Research and analysis

Spotlight on sexually transmitted infections in London: 2023 data

Updated 29 May 2025

Applies to England

Summary

This report focusses on sexually transmitted infections (STIs) in London. HIV is reported on separately. Please access the UK Health Security Agency’s (UKHSA) report on STIs and screening for chlamydia in England for a national perspective (1).

STIs represent an important public health problem in London. The health risks associated with them are well documented. Untreated syphilis, for example, can cause heart and brain disease, (2), while complications of gonorrhoea and chlamydia include pelvic inflammatory disease (PID) which can damage fertility. STIs can also increase the risk of acquiring HIV.

More than 128,000 new STIs were diagnosed in London residents in 2023, representing a rate of 1,448 diagnoses per 100,000 population. This rate is more than twice that of any other English region.

Rates by local authority (LA) ranged from 516 new STI diagnoses per 100,000 population in Bexley to 3,730 in Lambeth.

While this report primarily focuses on the trend between 2022 and 2023, some trends relative to 2019 or earlier are included to provide a comparison to sexual health service provision and STI diagnoses prior to the COVID-19 pandemic. Access to sexual health services (SHSs) was restricted during the main pandemic year (2020) and to a lesser extent during 2021. Trends in consultations, tests and diagnoses during recent years must be interpreted in that context.

Overall, men continued to have higher rates of new STIs than women in 2023 (1,993 and 886 per 100,000 residents, respectively).

Where gender and sexual orientation are known, gay, bisexual and other men who have sex with men (GBMSM) account for 49% of London residents diagnosed with a new STI (85% of those diagnosed with syphilis and 73% of those diagnosed with gonorrhoea). This data excludes chlamydia diagnoses reported via CTAD.

STIs disproportionately affect young people. London residents aged between 15 and 24 years accounted for 27% of all new STI diagnoses in 2023.

The White British ethnic group had the highest number of new STI diagnoses in 2023 (34,735) followed by the White other group (28,218). Taken together, the 2 White ethnic groups accounted for 55% of new STI diagnoses in London residents. Although only 9% of new STIs were in the Black Caribbean ethnic group, they had the highest rate: 2,950 per 100,000, which more than twice the rate seen in the combined White ethnic group.

Where country of birth was known, 56% of London residents diagnosed with a new STI in 2023 (excluding chlamydia diagnoses reported via CTAD) were UK-born. Heterosexual men and heterosexual or bisexual women diagnosed with a new STI were more likely than GBMSM to be UK-born.

The rate of new STIs among people who lived in the most deprived areas (1,922 per 100,000) was 3.6 times higher than the rate for people who lived in the least deprived areas (537 per 100,000).

Access to sexual health services

Access to sexual health services (SHSs) has an impact on trends in STI diagnoses. Overall, the STI testing rate (excluding chlamydia in under 25 year olds) in London in 2023 increased by 10% compared to 2022 and was 12% higher than prior to the COVID-19 pandemic in 2019. Positivity in London residents tested for STIs (excluding chlamydia in under 25 year olds) remained stable at 8.5% when 2023 is compared to 2022. However, it was lower than reported for 2019, the last pre-pandemic year (9.1%).

There was a 6% increase in the number of SHS consultations (which include asymptomatic screening via the internet) in London in 2023 compared to 2022 (from 1,480,317 to 1,574,578).

Of all consultations in 2023, over half (57%, 891,287) were via the internet (compared to 21% in 2019), 41% (648,149) were delivered face-to-face and 2% (35,142) were via telephone. Compared to 2022, rises were seen in 2023 in consultations via the internet (12% increase) and face-to-face (3% increase), but there were 36% fewer telephone consultations. In 2023, the number of face-to-face consultations was 31% lower than in 2019. For heterosexual men, 66% of their consultations were online, compared to 62% for heterosexual or bisexual women and 48% for GBMSM.

Trends by STI

The number of new STIs diagnosed in London residents increased by 7% between 2022 and 2023. While the number of genital warts diagnoses decreased by 1%, rises were seen in the other major STIs: syphilis and gonorrhoea increased by 11%, chlamydia by 3% and genital herpes by 14%. There was also a 17% increase in trichomoniasis diagnoses and a 16% increase in diagnoses of mycoplasma genitalium.

While the overall number of new STIs diagnosed in London in 2023 was still 15% lower than seen in the pre-COVID-19 pandemic year of 2019, the numbers of syphilis and gonorrhoea diagnoses in 2023 exceeded those reported for 2019.

Although GBMSM continued to make up over 8 in 10 of those diagnosed with syphilis, the largest proportional rise in diagnoses between 2019 and 2023 was seen in heterosexual or bisexual women (57%).

Gonorrhoea diagnosis rates remained below pre-pandemic levels for the youngest age groups, but they were above those levels for all age groups from 25 to 34 years upwards. The largest rise was seen in the 35 to 44 year age group where the rate rose by 31% when 2023 is compared to 2019.

National chlamydia screening detection rate indicator

UKHSA recommends that local areas should be working towards achieving a chlamydia detection rate no lower than 3,250 per 100,000 female population aged 15 to 24 years. This is an indicator in the Public Health Outcomes Framework (3). In 2023, the chlamydia detection rate per 100,000 among London female residents aged 15 to 24 years was 2,028, less than two-thirds of the desired chlamydia detection rate and the second lowest chlamydia detection rate in this population over the last 10 years.

Populations with greater sexual health needs

Gay, bisexual and other sex who have sex with men

GBMSM continue to be affected by health inequalities in outcomes related to STIs. Where gender and sexual orientation are known, GBMSM accounted for 49% of London residents diagnosed with a new STI in 2023 (excluding chlamydia diagnoses reported via CTAD), 86% of those diagnosed with syphilis, 73% of those diagnosed with gonorrhoea and 48% of those diagnosed with chlamydia. The proportion of syphilis diagnoses in GBMSM among London residents has tended to decrease slightly over the past 5 years (due to an upward trend among heterosexuals, particularly heterosexual or bisexual women). For other major STIs, including gonorrhoea and chlamydia, the proportion in GBMSM has increased.

Among GBMSM, increases in diagnoses of all major STIs were seen in 2023. The number of new STIs diagnosed in GBMSM in 2023 was 9% higher than in 2022, with rises of 11% for both syphilis and gonorrhoea. For chlamydia a rise of 6% was seen and for genital herpes a rise of 4%. Diagnoses of syphilis, gonorrhoea, chlamydia and genital herpes in GBMSM had been following a rising trend prior to the COVID-19 pandemic which began in 2020. By 2023, syphilis and gonorrhoea diagnoses were, respectively, 9% and 15% higher than in 2019, the last pre-pandemic year.

There is evidence of a rebound in sexual mixing among GBMSM since the pandemic (4), and it is likely this has continued to contribute to the rise in STIs within this population in 2023. The high and increasing levels of gonorrhoea and infectious syphilis suggest that rapid STI transmission is occurring in dense sexual networks without consistent condom use, including those living with HIV. Condomless sex increases the risk of a range of infections that can be transmitted sexually, including hepatitis B.

Mpox is a zoonotic infection, caused by the monkeypox virus, that previously occurred mostly in West and Central Africa and is transmitted through close contact (including through sexual contact). Previous cases in the UK had been either imported from countries where mpox is endemic or had been contacts with documented epidemiological links to imported cases. In 2022, there was a very large outbreak of mpox with community transmission in the UK, mainly in GBMSM. London was most affected, with case numbers peaking in July (with 881 diagnoses), before falling to low numbers by November of the same year. The number of diagnoses in Londoners presumed to be GBMSM has remained low (5). This clade IIb outbreak is distinct from the clade Ib cases associated with travel that have been reported since October 2024.

Shigella is a gastrointestinal infection that can cause severe diarrhoea, with fever and abdominal pain. It is caused by a bacterium found in faeces. Sex that may involve anal or faecal contact is one way that the infection can spread. GBMSM are at increased risk. Following a fall in 2020, the number of shigella infections among presumptive GBMSM in London has followed a strongly rising trend since the first quarter of 2021, exceeding pre-pandemic levels by early 2022. There were 308 diagnoses reported in the third quarter of 2024.

Lymphogranuloma venereum (LGV), a form of chlamydia which spreads to the lymph nodes, continued to be diagnosed in London almost exclusively in GBMSM in 2023. The pandemic period decrease was small and the post-pandemic rebound has been similarly limited. There were 129 diagnoses reported in adult men resident in London in the third quarter of 2024.

Data for 2023 shows that GBMSM London residents diagnosed with a new STI were more likely to be born abroad, particularly in Europe or Latin America. They were more likely to belong to either the White British or White other ethnic groups than heterosexual men or heterosexual or bisexual women. They also had an older median age at diagnosis for all major STIs. Median age at diagnosis for a new STI was 34 years for GBMSM in 2023 compared to 29 for heterosexual men and 26 for heterosexual or bisexual women.

It is important to consider differences in service access when interpreting differences in diagnoses between groups. GBMSM tend to access sexual health services more frequently than heterosexual men or heterosexual or bisexual women and were more likely to access these services during the COVID-19 pandemic. Consultation numbers have also rebounded more strongly for this group since the pandemic with a 49% rise in consultations among GBMSM London residents from 2019 to 2023, compared to a 21% rise for heterosexual men and a 32% rise for heterosexual or bisexual women. GBMSM accounted for 23% of all consultations at SHSs in London in 2023 where gender and sexual orientation was known (compared to 21% in 2019).

Young people

STIs disproportionately affect young people. London residents aged between 15 and 24 years accounted for 24% of consultations at SHSs and 27% of all new STI diagnoses in 2023, whereas this age group accounts for around 12% of the London population. The age group with the highest new STI diagnosis rate was 20 to 24 year olds (4,339 per 100,000 population). The high rates of STIs among young people aged 20 to 24 years are likely to be due to greater rates of partner change compared to older age groups (6).

The pandemic appears to have had differing impacts by age group, both on consultation numbers and diagnosis rates. Consultation numbers in 2023 exceeded those in 2019, the last pre-pandemic year, for almost all age groups, except the youngest. Excluding those aged less than 15 years, the only age group with a decrease was the 15 to 19 year age group for which the number was still 22% lower. However, although an increase was seen for the 20 to 24 age group, at 16% this was the smallest increase reported for any age group. Examining these trends further by gender and sexual orientation, numbers of consultations and diagnoses in young GBMSM were less affected than those in young heterosexual men and young heterosexual or bisexual women.

The greatest expansion in consultations between 2019 and 2023 was via online access (triage via an online consultation form followed, where appropriate, by a test kit sent by post to the patient). The increase in consultations via this medium between 2019 and 2023 was proportionally lower for the 15 to 19 and 20 to 24 year age groups compared to older age groups and the 15 to 19 year age group saw an 11% decline when 2023 is compared to 2022. Again excluding those aged less than 15 years, the decrease in face-to-face consultations between 2019 and 2023 was also greater for the 15 to 19 and 20 to 24 year age groups than for other groups. These were also the only age groups which saw a decrease in face-to-face consultations in 2023 compared to 2022.

Younger age groups also had much lower new STI rates in 2023 than in 2019. In 2023, the new STI diagnosis rate for Londoners aged 15 to 19 years (1,652) was still 47% lower than in 2019. A 3% rise was seen compared to 2022. A similar picture was seen for Londoners aged 20 to 24 years. For this group the new STI diagnosis rate was 27% lower than that seen in 2019 and 1% higher than in 2022. By contrast the rate among 35 to 44 year olds (1,798) in 2023 was only 7% lower than the 2019 rate and 13% higher than the 2022 rate.

When 2023 is compared to 2019, a steep decline (71% decrease) is seen in genital warts diagnosis rates in females aged 15 to 19. However, most of this decline occurred by 2021. Since then, a plateau appears to have been reached for diagnoses in girls. Diagnoses in boys aged 15 to 19 have continued to decline slowly. The long-term decline in genital warts diagnoses followed the introduction for girls, in 2008, of vaccination against human papillomavirus (HPV), the virus which causes genital warts.

Young people may have been disproportionately affected by pandemic restrictions on social mixing. There may also be inequalities in service access. For example, young people may be more likely to be living at home with their families where they may find it difficult to receive test kits provided by online services. Trends seen for face-to-face services suggest they may also be finding these services more difficult to access due to reduced opening hours and reduced availability of walk-in appointments. Reductions in funding for organisations that work with and mentor young people may also affect engagement with sexual health services. The decline in chlamydia screening has contributed to the trends seen for young people, but similar patterns are also seen in GUMCAD data.

Ethnic groups affected by health inequalities

Large health inequalities are seen between ethnic groups with the Black and mixed ethnic groups particularly affected. However, when interpreting analyses by ethnic group it is important to understand that ethnicity is a complex concept and is self-identified within the limitations of the options that are provided. Ethnicity may incorporate cultural, religious and linguistic differences as well as differences in physical attributes and world region of origin. People may identify their ethnic group differently in different contexts or over time.

Ethnic group is not a proxy for country or world region of birth (for example most Londoners who identify as Black Caribbean are UK-born) and identification by ethnic group may vary by country of birth, as the meanings of terms like “White” and “Black” in relation to ethnicity are cultural rather than universal.

There are large differences in age structure between ethnic groups. STI rates for groups with older age distributions, such as the White British group, will tend to be depressed by a larger number of elderly people in the denominator. There is also intersectionality with other factors such as deprivation and stigma. It is not yet possible to measure some of these factors (for example stigma) consistently using existing data, although work is ongoing to address this.

People belonging to the Black African, Black Caribbean and Black other groups make up around 14% of the population of London, but they accounted for 19% of consultations at SHSs and 20% of new STI diagnoses in 2023. The number of new STI diagnoses in those belonging to a Black ethnic group was 22% lower than in 2019 but 5% higher than in 2022. Differences are seen between specific Black ethnic groups. STI rates for the Black African group tend to be lowest and those for the Black Caribbean group highest.

People belonging to Black ethnic groups diagnosed with a new STI were more likely to be female and aged 15 to 24 years compared to the White and Asian ethnic groups and, among men, there was a lower proportion of GBMSM. For all Black ethnic groups, a greater proportion of Black people diagnosed with a new STI in 2023 lived in areas categorised as falling into the top 2 quintiles of deprivation (representing the most deprived areas). Overall, 74% of those belonging to a Black ethnic group lived in an area within the top 2 deciles of deprivation compared to 62% of all Londoners diagnosed with a new STI in 2023.

One factor in which Black ethnic groups varied significantly was in the proportion born in the UK. Over 81% of Black Caribbean London residents diagnosed with a new STI in 2023 were born in the UK along with 77% of those in the Black other group, while for Black Africans the proportion was much lower at around 50%.

Although only 9% of new STIs reported for London residents in 2023 were in Black Caribbeans, they had the highest new STI diagnosis rate: 2,950 per 100,000 population (all ages). The new STI diagnosis rate is strongly influenced by diagnoses of chlamydia, the most prevalent STI. Research has found that, when compared to all other ethnic groups, there were no unique clinical or behavioural factors explaining the disproportionately high rates of STI diagnoses among people of Black Caribbean ethnicity; this ethnic disparity in STIs is likely influenced by underlying socioeconomic factors and the role they play in the structural determinants of the health of this community (7).

The mixed ethnic group is affected by health inequalities in relation to STIs in ways similar to those experienced by Black ethnic groups. The new STI diagnosis rate for this group in 2023 was 2,311 per 100,000 population (all ages). This was the second highest ethnic group-specific rate and the number of new STI diagnoses was 5% higher than in 2019 and 13% higher than in 2022. This ethnic group makes up around 6% of London’s population. It accounted for 9% of consultations at SHSs and 10% of new STI diagnoses in 2023. The mixed and other ethnic groups are particularly heterogenous and trends for these groups should be interpreted with caution as they are sensitive to changes in the groups’ composition.

The White other ethnic group is often grouped with the White British group into a single White ethnic group but, in London, differs from this group markedly. In 2023, it had the third highest new STI diagnosis rate at 1,891 per 100,000 population (all ages) and the highest rates for syphilis (94) and gonorrhoea (663). The number of new STI diagnoses was 10% lower than in 2019 but 8% higher than in 2022. This ethnic group makes up around 17% of London’s population. It accounted for 21% of consultations at SHSs and 25% of new STI diagnoses in 2023.

Londoners belonging to the White other ethnic group, diagnosed with a new STI in 2023, were less likely to be aged 15 to 24 years than any other ethnic group (15%) and more likely to be born abroad (84%) and male (77%). Over 80% of men in this ethnic group diagnosed with a new STI in 2023 were reported to be GBMSM. The most frequently reported world region of birth for Londoners in this group who were born abroad was Europe excluding the UK (70% of those born abroad) and around 13% of those born abroad had been born in Latin America.

Relationships between ethnic group and world region of birth are complex as can be seen above. This may be particularly true for those born in Latin America. In 2023, 46% of London residents born in Latin America, diagnosed with a new STI, identified themselves as belonging to the White other ethnic group, 27% to the other ethnic group and 23% to the mixed ethnic group.

It is also worth noting that the White British ethnic group remained the largest ethnic group, accounting for 36% of consultations and 30% of new STIs, and making up 37% of the population of London.

Implications for prevention

STI diagnoses have risen again in London. The number of gonorrhoea diagnoses, which can be a marker of higher risk sexual behaviour in the community, began to exceed the pre-pandemic level in 2022 and has continued to rise in 2023. Although GBMSM continue to account for the largest proportion of syphilis and gonorrhoea diagnoses, the extremely large proportional rise in syphilis seen in 2023 for heterosexual or bisexual women and very large rise in gonorrhoea seen in heterosexual men are also of concern. Increases in both these STIs were seen in many other English regions.

STI prevention efforts should include a range of measures. Proactive culturally competent and evidence-based health promotion and high-quality health education improve risk awareness and encourage safer sexual behaviour and more frequent testing. Consistent and correct condom use substantially reduces the risk of contracting and transmitting an STI. Vaccination reduces the risk of being infected with certain infections, for example HPV and hepatitis B. STI testing, open access to SHSs for rapid STI diagnosis and treatment with robust contact tracing, allows earlier diagnosis and treatment and reduces the length of time that people can transmit STIs to others. Such measures need to be effectively commissioned, including targeting programmes and resources to those groups highlighted above who have the greatest sexual health needs.

Established HIV prevention activities may also impact on wider STI control. The London HIV Prevention Programme (LHPP) promotes combined prevention choices for Londoners (18) and was able to support the mpox outbreak response. An England-wide HIV Prevention Programme runs campaigns to improve knowledge, understanding and interventions among populations most at-risk of HIV in England, particularly aimed at GBMSM and people of Black ethnicity and other groups in whom there is a higher or emerging burden of infection (8).

Access to services

Following the disruptions in service delivery during the pandemic, the number of Londoners receiving sexual health tests (for chlamydia, gonorrhoea, syphilis and HIV) has risen to levels above those seen in 2019. Considerable changes have occurred in how sexual health services are delivered over this period, with a reduction in face-to-face consultations which in 2023 remained much lower than in 2019. There has been a corresponding increase in online consultations, which now account for more than half of all consultations and offer a different option, including for asymptomatic screening.

Different population groups access services differently. Heterosexuals have a higher proportion of their sexual health service consultations online than GBMSM. Since 2019, the largest proportional increase in the number of consultations has been in GBMSM and the smallest proportional increase has been in heterosexual men. The post-pandemic bounceback in number of consultations has been smaller for younger compared to older age groups. Service providers will be aware that the impact of changes in consultation medium differs by sexual orientation and age group, and it remains important to understand whether the changes in how people use services has affected the equity of access to needed services (9)(10).

The number of sexual health screens rose in London between 2022 and 2023 while STI test positivity remained stable but at a lower level than before the pandemic. The lower positivity may reflect additional testing in lower risk groups who are less likely to test positive but may also indicate barriers to testing for some individuals resulting in missing diagnoses.

STI prevention and health promotion

STI prevention and health promotion for younger age groups remains a priority. Implementation of good quality evidenced-based Relationship Education in primary schools, as well as inclusive Relationships, Sex and Health Education (RSHE) in all secondary schools is important to support young people with the information and skills they need to prepare to look after their sexual health before sexual debut and beyond. This is particularly true for young people who belong to groups most impacted by sexual health inequalities (11)(12)(13)

Many areas in England, including London, continue to provide schemes which distribute condoms to young people (mostly under 20 years of age) and other groups most at risk through a variety of outlets via the C-Card scheme (14) and condoms are provided free from sexual health clinics for all ages. However, the evidence suggests that most of those who register with the C-Card scheme do not go on to become repeat users (15). Easy access to condoms for everyone without barriers can encourage consistent use.

The National HPV Vaccination Programme introduced vaccination against HPV, the virus which causes genital warts, for children aged 12 to 13 years (for girls in 2008 and for boys in 2019). Prior to the pandemic the programme achieved high coverage in girls and was successful in producing a longer-term decline in genital warts in those aged 15 to 19 years. However, vaccination was disrupted by the pandemic, with low coverage in 2019/2020 and has still to return to the levels seen prior to the pandemic (16). The slight increase in genital warts diagnoses in females aged 15 to 19 seen in 2022 was offset by a slight decrease in 2023 and numbers continue to decrease slowly in males belonging to that age group. However, the rapid declines of earlier years appear to have come to an end.

An additional HPV vaccination programme for GBMSM via SHSs and HIV clinics was introduced in 2018 (17). This group will have benefited less from the years when the childhood HPV vaccination programme was female-only (18). The National Chlamydia Screening Programme (NCSP) is also targeted at young people. In June 2021, the NCSP changed to focus on reducing reproductive harm of untreated infection primarily in young women (19) and programmes are recommended to achieve the new Detection Rate Indicator (DRI) in order to do so. It is of concern that the detection rate for London remains considerably below the level aimed for by the NCSP.

Black ethnic groups continue to be affected by health inequalities, including in relation to sexual health, with Black Caribbeans particularly affected. Priorities and areas for action that have been identified for Black Caribbean communities include: building trust in a context of historical and ongoing health inequalities, raising awareness among Black Caribbean communities about how STIs are prevented, transmitted, diagnosed and treated and how to improve sexual wellbeing, using multiple channels, brands and influencers that are familiar, relatable and trusted by the target audience; workforce training and development ensuring that services are equipped to provide non-judgmental, empathetic and culturally competent approaches to sexual health care; encouraging ongoing collaboration with local partners and ensuring that community members are involved in the design and delivery of sexual health promotion and sexual health interventions (20).

As GBMSM continue to experience high rates of STIs they remain a priority for targeted STI prevention and culturally appropriate health promotion beyond HIV prevention, including full immunisation against hepatitis A, hepatitis B, HPV and mpox.

There is a continued need to strengthen public health measures to reduce transmission of syphilis across London. National clinical guidelines recommend frequent testing in GBMSM at higher risk (21), but surveillance data has suggested that this is not uniformly occurring, especially in GBMSM living with HIV. There have also been concerns about poor knowledge and awareness of syphilis among GBMSM (22). The Syphilis Action Plan includes recommendations to address the increase in syphilis in England (23).

The continued rise in shigella infections in 2024, among presumptive GBMSM, to levels much higher than observed pre-pandemic is concerning. This rise, in the context of reports of extensively drug-resistant infection (24), necessitates a continued focus on culturally competent harm reduction messages for GBMSM regarding the practice of good hygiene during and after sex and the recognition of symptoms (25).

UKHSA’s main messages

Commissioners and providers of SHSs have an important role in communicating messages about safer sexual behaviours and how to access services.

Main prevention messages

Using condoms consistently and correctly protects against HIV and other STIs such as chlamydia, gonorrhoea, and syphilis – condoms can also be used to prevent unplanned pregnancy.

Regular screening for STIs and HIV is essential to maintain good sexual health – everyone should have an STI screen, including an HIV test, on at least an annual basis if having condomless sex with new or casual partners. In addition:

• women, and other people with a womb and ovaries, aged under 25 years who are sexually active should have a chlamydia test annually and on change of sexual partner

• gay, bisexual and other men who have sex with men (GBMSM) should have tests for HIV and STIs annually or every 3 months if having condomless sex with new or casual partners

HIV pre-exposure prophylaxis (PrEP) is available for free from specialist SHSs and can be used to reduce an individual’s risk of acquiring HIV.

HIV post-exposure prophylaxis (PEP) can be used to reduce the risk of acquiring HIV following some sexual exposures – PEP is available for free from most specialist SHSs and most emergency departments.

People living with diagnosed HIV who are on treatment and have an undetectable viral load are unable to pass on the infection to others during sex – this is known as ‘Undetectable=Untransmittable’ or ‘U=U’.

Vaccination against human papillomavirus (HPV), hepatitis A, hepatitis B and mpox will protect against disease caused by these viruses and prevent the spread of these infections:

• hepatitis B and HPV vaccines are components of the UK routine immunisation schedule

• GBMSM can obtain the hepatitis A and hepatitis B vaccines from specialist SHSs – these vaccines are also available for other people at high risk of exposure to the viruses

• GBMSM aged up to and including 45 years can obtain the HPV vaccine from specialist SHSs

Specialist sexual health services are free and confidential and offer testing and treatment for HIV and STIs, condoms, vaccination, HIV PrEP and PEP:

• clinic-based services are commissioned for residents of all areas in England

• online self-sampling for HIV and STIs is widely available

• information and advice about sexual health including how to access services is available at NHS Sexual Health Services and from the national sexual health helpline on 0300 123 7123

Charts, tables and maps

Figure 1. New STI diagnosis rates by UKHSA region of residence, England, 2023

Data sources: GUMCAD, CTAD

Figure1-2023

Figure 1 is a column chart showing new STI diagnosis rates by English region for the year 2023. Rates are per 100,000 population and are not age-restricted or adjusted.

The chart shows that London not only had the highest new STI diagnosis rate of all English regions (1,448) but that its rate was more than twice that of the region with the next highest rate (the North West with 698). The London rate was also 7.5% higher than in 2022 (1,348).

Figure 2. Number of diagnoses of the 5 main STIs, London residents, 2019 to 2023

Data sources: GUMCAD, CTAD

Figure2-2023

Notes

It is important to consider whether there have been any changes to testing or vaccination practices when interpreting increases or decreases in STIs. The following paragraphs list various considerations.

Any increase in gonorrhoea diagnoses may be due to the increased use of highly sensitive nucleic acid amplification tests (NAATs) and additional screening of extra-genital sites in GBMSM.

Any decrease in genital wart diagnoses may be due to a moderately protective effect of HPV-16/18 vaccination.

Any increase in genital herpes diagnoses may be due to the use of more sensitive NAATs.

Increases or decreases may also reflect other changes in testing practices (for example populations identified as being at risk, increased testing due to concern about a specific STI) and access to testing (for example increased access via online services, decreased access to face-to-face testing during the COVID-19 pandemic).

Figure 2 is a line chart showing trends in the diagnoses of the 5 main STIs (syphilis, gonorrhoea, chlamydia, genital herpes and genital warts) in London residents from 2019 to 2023. The chart shows chlamydia (52,466 diagnoses) as the top line of the chart, which reflects the fact that this is the most prevalent STI in the general population. It also shows that, while chlamydia, genital herpes and genital warts remained at lower levels than at the beginning of the 5-year period (and before the pandemic), gonorrhoea and syphilis had rebounded to higher levels. Syphilis diagnoses were 13% higher and gonorrhoea diagnoses were 8% higher than in 2019.

Figure 3. Diagnosis rates of the 5 main STIs, London residents, 2019 to 2023

Data sources: GUMCAD, CTAD

Figure3-2023

See notes for Figure 2.

Figure 3 is a line chart. Like Figure 2 it shows trends in the 5 main STIs, but as rates rather than numbers. For 2023, these ranged from 49.6 per 100,000 population for syphilis to 591.8 for chlamydia. The rate for genital warts was slightly lower than in 2022. Rates of the remaining 4 main STIs were higher in 2023 than in the previous year.

Table 1. Percentage change in new STI diagnoses, London residents

Data sources: GUMCAD, CTAD

Diagnoses	2023	Percentage change 2019 to 2023	Percentage change 2022 to 2023
New STIs	128,412	-15%	7%
Syphilis	4,396	13%	11%
Gonorrhoea	35,232	8%	11%
Genital warts	7,005	-42%	-1%
Genital herpes	7,230	-21%	14%
Chlamydia	52,466	-20%	3%
Trichomoniasis	3,352	-17%	17%
M. genitalium	3,599	38%	16%

See notes for Figure 2.

Table 1 summarises the changes seen in the previous 2 charts. It is especially useful for less common STIs such as syphilis as changes for these can be hard to see in charts which are scaled to include infections with much higher numbers, such as chlamydia. The table shows the number of diagnoses of new STIs and each of the 5 main STIs for London residents in 2023. Two columns follow this one. The first shows percentage change from 2019 (the first year of the 5-year period used for these reports) to 2023, while the second shows percentage change from 2022 to 2023.

While the number of new STIs was 15% lower in 2023 (128,412 diagnoses) compared to 2019, there had been a 7% increase when 2023 was compared to 2022, reflecting the rebound that is being seen in diagnoses. Syphilis (4,396 diagnoses) and gonorrhoea (35,232 diagnoses), 2 bacterial STIs of particular concern as they are often linked with higher risk sexual behaviours and dense sexual networks, were respectively 13% and 8% higher than in 2019 and both 11% higher than in 2022. Only one of the 5 main STIs saw a year on year decline in diagnoses in 2023 and that was genital warts (7,005 diagnoses) which fell by 1% and was 42% lower than in 2019.

Figure 4. Rates of new STIs per 100,000 London residents by age group (for those aged 15 to 64 years only) and gender, 2023

Data sources: GUMCAD, CTAD

Figure4-2023

Figure 4 is a pyramid chart which shows rates of new STIs by age group and gender in 2023. Rates are by 100,000 population in each age group for each gender and only Londoners aged 15 to 64 years are included. This reflects the sensitivity of data relating to those aged less than 15 years and the need to prevent the disclosure of small numbers.

The distribution of rates by age and gender in 2023 was skewed towards females in the youngest age group (15 to 19 year olds), was similar for both males and females for 20 to 24 year olds and was increasingly skewed towards males in age groups for those aged 35 years and above. The highest rates for females and males were 3,996 (20 to 24 year age group) and 4,898 (25 to 34 year age group). The shape of this age and gender pyramid does not tend to change significantly over time and is dominated by diagnoses of chlamydia, the most common STI in the UK.

Figure 5. Rates of gonorrhoea per 100,000 residents by age group (for those aged 15 to 64 years only) in London, 2019 to 2023

Data sources: GUMCAD

Figure5-2023

Age-specific rates are shown for those aged 15 to 64 years only.

Figure 5 is a line chart showing trends by age group in diagnoses of gonorrhoea in London residents for the years 2019 to 2023. As with the previous chart, only Londoners aged 15 to 64 years are included. The 25 to 34 year age group had the highest gonorrhoea diagnosis rates (854 per 100,000 population in 2019 and 989 in 2023), followed by the 20 to 24 year age group, (993 in 2019 and 901 in 2023).

Rates for other age groups were much lower. The rate for the youngest age group, the 15 to 19 year olds, fell most during the pandemic. By 2023 it had risen slightly to 269 but this was still well below the 492 seen in 2019. Similar trends have been seen in consultations (see figure 24). Younger age groups appear to have been more impacted by disruptions to service access and probably opportunities for social contact during the COVID-19 pandemic, compared to older age groups.

Gonorrhoea is the second most common STI in the UK, accounting for 28% of new STIs diagnosed in London residents in 2023. It is caused by the bacterium Neisseria gonorrhoeae. Symptoms vary and in some people (particularly women) may be absent. For those who do become symptomatic, symptoms normally start to show about 2 weeks after infection but in some cases may take months to appear (26). Gonorrhoea can still be transmitted even when a person has no symptoms. If untreated it can lead to complications, including fertility problems for women (27). Cases of gonorrhoea where the organism is resistant to antibiotics have become increasingly common (28).

Figure 6. Rates of genital warts per 100,000 residents aged 15 to 19 years by gender in London, 2019 to 2023

Data sources: GUMCAD

Figure6-2023

Figure 6 is a line chart showing trends in genital warts diagnoses by gender for London residents aged 15 to 19 years over the years 2019 to 2023. Last year’s rise in rate for females was reversed in 2023 with the rate falling to 26 from 30 per 100,000 girls aged 15 to 19 years in 2022. The rate for boys aged 15 to 19 years continued to decline, albeit more slowly than in previous years, and reached 17 in 2023.

Genital warts are small, rough lumps which form around the genital area and anus. This STI is caused by the human papillomavirus (HPV), a virus which can also cause cancer. It can take from a few weeks to several months for warts to appear after infection. People without symptoms can still pass the virus on (29).

The trend seen in the chart needs to be understood within the context of a sustained steep decline in rates over a decade to 2019, following the introduction of the HPV vaccination programme for children aged 12 to 13 years (for girls in 2008 and for boys in 2019). In 2019, the first year in the chart, rates were 94 per 100,000 girls aged 15 to 19 years and 59 per 100,000 boys aged 15 to 19 years, while in 2014 the equivalent rates were 372 for girls and 145 for boys.

Disruptions to the HPV vaccination programme are known to have occurred during the COVID-19 pandemic (2020 to 2021) and there may have been underdiagnosis during that period due to restricted access to services. In addition, as mentioned elsewhere in the report, numbers of consultations in the 15 to 19 year age group have yet to return to pre-pandemic levels and so there is a possibility that for this age group underdiagnosis continues to be an issue, even for post-pandemic years.

Figure 7. Syphilis diagnoses by number and percentage clinical stage: London residents, 2019-2023

Data sources: GUMCAD

Figure7-2023

Figure 7 is a line chart showing trends in diagnoses of infectious syphilis by clinical stage at diagnosis for London residents over the years 2019 to 2023. The first and final years are labelled with the numbers of diagnoses for each stage and, in brackets, the percentage of the total the stage accounts for.

The chart shows that diagnoses at the early latent stage have continued to increase (from 1,442 diagnoses in 2019 or 37% of the total to 1,822 diagnoses in 2023 or 41% of the total). The decline in primary syphilis diagnoses seen during the pandemic years (2020 to 2021) has reversed. The number of primary syphilis diagnoses in 2023 was 1,605, up from 1,439 in 2019, while proportionally this stage accounted for 37% of diagnoses in both years. Secondary syphilis diagnoses have declined slightly. This stage accounted for 969 diagnoses (or 22% of the total) in 2023, down from 994 diagnoses (or 26%) in 2019.

Syphilis is caused by the bacterium Treponema pallidum. It is primarily sexually transmitted but can also be transmitted from mother to baby during pregnancy or childbirth. As shown in the chart, it is an STI with multiple clinical stages. Primary syphilis describes the first stage after diagnosis which lasts around 21 days during which the person will develop a hard sore or chancre, usually in the genital area or near the anus. Secondary syphilis describes the stage that syphilis progresses to if not treated at the primary stage. Rashes and lesions develop at this stage. The next stage, latent syphilis, often has no symptoms, but will eventually, over a period of years, progress without treatment to tertiary syphilis (not shown in the chart above) which involves serious health complications and may cause death. Late latent and tertiary syphilis is not infectious apart from, rarely, from mother to baby. It should be noted that the classification of syphilis diagnoses by clinical stage can be challenging and some diagnoses may be misclassified (30)(31).

The dip in primary syphilis diagnoses seen during the pandemic years (2020 to 2021) may reflect a combination of behavioural change (due to decreased opportunities for social mixing) and reduced access to services, leading to delays in diagnosis.

Differences in trends by clinical stage were seen by gender and sexual orientation and as GBMSM account for 85% of diagnoses the overall trend is dominated by the trend for this group, which was the one most affected by the pandemic dip in primary syphilis diagnoses (followed by resurgence). Heterosexual men saw a slight (3%) decline in the number of primary syphilis diagnoses between 2019 and 2023 but continued to be the only group for which this stage was the most common stage at diagnosis (51% of syphilis diagnoses in 2019 and 44% in 2023). Heterosexual and bisexual women by contrast saw the greatest relative increase in early latent syphilis diagnoses (87%) between 2019 and 2023 and an increase in the proportion this stage made up of all syphilis diagnoses (from 41% in 2019 to 49% in 2023).

Figure 8. Rates of new STIs by ethnic group per 100,000 residents in London, 2023

Data sources: GUMCAD, CTAD

Figure8-2023

Figure 8 is a column chart showing rates of new STI diagnoses by ethnic group among London residents in 2023. The chart shows that the Black Caribbean ethnic group had the highest new STI diagnosis rate with 2,950 per 100,000 population. The next highest rates were those for the mixed ethnic group (2,311) and White other ethnic group (1,891). The ethnic groups with the lowest rates were the Indian, Pakistani and Bangladeshi (IPB) group (376), Asian other group (984) and White British group (1,072). Rates rose for all ethnic groups when compared with 2022.

Rates are for all ages. Age distributions will differ by ethnic group with the White British group having the oldest age distribution which will depress its rate as numbers of STI diagnoses in the oldest age groups are low. Groups containing larger numbers of migrants tend to have younger age distributions, although this is sensitive to the migration pattern for each ethnic group over time and to changes in self-identification. Identification with an ethnic group may also vary by context.

Ethnic group should not be interpreted as a proxy for world region of birth. Around half of those in the IPB and Black African ethnic groups diagnosed with a new STI in 2023 were born in the UK, while for other groups the proportion was even higher: around 6 in 10 for the mixed group, more than 3 in 4 of the Black other group and around 8 in 10 for Black Caribbeans.

Other important determinants, such as deprivation and issues of stigma, also vary by ethnic group. Ethnic group specific rates should always be interpreted in the wider context of determinants and never in isolation.

In addition, differences are seen when ethnic group specific rates are calculated for specific STIs. The White other ethnic group has the highest rate for both gonorrhoea and syphilis for example.

People’s sexual networks tend to contain more people of the same or similar ethnic group and a person’s risk of acquiring an STI is affected by the prevalence of STIs within their sexual network. However, the groups shown are relatively broad and some are more heterogenous than others.

The other and mixed ethnic group are extremely heterogenous and their composition will vary at a local level and over time. At a regional level, just under one-third of Londoners in the other ethnic group and diagnosed with a new STI in 2023 were born in Latin America, just over a quarter in the UK, around one-fifth in the Middle East or Central Asia and one-tenth in the European Union (EU). Around two-fifths of those in the mixed ethnic group were described as having ‘any other mixed background’, while around 3 in 10 were described as having a mixed White and Black Caribbean background, around 1 in 7 a mixed White and Black African background and around 1 in 8 a mixed White and Asian background.

Table 2. Percentage of London residents diagnosed with a new STI by ethnic group, 2023

Data sources: GUMCAD, CTAD

Ethnic group	Number	Percentage excluding unknown
White (British)	34,735	30%
White (other)	28,218	25%
Asian (IPB*)	4,773	4%
Asian (Chinese)	2,241	2%
Asian (other)	3,947	3%
Black (African)	9,874	9%
Black (Caribbean)	10,188	9%
Black (other)	2,587	2%
Mixed	11,688	10%
Other	6,161	5%
Unknown	14,000

Table 2 summarises the number of new STI diagnoses by ethnic group and the percentage that each group made up of all new STI diagnoses in 2023 where ethnic group is known. White ethnic groups accounted for 55% of new STI diagnoses (62,953 diagnoses), with the White British group making up the first 30% (34,735) and the White other group the remaining 25% (28,218). Asian ethnic groups accounted for 10% of new STI diagnoses (10,961), Black ethnic groups for 20% (22,649), the mixed ethnic group for 10% (11,688) and the heterogenous other group for 5% (6,161).

There has been little change in the distribution of new STI diagnoses by ethnic group over the past 5 years. The largest change was a 2% decline in the proportion of diagnoses in those recorded as Black Caribbean from 11% in 2019 to 9% in 2023.

Figure 9: Percentage of London residents diagnosed with a new STI by world region of birth (note 1), 2023

Data sources: GUMCAD data only

Figure9-2023

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. For this chart ‘heterosexuals’ includes heterosexual men and heterosexual or bisexual women

Note 2: SSA = Sub-Saharan Africa.

Figure 9 is a column chart showing the proportion of London residents who were diagnosed with a new STI in 2023 by their world region of birth. This chart is based only on diagnoses reported to GUMCAD as CTAD, the dataset which reports data about community tests and diagnoses of chlamydia, does not collect information about country of birth. The proportions are calculating using all GUMCAD new STI diagnoses where country of birth was reported, apart from chlamydia, for which only diagnoses at specialist SHSs are included.

The chart shows that over half of Londoners diagnosed with a new STI in 2023 were born in the UK (56%) with the next most common world region of birth being the European Union (EU) at 16%. These proportions have remained relatively stable over the period 2019 to 2023. No category saw an increase or decrease of more than one percentage point over the 5-year period except for the EU, for which a 2% decrease was recorded, and Latin America and the heterogenous other category, for which increases of 2% were recorded.

Variation was seen by sexual orientation. For example, GBMSM Londoners diagnosed with a new STI were more likely to be born in the EU (23%) or Latin America (9%) compared to other groups while heterosexual men and heterosexual or bisexual women were more likely to be born in the UK (63%).

London is a global city (32) with large communities of people born outside the UK, in Europe or in populous world regions such as Latin America and Sub-Saharan Africa. It has the highest proportion of people born abroad of any city in the UK. (33). Migrants are more likely than non-migrants to be working-age adults, rather than older adults, for example pensioners, who tend to have a lower incidence of STIs. It is essential to consider the size of a community and its distributions by gender and age when interpreting the proportion of diagnoses in people belonging to that community.

Figure 10. Rates of new STIs per 100,000 residents by decile of deprivation (note 1) in London residents, 2023

Data sources: GUMCAD, CTAD

Figure10-2023

Note 3: Deciles run from 1 to 10 in order of decreasing deprivation, with 1 being the decile for the most deprived area.

Figure 10 is a column chart which shows the new STI diagnosis rate by 100,000 population for each decile of deprivation in 2023. Deciles run from 1 to 10 in order of decreasing deprivation and are calculated at the level of lower super output area (LSOA) of residence, a unit of geography containing around 1,500 residents, across England. All new STI diagnoses in London residents reported with an LSOA of residence code that could be linked to Index of Multiple Deprivation (IMD) data for 2019 are included. The rates are not adjusted for the underlying population demographics for example age distribution.

The chart shows that new STI diagnosis rates were highest in LSOAs which are linked to the decile of third-highest deprivation (2,103 per 100,000 population) falling thereafter with each decile and reaching 537 for the decile of lowest deprivation. Rates for each of the first 5 deciles were above the London regional rate of 1,448 and almost three-quarters of Londoners diagnosed with a new STI in 2023 lived in an area where deprivation was within the first 5 deciles.

Differences are apparent when these diagnoses are stratified by ethnic group, with the proportion living in areas in the first 5 deciles of deprivation lower for those reported to be White British (66%), slightly lower for those belonging to Asian ethnic groups (71%), slightly higher for those in the mixed ethnic group (77%) and higher for those belonging to Black ethnic groups (84%). Very similar proportions were seen even when these groups were further stratified by whether born in the UK. The rates in the least deprived deciles may be depressed by the tendency for more affluent areas to have older populations. However, the association between deprivation and increased health inequalities is well evidenced (34).

Figure 11. Diagnoses of the 5 main STIs among Heterosexual men and heterosexual or bisexual women*, London residents, 2018 to 2022

Data sources: GUMCAD, CTAD

Figure11-2023

*Data on sexual orientation is not collected by CTAD. All information about heterosexual men and heterosexual or bisexual women is based on diagnoses made in specialist and non-specialist services which report to GUMCAD and exclude chlamydia diagnoses via online services.

Notes

It is important to consider whether there have been any changes to testing or vaccination practices when interpreting increases or decreases in STIs. The following paragraphs list various considerations.

Increases in gonorrhoea may be due to the increased use of highly sensitive nucleic acid amplification tests (NAATs) and additional screening of extra-genital sites in GBMSM.

Decreases in genital wart diagnoses may be due to the moderately protective effect of HPV-16/18 vaccination.

Increases in genital herpes diagnoses may be due to the use of more sensitive NAATs.

Figure 11 is a line chart showing trends in the diagnoses of the 5 main STIs (syphilis, gonorrhoea, chlamydia, genital herpes and genital warts) in heterosexual men and heterosexual or bisexual women resident in London for the period 2019 to 2023. The data comes from GUMCAD only as CTAD does not collect information on sexual orientation. It also excludes chlamydia diagnoses reported via online services due to a proportion of missing information about sexual orientation. It is important to be aware of these exclusions when interpreting the number of chlamydia diagnoses.

Diagnoses of all 5 major STIs fell in 2020 and, with the exception of syphilis, in 2021. Since 2022, diagnoses of all 5 have been rising. Diagnoses of syphilis, a bacterial STI which can be a marker of higher risk sexual behaviour in the community, had already returned to pre-pandemic levels by 2021 and in 2023 the number of diagnoses was 28% (556 diagnoses) higher than in 2019, the last pre-pandemic year. Chlamydia remained the most prevalent STI among heterosexuals with 10,605 diagnoses reported to GUMCAD.

Table 3. Percentage change in new STI diagnoses in heterosexual and female heterosexual or bisexual* residents in London

Data sources: GUMCAD data only

Diagnoses	Gender	2023	Percentage change 2019 to 2023	Percentage change 2022 to 2023
New STIs	Total	44,907	-38%	16%
New STIs	Male	21,805	-40%	17%
New STIs	Female	23,102	-36%	14%
Syphilis	Total	556	28%	18%
Syphilis	Male	327	13%	5%
Syphilis	Female	229	57%	41%
Gonorrhoea	Total	8,292	-18%	16%
	Male	4,086	-20%	22%
	Female	4,206	-16%	12%
Chlamydia	Total	10,605	-56%	18%
	Male	4,816	-56%	17%
	Female	5,789	-56%	19%
Genital herpes	Total	5,378	-27%	21%
	Male	1,695	-26%	29%
	Female	3,683	-27%	18%
Genital warts	Total	5,250	-46%	1%
	Male	2,868	-47%	2%
	Female	2,382	-45%	1%

See notes for Figure 10

Table 3 summarises the changes seen in the previous chart. The table shows the number of diagnoses of new STIs and each of the 5 main STIs for heterosexual men and heterosexual or bisexual women resident in London in 2023. For each STI category there is a row showing the total (men and women) and then rows by gender. Two more columns follow. The first shows percentage change from 2019 (the first year of the 5-year period used for these reports) to 2023, while the second shows percentage change from 2022 to 2023.

When 2023 is compared to the previous year, 2022, diagnoses of most of the 5 main STIs remained at lower levels for heterosexual men and heterosexual or bisexual women resident in London. The largest percentage rise overall for the group was in the number of genital herpes diagnoses (21%) with a particularly large increase for heterosexual men (29%). This was the largest year-on-year increase seen for heterosexual men. A large rise was also seen in gonorrhoea diagnoses in this group: 22%. For heterosexual or bisexual women the largest year on year increase was in syphilis diagnoses, an increase of 41%. By contrast, the rise among heterosexual men was 5%.

Diagnoses of the most of the 5 main STIs remained below pre-pandemic levels. Only for syphilis were numbers higher in 2023 than in 2019. The rise was particularly marked in heterosexual or bisexual women who saw a 57% increase, while for heterosexual men the rise was 13%.

Heterosexual or bisexual women in London diagnosed with an STI tended to be younger than heterosexual men. The age difference was largest for syphilis. Heterosexual/ bisexual women diagnosed with syphilis in 2023 had a median age of 29 years (interquartile range (IQR): 25 to 36 years) compared to 34 years (IQR: 29 to 43 years) for heterosexual men. These median ages remained stable over the 5-year period.

Despite the rising trends for heterosexual men and heterosexual or bisexual women, these groups accounted for fewer than 14% of syphilis diagnoses in Londoners with a known gender and sexual orientation diagnosed in 2023. Numbers remain low in comparison with other major STIs and trends are consequently more sensitive to relatively small changes in absolute numbers. The most prevalent STI for heterosexual men and heterosexual or bisexual women in 2023 remained chlamydia (10,605 chlamydia diagnoses). Heterosexual men and heterosexual or bisexual women accounted for more than half of chlamydia diagnoses in 2023 in Londoners (where gender and sexual orientation were known).

Figure 12. Diagnoses of the 5 main STIs among GBMSM*, London residents, 2019 to 2023

Data sources: GUMCAD data only

Figure12-2023

*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.

Notes

It is important to consider whether there have been any changes to testing or vaccination practices when interpreting increases or decreases in STIs. The following paragraphs list various considerations.

Increases in gonorrhoea may be due to the increased use of highly sensitive nucleic acid amplification tests (NAATs) and additional screening of extra-genital sites in GBMSM.

Decreases in genital wart diagnoses may be due to the moderately protective effect of HPV-16/18 vaccination.

Increases in genital herpes diagnoses may be due to the use of more sensitive NAATs.

Increases or decreases may also reflect other changes in testing practices (for example populations identified as being at risk, increased testing due to concern about a specific STI) and access to testing (for example increased access via online services, decreased access to face-to-face testing during the COVID-19 pandemic).

Figure 12 is a line chart showing trends in the diagnoses of 5 main STIs (syphilis, gonorrhoea, chlamydia, genital herpes and genital warts) in GBMSM London residents from 2019 to 2023. The data comes from GUMCAD only as CTAD does not collect information on sexual orientation. It also excludes chlamydia diagnoses reported via online services due to the proportion of missing information about sexual orientation. It is important to be aware of this when interpreting the number of chlamydia diagnoses.

The chart shows that gonorrhoea (23,542 diagnoses), rather than chlamydia, remained the most prevalent STI among GBMSM in 2023. It also shows that both syphilis (3,468 diagnoses) and gonorrhoea, 2 important bacterial STIs, continued to be diagnosed at higher levels than before the pandemic. Rises were seen for all 5 main STIs when 2023 is compared to the previous year 2022, with syphilis and gonorrhoea diagnoses both increasing by 11%.

Table 4. Percentage change in new STI diagnoses in GBMSM* residents in London

Data sources: GUMCAD data only

Diagnoses	2023	Percentage change 2019 to 2023	Percentage change 2022 to 2023
New STIs	43,812	-<1%	9%
Syphilis	3,468	9%	11%
Gonorrhoea	23,542	15%	11%
Genital warts	798	-32%	1%
Genital herpes	976	-1%	4%
Chlamydia	10,005	-24%	6%

See notes for Figure 11

Table 4 summarises the changes seen in the previous chart. The table shows the number of diagnoses of new STI and each of the 5 main STIs for GBMSM London residents in 2023. Two more columns follow. The first shows percentage change from 2019 (the first year of the 5-year period used for these reports) to 2023, while the second shows percentage change from 2022 to 2023.

The only one of the 5 main STIs where numbers remained significantly lower than before the pandemic was genital warts diagnoses. The 798 diagnoses seen for 2023 was 32% lower than the 1,165 diagnoses seen in 2019. The total number of new STI diagnoses in GBMSM Londoners was at almost the same level (less than 1% lower) in 2023 (43,812) compared to 2019 but 9% higher than in 2022. New diagnoses of syphilis were 9% higher in 2023 compared to 2019 and 11% higher than 2022, while gonorrhoea diagnoses were 15% higher than in 2019 and had risen by 11% when compared with 2022.

The 5-year and year-on-year increases for syphilis are smaller than those described above for heterosexual or bisexual women and the year-on-year rise for gonorrhoea smaller than that described for heterosexual men, but GBMSM accounted for 85% of syphilis diagnoses and 73% of gonorrhoea diagnoses in London residents in 2023. For syphilis this proportion was only slightly below the 88% for 2019, while for gonorrhoea it was higher than the 67% in 2019.

Median age at diagnosis for syphilis for GBMSM diagnosed with syphilis in 2023 was 37 years (IQR: 31 to 45 years) and for those diagnosed with gonorrhoea was 33 years (IQR: 28 to 40 years). These median ages have remained stable over the 5-year period. There was a slight increase in median age at diagnosis for GBMSM diagnosed with any new STI from 32 years (IQR: 27 to 40 years) to 34 years (IQR: 28 to 41 years) over the 5 period.

Figure 13a. Rate of new STI diagnoses per 100,000 population by local authority of residence, London residents, 2023

Data sources: GUMCAD, CTAD

Figure13a-2023

Figure 13a is a column chart which displays the rate of new STI diagnoses in 2023 by London local authority (LA) of residence. Rates are by 100,000 population and for all ages. Local Authorities are shown in descending order. The overall London rate and England rate are represented as lines.

The LA with the highest rate was Lambeth (3,730 per 100,000). Bexley had the lowest rate (516). The ordering of the LAs reflects a tendency for inner London LAs to have higher rates than outer London LAs. Inner London LAs tend to have more diverse populations, especially in relation to sexual orientation, ethnicity and country of origin, in comparison with outer London LAs. They may also have higher socio-economic deprivation scores. Twenty-six of London’s 33 LAs had new STI rates that were greater than the rate for England as a whole.

Figure 13b. Rate of new STI diagnoses (excluding chlamydia diagnoses in residents aged under 25 years) per 100,000 population by local authority of residence, London, 2023

Data sources: GUMCAD, CTAD

Figure13b-2023

Prior to 2023, this figure showed rates for the population aged 15 to 64 years, excluding chlamydia in those aged 15 to 24 years.

Figure 13b is another column chart. Like the previous chart it displays the rate of new STI diagnoses in 2023 by London LA, however for this version of the rate, chlamydia diagnoses in those aged less than 25 years are excluded. This is because this age group is actively targeted for screening for chlamydia. Variations in the local implementation of screening may distort the new STI rate and removing diagnoses for the affected age group helps us address this issue. The demographic profile of the local population also needs to be considered when interpreting this chart. As with the previous chart, the London and England rates are superimposed on the chart as lines.

The ordering of LAs is not markedly different in this version of the chart. As with the previous chart, Lambeth had the highest rate (3,304 per 100,000) and Bexley the lowest (386). Twenty-seven of London’s 33 LAs had a rate higher than that for England as a whole.

Figure 14. Chlamydia detection rate per 100,000 female residents aged 15 to 24 years by local authority of residence, London, 2023

Data sources: GUMCAD, CTAD

Figure14-2023

Prior to 2023, this figure showed rates for the whole population aged 15 to 24 years, regardless of gender.

Figure 14 is another column chart. Rates are shown in descending order as with the previous charts and show the chlamydia detection rate in 2023 for girls and women resident in London aged 15 to 24 years, the age group targeted for chlamydia screening. Rates are by 100,000 female population in this age group. Prior to 2023, STI Spotlight reports showed this rate unrestricted by gender. In June 2021 the focus of the National Chlamydia Screening Programme (NCSP) was changed to a focus on reducing the harms from untreated chlamydia infection and a new detection rate indicator (DRI) of 3,250 per 100,000 female population aged 15 to 24 years.

Although there are more inner London LAs towards the left of the chart and more outer London LAs towards the right, there is more geographic variation for this rate. For example, Bromley (1,988), an outer London LA is in the middle of the chart. Lambeth had the highest chlamydia detection rate (3,542) and Redbridge the lowest (1,079).

Chlamydia detection rates for girls and women aged 15 to 24 years are tending to fall in London local authorities. The rate for London as a region was 2,028 in 2023. This is only 62% of the 3,250 DRI target and also represents a fall of 43% from 3,531 in 2019. The number of London LAs that are displaced to the right (lower detection rate) compared to the previous chart (higher new STI rate) is of concern as it suggests there may be a greater shortfall in detections for these LAs.

Chlamydia is the most common STI in the UK. Including diagnoses made via community screening, it accounted for 41% of new STIs diagnosed in London residents in 2023. It is particularly common in younger age groups. Most people who become infected do not have any symptoms but if symptoms do develop this can happen any time from a week to several months after infection. Untreated chlamydia infections can result in serious health problems. They may increase the risk of HIV and STI transmission acquisition and transmission and cause fertility problems for women (35).

Figure 15. Rate of gonorrhoea diagnoses per 100,000 population by local authority of residence, London residents, 2023

Data sources: GUMCAD

Figure15-2023

Figure 15 is also a column chart. It shows rates of gonorrhoea diagnoses in 2023 in London residents by 100,000 population. The rates are not gender-specific but as gonorrhoea is a more common STI among GBMSM, LAs with larger GBMSM populations will tend to have higher rates. The demographic profile of the local population needs to be considered when interpreting this chart.

Lambeth had the highest gonorrhoea diagnosis rate in London in 2023 with 1,295, while Sutton had the lowest at 103. All London LAs saw an increase when 2023 is compared 2022, apart from Westminster (-4%), Hillingdon (-3%) and Kingston upon Thames (-1%).

Figure 16. Map of new STI rates per 100,000 residents by local authority in London, 2023

Data sources: GUMCAD, CTAD

Figure16-2023

Figure 16 is a map showing new STI diagnosis rates per 100,000 population for London LAs in 2023. The higher rates in inner London LAs described for figure 12a earlier can be seen clearly. Also visible are higher rates in some outer London boroughs. These tend not to be quite as high as those seen in inner London but are still considerably higher than those in nearby outer London LAs. Examples are Waltham Forest in North London (1,235), Brent in West London (1,594), Newham in East London (1,263) and Croydon in South London (1,111). These may in part reflect changes in settlement patterns for economically disadvantaged and migrant communities.

Figure 17. Map of new STI rates per 100,000 residents by middle super output area (MSOA) in London, 2023

Data sources: GUMCAD, CTAD

Figure17-2023

Figure 17 shows a map of new STI rates per 100,000 residents by middle super output area (MSOA) of residence in 2023.

The map shows that when we look at London in more geographical detail than at LA level we see even more geographical variation: areas of lower rates in areas within inner London LAs and areas of higher rates in some outer London LAs. An area just south of the River Thames encompassing Lambeth and north-east Wandsworth forms a large area with high diagnosis rates but there are also other areas in outer London boroughs, for example an area in the ‘Thames gateway’ area in east London and areas in Barnet, Croydon and on the western edge of Hillingdon.

MSOA is a geographical classification designed to create areas of similar population size (around 7,500 residents) and as such may vary widely in area size, reflecting differences in population densities. Inner London LAs tend to have considerably higher population densities than outer London ones. The total area of lighter coloured MSOAs may look larger in the map above but this reflects lower diagnosis rates in outer London LAs with lower population densities. In addition, a greater proportion of the population in outer London is 65 years or older compared to inner London, an age group in which STI diagnoses tend to be lower. This difference in age structure will tend to depress rates for areas in outer London relative to those for inner London.

Figure 18. STI testing rate (excluding chlamydia in under 25 year olds) per 100,000 population in London residents aged 15 to 64 years, 2012 to 2023

Data sources: GUMCAD, CTAD

Figure18-2023

Figure 18 is a line chart showing trends in the STI testing rate for London and England from 2012 to 2023. Tests for chlamydia in those aged less than 25 years are excluded. The line for London is considerably above that of England. In 2023, London had a testing rate of 9,369 per 100,000 population aged 15 to 64 years, compared to England’s 4,111. The lines for both London and England show a noticeable downward turn in 2020, the main pandemic year, but both lines turn upward again from 2021 onwards. London’s rate has risen more steeply than England’s over the 5-year period from 2019 to 2023: 12% compared to 4%. It now exceeds pre-pandemic levels but, as the next chart shows, positivity has not returned to pre-pandemic levels.

Figure 19. STI testing positivity rate(note 4) (excluding chlamydia in under 25 year olds) in London residents, 2019 to 2023

Figure19-2023

Note 4: The numerator for the STI testing positivity rate now only includes infections which are also included in the denominator. These are: chlamydia (excluding diagnoses in those aged under 25 years), gonorrhoea, syphilis and HIV. Up to 2018 (data for 2017) it included all new STIs.

Figure 19 is a line chart like the one preceding it. It has 2 lines, one each for London and England, covering the 5-year period 2012 to 2023. Whereas figure 17 showed the STI testing rate, this chart shows the proportion of tests that were positive. As with the previous chart, chlamydia tests in those aged less than 25 years are excluded. The line for London is higher than the line for England as a whole, but the difference is not so marked as seen for the testing rate. In 2023, 8.5% of STI tests in Londoners were positive, compared to 7.3% for England residents as a whole. Positivity rose slightly in the main COVID-19 pandemic year, 2020, before falling in 2021. Since then it has risen but remains at lower levels than before the pandemic.

The difference in trends for London’s STI testing rate compared to its STI testing positivity rate may be partly a reflection of more testing in groups with a lower prevalence of STIs, but it is important not to over-interpret a two-year trend.

Table 5. Number of diagnoses of new STIs by UKHSA region of residence, data source and data subset 2023

Data sources: GUMCAD, CTAD

UKHSA region of residence	GUMCAD : specialist SHSs	GUMCAD: non-specialist SHSs(note 5)	CTAD(note 6)	Total
East Midlands	14,758	8,212	5,029	27,999
East of England	18,062	4,855	7,409	30,326
London	87,279	12,689	28,444	128,412
North East	11,007	2,045	2,743	15,795
North West	35,993	4,742	11,742	52,477
South East	31,875	2,495	11,671	46,041
South West	17,956	3,944	6,017	27,917
West Midlands	20,031	4,588	5,183	29,802
Yorkshire and Humber	21,991	2,478	7,895	32,364

Note 5: Diagnoses from sexual and reproductive health services reporting to GUMCAD are included in the ‘Non-specialist sexual health services (SHSs)’ total.

Note6: Including site type 12 chlamydia from GUMCAD.

Table 5 summarises new STI diagnoses for each UKHSA English region in 2023 by the surveillance system through which they were reported and, for GUMCAD, whether they were reported by specialist or non-specialist sexual health services (SHSs). Of the 128,412 new STI diagnoses in London residents, about two-thirds were reported by specialist SHSs via GUMCAD while about 1 in 10 were reported via the same system but by non-specialist SHSs. Just over a fifth of new STI diagnoses were reported through CTAD. London’s proportion via CTAD was in line with the UKHSA English region average. Its proportion via specialist SHSs was a little higher.

Table 6. Number of diagnoses of the 5 main STIs in London by STI, data source and data subset 2023

Data sources: GUMCAD, CTAD

5 main STIs	GUMCAD		CTAD(note 8)	Total
	Specialist SHSs	Non-specialist SHSs(note 7)
Chlamydia	23,478	544	28,444	52,466
Genital herpes	7,001	229		7,230
Genital warts	6,768	237		7,005
Gonorrhoea	24,029	11,203		35,232
Syphilis	4,365	31		4,396

Note7: Diagnoses from sexual and reproductive health services reporting to GUMCAD are included in the ‘Non-specialist sexual health services (SHSs)’ total. It is possible 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.

Note 8: Including site type 12 chlamydia from GUMCAD.

Table 6 summarises diagnoses of the 5 main STIs for London residents in 2023 by the surveillance system through which they were reported and, for GUMCAD, whether they were reported by specialist or non-specialist sexual health services (SHSs). CTAD only collects information on chlamydia diagnoses so the only entry in that column is for that STI. It accounted for 54% of chlamydia diagnoses with 45% being reported by specialist SHSs through GUMCAD and just 1% by non-specialist SHSs through GUMCAD. The only STI where more than 3% of diagnoses were reported via non-specialist SHSs was gonorrhoea (32%). The STI with the highest proportion reported via specialist SHSs was syphilis, where 99% of diagnoses were in this group.

Figure 20. Shigella diagnoses in London residents presumed GBMSM by year and quarter of specimen: 2017 to Q3 of 2024

Data source: SGSS

Figure20-2023

Figure 20 is a line chart which shows shigella diagnoses in London residents presumed to be GBMSM between the beginning of 2017 and the end of the third calendar quarter (September) of 2024. Years are subdivided into quarters. Unlike the preceding charts, the data is drawn from the laboratory reporting system, SGSS. Whilst SGSS data is more timely than data available from the GUMCAD Surveillance System, given the voluntary reporting of STIs, the data for STIs in SGSS cannot be considered complete.

The chart shows a steep fall of shigella diagnoses in London residents presumed GBMSM in 2020, the main pandemic year, followed by a renewed rising trend beginning in the second quarter of 2021. By the end of 2022 the number of shigella diagnoses in this group was already higher than seen before the pandemic and in quarter 3 of 2023, reached 322, the highest number reported over the period. Numbers of diagnoses have remained high since then. In quarter 3 of 2024, the most recent quarter for which we have data, there were 308 diagnoses.

Figure 21. LGV diagnoses in London adult male residents aged 16 years or older by year and quarter of specimen: 2019 to quarter 3 of 2024

Data source: SGSS

Figure21-2023

Figure 21 is a line chart showing LGV diagnoses in London adult male residents aged 16 years or older by year and calendar quarter from the beginning of 2019 to the end of the third quarter (September) of 2024. As with the previous chart, it is based on data from the laboratory reporting system, SGSS. Only data for men is included as LGV is very rare in women and investigations of cases reported to be female have suggested that these are mostly due to reporting errors.

The trend for LGV is more difficult to interpret. The number of LGV diagnoses peaked in the third quarter of 2019 with 194 diagnoses and then fell. As with other STIs, there was a steep drop in the second quarter of 2020, the main lockdown period. However, the number of LGV diagnoses then rose in the next quarter before falling again in 2021. A pattern of peaks and troughs continued, with numbers reaching 195 in the fourth quarter of 2022, before falling again. Numbers have been more stable since late 2023, with 129 diagnoses reported for quarter 2024, the most recent quarter for which we have data.

Figure 22. Confirmed and highly probable mpox cases by year and month of specimen: London residents, 2022 to September 2024

Data source: SGSS and Rare and Imported Pathogens Laboratory, UKHSA

Figure22-2023

Mpox is a zoonotic infection, caused by the monkeypox virus, that previously occurred mostly in West and Central Africa and is transmitted through close contact (including through sexual contact). Previous cases in the UK had been either imported from countries where mpox is endemic or contacts with documented epidemiological links to imported cases.

In 2022, there was a very large outbreak of mpox with community transmission in the UK, mainly in GBMSM. London was most affected, with 2,439 cases reported in 2022 (69% of the England total), with 98% being adult males. In response to the rise in mpox cases, over 50,000 mpox vaccinations were given in 2022 in London, mainly to GBMSM, with vaccination persisting into 2023.

Figure 22 is a bar chart showing the number of confirmed and highly probable mpox cases in London residents by month from 2022 to September 2024. The figure shows a rapid increase in cases in May 2022, to a peak of more than 800 cases being reported in July 2022 and a subsequent decline to low numbers by November 2022. The number of diagnoses each month remains low in 2024 but has tended to increase slightly in the most recent months with 31 diagnoses reported for September 2024, the most recent month for which we have data.

Figure 23. Consultations by service medium: London residents, 2019 to 2023

Data source: GUMCAD

Figure23-2023

Figure 23 is a column chart. It shows the number of sexual health consultations for London residents for the 5 years from 2019 to 2023 by consultation medium. Consultations is a term used here to describe contacts with sexual health services, which may vary from a face-to-face clinic appointment, to online triage or asymptomatic screening.

The rise in online consultations can be seen throughout the 5-year period, but it accelerated rapidly in 2020, the main pandemic year, due to the need to facilitate access to services during the first lockdown when face-to-face consultations were tightly restricted. Compared to 2019, the number of online consultations was 242% higher in 2023. The number rose by 12% when 2023 is compared to 2022. As a proportion of all consultations, online consultations increased from 21% in 2019 to 57%, the majority, by 2023.

Consultations by phone also rose in response to the pandemic, albeit from a much smaller base (1% in 2019), however in 2023 the number of phone consultations fell by 36% compared to 2022 and accounted for just 2% of all consultations.

Face-to-face was the only consultation medium to decline over the 5-year period. Face-to-face consultations fell by 31%, although numbers have been rising since 2021. In 2019, 78% of consultations were face-to-face but by 2023 this had fallen to 41%.

When all consultation mediums are considered together, the total number of consultations increased by 30% from 1,213,389 to 1,574,578 between 2019 and 2023. GBMSM saw a higher proportional rise in consultations in this time period (49% increase), compared to heterosexual or bisexual women (32% increase) and heterosexual men (21% increase).

There was also variation by sexual orientation for the proportion of consultations that were online, with the highest proportion of online consultations in 2022 being among heterosexual men (66%), compared to heterosexual or bisexual women (62%) and GBMSM (48%). This variation may reflect preferences in contact type, availability of a face-to-face consultation or clinical need for a face-to-face consultation.

Figure 24. Consultations by age group: London residents aged 15 to 64 years, 2019 to 2023

Data source: GUMCAD

Figure24-2023

Figure 24 is a line chart. It shows the number of sexual health consultations for London residents aged 15 to 64 years for the 5 years from 2019 to 2023 by age group.

Clear differences are seen in the trends by age group. Most age groups saw rises in the number of consultations between 2019 and 2023. However, these rises varied greatly in size. The largest increases were seen for the 25 to 34 and 35 to 44 year age groups: Both these groups saw consistent year on year rises. For the 25 to 34 year age group the number of consultations in 2023 represented a 43% increase compared to 2019, while for the 35 to 44 year age group the increase was 39%.

By contrast, for the 15 to 19 year age group the number of consultations in 2023 represented a fall of 22% compared to 2019 for the 15 to 19 year age group. For the 20 to 24 year age group, the number of consultations in 2023 did represent an increase compared to 2019, but at 16% it was much lower than that seen for older age groups. Both age groups saw decreases in 2023 compared to the previous year (a 10% fall for the 15 to 19 year age group and a 2% fall for the 20 to 24 year age group).

Trends in consultations for Londoners aged 15 to 19 years and 20 to 24 years, especially the former, are strongly influenced by trends for girls and women, who account for around three-quarters of consultations in those aged 15 to 19 years and two-thirds of those aged 20 to 24 years. In addition, heterosexual boys and men make up a greater proportion of men accessing consultations in the younger age group than seen for older age groups.

Information on data sources

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

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 NHS and local authority or NHS-commissioned chlamydia testing carried out in England. CTAD is comprised of all chlamydia (NAATs) tests for all ages (apart from 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.

Chlamydia diagnoses in people aged 15 to 25 years may be excluded in some data analysis or graphs as these individuals are in the age group targeted by the National Chlamydia Screening Programme (NCSP).

New STIs

New STI diagnoses comprise diagnoses of the following: chancroid, 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

ONS mid-year population estimates for 2022 were used as a denominator for rates (other than by ethnic group) for 2023. ONS estimates of population by ethnic group for the year 2019 were used as a denominator for rates by ethnic group for 2023. 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 2023 in this report with rates by 2022 in last year’s report, as the rates in the last report used the 2011 estimates.

Data completeness

The completion of all demographic variables used in analyses in this report was above 90% for 2023, apart from ethnic group which was 89% complete. Sexual orientation and country of birth (from which world region of birth is derived) are only reported by GUMCAD. CTAD data is therefore not included when calculating variable completeness for these variables.

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, access the online Sexual and Reproductive Health Profiles.

For more information on local sexual health data sources, see the 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. Please contact GUMCAD@ukhsa.gov.uk for further information regarding access to the Data Exchange.

For a report on HIV in London, access the Annual Epidemiological Spotlight on HIV in London.

For other queries, please contact FES.SEaL@ukhsa.gov.uk.

About the Field Service

The Field Service 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 FES.SEaL@ukhsa.gov.uk.

Acknowledgements

We would like to thank the following:

*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

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