The largest reductions were observed among younger age groups.

Among people aged 20 to 24 years, the rate decreased from 558 per 100,000 population in 2016 to 55 per 100,000 in 2025, a reduction of 90.1%. Among those aged 15 to 19 years, the rate decreased from 231 per 100,000 in 2016 to 5 per 100,000 in 2025.

By 2025, the highest genital warts diagnosis rate was among people aged 25 to 34 years, at 88 per 100,000 population, followed by those aged 20 to 24 years at 55 per 100,000 and those aged 35 to 44 years at 53 per 100,000. Rates were lower among people aged 45 to 64 years, at 19 per 100,000, and those aged 15 to 19 years, at 5 per 100,000.

Overall, the age distribution of genital warts diagnoses changed substantially over the period, with the particularly large declines among those aged under 25 years consistent with the expected population-level impact of HPV vaccination.

Figure 27. Rates of genital warts per 100,000 aged 15 to 19 and 20 to 24 years by gender, East Midlands, 2016 to 2025

Data sources: GUMCAD, ONS Census 2021 mid-year estimates.

Rates of genital warts declined substantially among both age groups and genders in the East Midlands between 2016 and 2025. Throughout the period, rates remained higher among people aged 20 to 24 years than among those aged 15 to 19 years, regardless of gender.

Among people aged 20 to 24 years, males had the highest diagnosis rates throughout the study period, decreasing from 610.0 per 100,000 population in 2016 to 64.9 per 100,000 in 2025. Rates among females aged 20 to 24 years also declined substantially, from 498.5 to 40.4 per 100,000 over the same period. Both groups experienced a particularly marked decline between 2019 and 2020, followed by a continued downward trend.

Among those aged 15 to 19 years, rates declined to very low levels by 2025. Rates among females decreased from 312.9 per 100,000 population in 2016 to 10.7 per 100,000 in 2025, while rates among males decreased from 149.4 to 9.4 per 100,000.
Overall, genital wart diagnosis rates decreased markedly across all 4 groups between 2016 and 2025. The largest relative reduction was observed among females aged 15 to 19 years, whose rate decreased by 96.6%. The substantial reductions among younger people are consistent with the expected population-level impact of HPV vaccination.

Figure 28. Rates of genital warts per 100,000 by age group (for those aged 15 to 64 years only) and gender, East Midlands, 2025

Data sources: GUMCAD, ONS Census 2021 mid-year estimates.

In 2025, genital wart diagnosis rates in the East Midlands varied by both age group and gender. For both males and females, the highest rates were observed among those aged 25 to 34 years, while the lowest rates were recorded among those aged 15 to 19 years.

Among males, the highest rate was observed among those aged 25 to 34 years, followed by those aged 20 to 24 years and 35 to 44 years. Rates were lower among males aged 45 to 64 years and lowest among those aged 15 to 19 years.

A similar age pattern was observed among females. The highest rate was among those aged 25 to 34 years, followed by those aged 35 to 44 years and 20 to 24 years. Rates were substantially lower among females aged 45 to 64 years and 15 to 19 years.

Comparing genders within age groups, males had higher genital wart diagnosis rates than females among those aged 20 to 24, 25 to 34, 35 to 44 and 45 to 64 years. Rates among those aged 15 to 19 years were similar between males and females. The largest difference between genders was observed among those aged 25 to 34 years.

Syphilis

Although less common than some other STIs, syphilis remains an important public health concern because untreated infection can lead to serious neurological, cardiovascular and congenital complications.

Syphilis diagnoses have increased overall in the East Midlands over the last decade, despite fluctuations over time. The number of diagnoses increased from 267 in 2016 to 346 in 2025, representing a 30% increase. Although diagnoses declined in the most recent year, levels in 2025 remained higher than those recorded at the beginning of the period.

The epidemiology of syphilis also differs across population groups, with variation by age, gender and sexual orientation. Understanding these patterns alongside geographical variation is important for identifying populations experiencing a greater burden of infection and informing targeted prevention, testing and sexual health interventions.

Figure 29. Number of syphilis diagnoses, East Midlands, 2016 to 2025

Data source: GUMCAD.

Syphilis diagnoses in the East Midlands increased overall between 2016 and 2025, although the trend fluctuated between 2016 and 2025.There were 267 diagnoses in 2016. Diagnoses increased in 2017, declined slightly in 2018 and then increased again in 2019. This was followed by a marked decline in 2020, after which diagnoses increased through 2021 and 2022. Numbers remained at a comparatively high level between 2022 and 2024 before declining in 2025.

In 2025, 346 syphilis diagnoses were recorded, representing a 30% increase compared with 2016. Despite the decline in the most recent year, diagnoses remained higher than at the beginning of the study period.

Overall, the figure demonstrates a long-term increase in syphilis diagnoses in the East Midlands between 2016 and 2025, alongside considerable year-to-year variation.

Figure 30. Rates of syphilis per 100,000 by age group (for those aged 15 to 64 years only), East Midlands, 2016 to 2025

Data sources: GUMCAD, ONS Census 2021 mid-year estimates.

Rates of syphilis varied by age group across the study period. In 2016, the highest rates were observed among people aged 20 to 24 years and 25 to 34 years, both at 13 per 100,000 population. The lowest rate was among those aged 15 to 19 years, at 4 per 100,000.

Rates fluctuated across all age groups over the study period. Among people aged 25 to 34 years, the rate increased from 13 per 100,000 in 2016 to 19 per 100,000 in 2025 and was the highest of all age groups in 2025. Among those aged 35 to 44 years, the rate increased from 9 to 13 per 100,000, while the rate among those aged 45 to 64 years increased from 6 to 7 per 100,000.

In contrast, the rate among people aged 20 to 24 years decreased from 13 per 100,000 in 2016 to 10 per 100,000 in 2025, despite reaching higher levels during the intervening years. Rates among those aged 15 to 19 years remained comparatively low throughout the period, decreasing from 4 to 3 per 100,000 between 2016 and 2025.

Overall, the age distribution of syphilis diagnoses changed over the study period. By 2025, rates were highest among adults aged 25 to 34 years and 35 to 44 years, while rates among those aged 15 to 24 years were lower than at the beginning of the study period.

Figure 31. Rates of syphilis per 100,000 by age group (for those aged 15 to 64 years only) and gender, East Midlands, 2025

Data sources: GUMCAD, ONS Census 2021 mid-year estimates.

Rates of syphilis diagnoses in 2025 varied considerably by both age group and gender in the East Midlands. Rates were higher among males than females across all age groups, with the greatest difference observed among those aged 25 to 34 years.

Among males, the highest rate was recorded among those aged 25 to 34 years, at approximately 30 per 100,000 population. This was followed by males aged 35 to 44 years, at approximately 21 per 100,000, and those aged 20 to 24 years, at approximately 15 per 100,000. Rates were lower among males aged 45 to 64 years and lowest among those aged 15 to 19 years.

Among females, rates were substantially lower than among males. The highest female rate was observed among those aged 25 to 34 years, at approximately 7 per 100,000 population, followed by those aged 20 to 24 years, at approximately 5 per 100,000. Rates among females aged 15 to 19 years, 35 to 44 years and 45 to 64 years were comparatively low.

Overall, the distribution indicates that the highest rate of diagnosed syphilis in the East Midlands in 2025 was concentrated among males aged 25 to 34 years, with marked differences between males and females across the adult age groups.

Genital herpes

Genital herpes remains an important sexually transmitted infection in the East Midlands. Although the number of diagnoses has declined compared with the beginning of the reporting period, genital herpes continues to account for a substantial number of diagnoses each year.

Effective clinical management, timely diagnosis and access to sexual health services remain important in reducing the impact of infection on affected individuals and limiting onward transmission.

Figure 32. Number of genital herpes diagnoses, East Midlands, 2016 to 2025

Data source: GUMCAD.

Genital herpes diagnoses in the East Midlands decreased overall between 2016 and 2025, although the trend varied considerably over the period.

There were 2,254 diagnoses in 2016. Diagnosis numbers remained relatively stable between 2016 and 2018 before increasing to their highest level of the period in 2019. This was followed by a marked decline in 2020, after which diagnoses increased progressively between 2021 and 2024.

In 2025, there were 2,135 diagnoses, representing a slight decrease from 2024. Despite the recovery in diagnosis numbers following the substantial decline in 2020, the number recorded in 2025 remained below both the 2019 peak and the 2,254 diagnoses recorded in 2016.

Overall, the figure demonstrates a period of relative stability before 2020, followed by a substantial reduction in diagnoses in 2020 and a gradual recovery thereafter. However, by 2025, genital herpes diagnoses had not returned to the levels observed before 2020.

Figure 33. Rates of genital herpes per 100,000 by age group (for those aged 15 to 64 years only), East Midlands, 2016 to 2025

Data sources: GUMCAD, ONS Census 2021 mid-year estimates.

Rates of genital herpes diagnoses in the East Midlands varied by age group between 2016 and 2025, with the highest rates consistently observed among people aged 20 to 24 years. The all-ages rate declined over the period, although trends differed between age groups.

In 2016, the all-ages genital herpes diagnosis rate was 74 per 100,000 population. The highest age-specific rate was among people aged 20 to 24 years, at 200 per 100,000, followed by those aged 25 to 34 years (119 per 100,000) and 15 to 19 years (114 per 100,000). Lower rates were recorded among those aged 35 to 44 years (52 per 100,000) and 45 to 64 years (22 per 100,000).

Rates remained broadly stable across most age groups between 2016 and 2019, before declining markedly in 2020. Following 2020, rates generally increased among the younger age groups, although the extent and pattern of recovery differed by age. The rate among those aged 20 to 24 years remained substantially higher than that of the other age groups throughout the period.

By 2025, the all-ages rate was 65 per 100,000 population, compared with 74 per 100,000 in 2016. The highest age-specific rate remained among people aged 20 to 24 years (167 per 100,000), followed by those aged 25 to 34 years (108 per 100,000) and 15 to 19 years (81 per 100,000). Rates were lower among those aged 35 to 44 years (52 per 100,000) and 45 to 64 years (23 per 100,000).

Overall, the age distribution of genital herpes diagnoses remained broadly consistent over the reporting period, with the greatest burden concentrated among younger adults, particularly those aged 20 to 24 years. Despite increases following the decline in 2020, the all-ages rate in 2025 remained below the rate recorded in 2016.

Figure 34. Rates of genital herpes per 100,000 by age group (for those aged 15 to 64 years only) and gender, East Midlands, 2025

Data sources: GUMCAD, ONS Census 2021 mid-year estimates.

In 2025, genital herpes diagnosis rates in the East Midlands varied substantially by both age group and gender. The highest rates were observed among younger adults, particularly females aged 20 to 24 years, while rates were considerably lower among older age groups.

Among females, the highest diagnosis rate was observed among those aged 20 to 24 years, followed by females aged 25 to 34 years and 15 to 19 years. Rates were lower among females aged 35 to 44 years, with the lowest female rate observed among those aged 45 to 64 years.

Among males, the highest diagnosis rate was also observed among those aged 20 to 24 years, followed by males aged 25 to 34 years. Rates were lower among males aged 15 to 19 years and 35 to 44 years, and lowest among those aged 45 to 64 years.

Across all age groups, females had higher genital herpes diagnosis rates than males. The difference between genders was particularly pronounced among those aged 20 to 24 years, where the female rate was more than twice the male rate. A substantial difference was also evident among those aged 15 to 19 years. The difference between males and females narrowed progressively across the older age groups, with the most similar rates observed among those aged 45 to 64 years.

Overall, genital herpes diagnosis rates in the East Midlands in 2025 were concentrated among younger adults, particularly females aged 20 to 24 years. Rates declined across the older age groups for both genders, with the lowest rates observed among those aged 45 to 64 years.

Information on data sources

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

The gender and age group chart is restricted to those aged 15 to 64 years as information about STIs in those aged under 15 years is considered highly sensitive. Analyses specific to this group are not provided in routine outputs. Rates for those aged 65 or older are withheld to ensure that no deductive disclosure is possible for the under 15 years age group. The proportion of STIs in those aged under 15 years or older than 64 years is very low.

GUMCAD surveillance system

This disaggregate reporting system collects information about attendances and diagnoses at specialist (Level 3) and non-specialist (Level 2) sexual health services. 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 local authority and NHS 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
• Lymphogranuloma venereum (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 for numerators >= 10. For small numerators Byar’s method is less accurate and so an exact method based on the Poisson distribution is used.

ONS mid-year population estimates for 2024 were used as a denominator for rates (other than by ethnic group) for 2025. ONS estimates of population by ethnic group for the year 2021 were used as a denominator for rates by ethnic group for 2025. 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 2025 in this report with rates by 2024 in last year’s report, as the rates in the last report used the 2011 estimates.

Interpreting trends

When interpreting trends in the number of STI diagnoses it is important to consider the potential impact of changes to testing, vaccination programmes and the availability of interventions (such as prophylaxis). Specifically, diagnostic testing for gonorrhoea and genital herpes now includes in some areas highly sensitive testing using nucleic acid amplification tests. Additionally, there is some screening of GBMSM at extra-genital sites. Where in place, both will have led to increased case ascertainment of gonorrhoea and genital herpes. Local testing practices for all STIs may vary.

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, see the online Sexual and Reproductive Health Profiles.

For more information on HIV data, see the separate HIV Spotlight report.

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.

About the Field Services

The Field Services was established in 2018 as a national service comprising geographically dispersed multi-disciplinary teams integrating expertise in Field Epidemiology, Real-time Syndromic Surveillance and Public Health Microbiology to strengthen the surveillance, intelligence and response functions of UKHSA.

You can contact your local FS team at FSMidlands@ukhsa.gov.uk

Acknowledgements

We would like to thank:

• 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