Research and analysis

Spotlight on sexually transmitted infections in the South West: 2023 data

Updated 21 August 2025

Summary

This report focuses on sexually transmitted infections (STIs) in the South West, excluding HIV which is addressed in the HIV Spotlight report (1). This report primarily focuses on trends between 2022 and 2023, but trends relative to 2019 are included to provide a comparison to the period before the COVID-19 pandemic.

In 2023, the South West had the second lowest rate of new STI diagnoses out of all the UK Health Security Agency (UKHSA)’s regions. Whilst incidence is lower compared to other areas, STIs remain an important public health problem in the South West. A total of 27,917 new STIs were diagnosed among South West residents in 2023, representing a rate of 484 diagnoses per 100,000 population.

Rates of new diagnoses varied by geography, with the highest rates seen among residents of the Bristol (760 per 100,000) and Plymouth (755 per 100,000) upper-tier local authority areas (UTLAs). Both these UTLAs had rates above the national average for England. North Somerset (350 per 100,000), Somerset (346 per 100,000), and Wiltshire (311 per 100,000) had the lowest incidence of new STI diagnoses in the South West. These trends reflect of the fact that predominantly urban areas have a younger and more densely distributed population with diverse sexual networks compared to predominantly rural areas.

The total number of new STIs diagnosed among residents in the South West in 2023 is similar to what was observed in 2022. However, diagnoses of certain STIs have increased in 2023, as described further in the ‘Overall trends in STI diagnoses’ section below. Chlamydia and gonorrhoea remain the most common newly diagnosed STIs in South West residents.

Overall, young people in the South West continue to have the highest rates of new STIs. Females aged 20 to 24 years had the highest rate of new STI diagnoses (3,176 per 100,000), followed by males in the same age group (2,300 per 100,000).

The rate of new STIs among people who lived in the most deprived areas (729 per 100,000) was over double that of people who lived in the least deprived areas (332 per 100,000). Where country of birth was known, 86% of South West residents diagnosed with a new STI in 2023 (excluding chlamydia diagnoses reported through CTAD) were UK-born.

Access to sexual health services

Access to sexual health services (SHSs) has downstream impacts on sexual health data, especially counts and trends of new STI diagnoses. Overall, STI testing rates (excluding chlamydia in under 25 year olds) in the South West continued to increase in 2023, and are approaching those seen in 2019 prior to the COVID-19 pandemic. The STI testing positivity rate (excluding chlamydia in under 25 year olds) is at the highest it has been between 2012 and 2023, at 5.2%, although this is similar to the 2022 rate (which was 5.0%).

Compared to other English regions, the South West reported a relatively large proportion of diagnoses via non-specialist sexual health services, including remote online sexual health testing services.

There were almost 10,000 more consultations in 2023 (323,155) compared to 2022 (313,229), a rise of 3.2%. The most common consultation medium was face-to-face (160,426) followed by online consultations (123,490) and telephone consultations (39,239). Compared to 2022, the number of telephone consultations decreased by 8.5%, online consultations increased by 0.4%, and face-to-face consultations increased by 8.8%. However, the number of online consultations has notably increased between 2019 (53,083) and 2023 (123,490). Among gay, bisexual, and other men who have sex with men (GBMSM), 60% of consultations occurred in face-to-face appointments, compared to 42% of men who have sex with women (MSW), 43% of women that have sex with men (WSM), and 28% of women who have sex with women (WSW).

Overall trends in STI diagnoses

The total number of new STIs diagnosed among residents in the South West in 2023 is similar to what was observed in 2022 (27,917 in 2023, 27,847 in 2022, a 0.25% increase). However, there have been increases in gonorrhoea and syphilis counts in the last year. The following changes were observed in the number of diagnoses of the 5 main STIs between 2022 and 2023:

• gonorrhoea increased by 14%
• syphilis increased by 13%
• genital herpes remained stable (0% change)
• chlamydia decreased by 3%
• genital warts decreased by 11%

In 2023, 85,223 gonorrhoea diagnoses were recorded in England, marking the highest number of cases in any one year since records began in 1918 (2). Consistent with the national picture, a notable increase in gonorrhoea was seen in the South West towards the end of 2022 and in 2023. Among South West residents, gonorrhoea rates were highest in those aged 20 to 24 years, however, diagnosis rates across all age groups were higher than pre-pandemic rates. While gonorrhoea rates fell in those aged 15 to 19 in 2023, they continued to increase in those aged 20 to 24. In addition to gonorrhoea, rates of syphilis in GBMSM were also higher in 2023 than pre-pandemic levels, as described below.

Diagnoses of genital warts decreased by 11% overall between 2022 and 2023. However, for the first time, there has been a small rise in diagnoses in both females and males aged 15 to 19. This trend may be due to improved detection of genital warts in this age group, corresponding with the recent increase in face-to-face SHS consultations. There has been a 13% increase in syphilis diagnoses between 2022 to 2023, with 394 new diagnoses in 2023. The majority of these (285 diagnoses) were among GBMSM. Trends in STIs among GBMSM are described in more detail further below.

National chlamydia screening detection rate indicator

UKHSA recommends that local areas should be working towards achieving a chlamydia detection rate of at least 3,250 per 100,000 among women aged 15 to 24 years, and this is an indicator in the Public Health Outcomes Framework (3). In 2023, the chlamydia detection rate among women aged 15 to 24 years in the South West was 1,839 per 100,000, below the target level.

Populations with greater health needs

Gay, bisexual and other men who have sex with men

GBMSM continue to experience health inequalities related to STIs. Where gender and sexual orientation are known, GBMSM accounted for 19% of South West residents diagnosed with a new STI in 2023, excluding chlamydia diagnoses reported on CTAD.

Of all diagnoses of syphilis in 2023, 82% were among GBMSM, and of all diagnoses of gonorrhoea in 2023, 43% were among GBMSM.

Overall, new STIs in GBMSM have increased 20% between 2022 and 2023. Gonorrhoea and syphilis, important bacterial STIs that are often correlated with higher-risk sexual behaviours, have increased in GBMSM by 17% and 27% respectively. Both are now at higher levels than before the COVID-19 pandemic.

The largest year-on-year increase in GBMSM diagnoses was observed in genital herpes (33%), although counts are lower than other STIs (104 diagnoses in 2023).

Young people

STIs disproportionately affect young people. South West residents aged between 15 and 24 years accounted for 52% of all new STI diagnoses in 2023. Females aged 20 to 24 years had the highest rate of new STI diagnoses (3,176 per 100,000), followed by males in the same age group (2,300 per 100,000). This is substantially higher than the rate of new STI diagnoses among females and males of all ages (451 per 100,000 and 453 per 100,000 respectively).

A steep decline (77% decrease) was observed in genital warts diagnosis rates in females aged 15 to 19 between 2019 and 2023. This follows the introduction of vaccination against human papillomavirus (HPV) – the virus that causes genital warts – in 2008 for girls and 2019 for boys.

Black Caribbean residents

Although only 1% of new STIs diagnosed in the South West in 2023 were among people of Black Caribbean ethnicity, this group had the highest diagnosis rate, at 1,428 diagnoses per 100,000 residents. This is over triple the rate seen in the White ethnic group. Whilst the Black Caribbean ethnic group remains disproportionately affected by STIs, the overall new STI diagnosis rate has decreased marginally since 2022 (when it was 1,465 per 100,000).

The ethnic disparity in STIs is likely influenced by underlying socio-economic factors and the role they play in the structural determinants of the health of this community, as well as demographic differences including age (4).

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.

UKHSA’s main prevention messages include:

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 – and 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
• 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 and hepatitis B will protect against disease caused by these viruses and prevent the spread of these infections:

• 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.UK 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

Figure 1 is a column chart comparing rates of new STI diagnoses, per 100,000 population, by UKHSA region of residence in England for 2023.

The South West had the second lowest rate of all regions (484.3 per 100,000), which is a third that of the region with the highest rate (London at 1,448.3 per 100,000).

Figure 2. Number of diagnoses of the 5 main STIs, South West residents, 2019 to 2023 [note 1]

Data sources: GUMCAD, CTAD

Note 1: it is important to consider whether there have been any changes to testing or vaccination practices when interpreting increases or decreases in STIs, such as:

• 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 changes in testing practices

Figure 2 is a line chart showing trends in the number of diagnoses of the 5 main STIs (chlamydia, genital herpes, genital warts, gonorrhoea, and syphilis) in South West residents from 2019 to 2023.

Chlamydia diagnoses decreased from 15,314 in 2022 to 14,786 in 2023, but it remains the most frequently diagnosed STI.

The number of gonorrhoea diagnoses has increased from 4,185 in 2022 to 4,683 in 2023. Gonorrhoea is the only STI that has rebounded to higher levels than at the beginning of the 5-year period (that is, before the COVID-19 pandemic).

Genital herpes and genital warts diagnoses have both decreased, with genital warts diagnoses reduced to less than half that of 2019 levels (4,895 to 2,113). Syphilis remains the least frequently diagnosed STI (out of the 5 main STIs), with the number of new diagnoses consistent with pre-pandemic levels.

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

Data sources: GUMCAD, CTAD

See note 1 under figure 2.

Like the previous chart, Figure 3 shows the trends in the 5 main STIs among South West residents, but as rates rather than numbers.

These trends reflect those in Figure 2, with an increase in the rate of gonorrhoea between 2019 and 2023 (55.1 to 81.2 per 100,000). There have been declines in the rates of diagnosis for chlamydia, genital warts, genital herpes, and syphilis.

Table 1. Percentage change in new STI diagnoses, South West residents

Diagnoses	2023	Percentage change 2019 to 2023	Percentage change 2022 to 2023
New STIs	27,917	-21%	0%
Syphilis	394	0%	13%
Gonorrhoea	4,683	51%	14%
Genital warts	2,113	-57%	-11%
Genital herpes	2,096	-26%	0%
Chlamydia	14,786	-17%	-3%

Data sources: GUMCAD, CTAD. See note 1 under figure 2.

Table 1 summarises the trends in the number of diagnoses shown in Figure 2 and for all new STIs as a percentage change from 2019 to 2023, and from 2022 to 2023. It is especially useful for less prevalent STIs as changes for these can be difficult to see in charts that are scaled to include infections with much higher numbers, such as chlamydia.

Over the 5-year period, total new STI diagnoses have decreased in South West residents by 21%, although there was no change (0.3%) in the most recent year between 2022 and 2023. The overall decrease in new STI diagnoses in the last 5-year period can be attributed to decreases in chlamydia (17%), genital herpes (26%) and genital warts (57%).

The number of new gonorrhoea diagnoses has increased from 2019 to 2023 by 51%, with a 14% increase from 2022 to 2023.

Whilst there has been no change to the number of syphilis diagnoses between 2019 to 2023, there has been a 13% increase between 2022 to 2023, with 394 new diagnoses in 2023.

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

Data sources: GUMCAD, CTAD

Figure 4 shows the age and sex distribution of new STI diagnoses per 100,000 population in South West residents aged 15 to 64. Those aged under 15 years and above 64 years have been excluded due to the sensitivity of the data or the need to prevent disclosure of small numbers.

The distribution by age and gender is skewed towards females in the younger age groups (15 to 19 and 20 to 24) and skewed towards males in the older age groups (25 to 34, 35 to 44 and 45 to 64). The highest rates for new STI diagnoses were in females aged 20 to 24 years, followed by males aged 20 to 24 years and females aged 15 to 19 years. The lowest rates for new STIs were in those aged 45 to 64.

Figure 5. Rates of gonorrhoea per 100,000 residents by age group [note 2] (for those aged 15 to 64 years only) in the South West, 2019 to 2023

Data sources: GUMCAD. Note 2: age-specific rates are shown for those aged 15 to 64 years only.

Figure 5 is a line chart showing trends in the rate of new gonorrhoea diagnoses in the South West by age group between 2019 and 2023.

Overall, gonorrhoea rates have increased across all age groups from 2019 to 2023. The 20 to 24 year age group has consistently had the highest rates (262.5 and 474.6 per 100,000 in 2019 and 2023 respectively), and the 45 to 64 year age group has consistently had the lowest rates (22.7 and 25.4 per 100,000 respectively).

There has been a notable increase in the rate of gonorrhea in the 20 to 24 year age group between 2022 and 2023. Gonorrhoea rates decreased in those aged 15 to 19 from 2022 to 2023, although remain higher than pre-pandemic rates in 2019.

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

Data sources: GUMCAD

Figure 6 is a line chart showing trends in genital warts diagnoses per 100,000 South West residents aged 15 to 19 years from 2019 to 2023, stratified by gender.

Although rates remain low, for the first time in the reporting period there has been an increase in diagnoses among the 15 to 19 year age group, for both males and females; from 10.3 to 15.1 (males) and from 17.2 to 21.0 (females) between 2022 and 2023.

Figure 7. Rates of new STIs by ethnic group per 100,000 residents in the South West, 2023

Data sources: GUMCAD, CTAD

Figure 7 is a column chart showing rates of new STIs by ethnic group among South West residents in 2023.

The highest rates of new STI diagnoses were among the Black Caribbean ethnic group with 1,428.2 per 100,000 population, followed by the Black African ethnic group with 1,022.6 per 100,000 population. The White ethnic group had the lowest rate, at 415.0 per 100,000 population.

Table 2. Percentage of new STI diagnoses among South West residents by ethnic group, 2023

Ethnic group	Number	Percentage (excluding unknown)
White	22,035	89.4%
Black African	443	1.8%
Black Caribbean	246	1.0%
All other ethnic groups combined	1,920	7.8%
Unknown	3,273	-

Data sources: GUMCAD, CTAD

Table 2 summarises the number of new STI diagnoses in South West residents by ethnic group for 2023. Those with unknown ethnicity are excluded from the calculated percentages.

Those in the White ethnic group accounted for the greatest proportion of new STI diagnoses (89.4%), while also having the lowest diagnosis rate (415.0 per 100,000 population, see Figure 7). The number of diagnoses among the Black African and Black Caribbean ethnic groups accounted for a small proportion of overall new diagnoses (1.8% and 1.0% respectively), but as shown above, had disproportionately high diagnosis rates.

Figure 8. Percentage of new STI diagnoses among South West residents by world region of birth [note 3], 2023

Data sources: GUMCAD data only.

Note 3: 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.

Figure 8 is a column chart showing the proportion of South West residents diagnosed with a new STI by world region of birth in 2023 (excluding chlamydia diagnoses reported via CTAD).

Those born in the UK accounted for the majority of diagnoses, at 86%. Those born in the EU, sub-Saharan Africa, and Caribbean/Central and South America accounted for 6%, 3% and 1% of new STI diagnoses in the region respectively.

The proportion of new STI diagnoses among those born in all other countries remains at 4% for 2023.

Figure 9. Rates of new STIs per 100,000 residents by decile of deprivation [note 4] in South West residents, 2023

Data sources: GUMCAD, CTAD.

Note 4: deciles run from 1 to 10 in order of decreasing deprivation, with 1 being the decile for the most deprived areas.

The Figure 9 column chart shows rates of new STI diagnoses among South West residents by deprivation decile per 100,000 population for 2023.

Deprivation deciles are based on the 2019 Index of Multiple Deprivation, which is calculated at the lower super output area (LSOA) of residence, a unit of geography containing around 1,500 residents, across England.

Deciles 1 and 2, reflecting the highest levels of deprivation, had the highest rates of new STI diagnoses, at 729 and 721 per 100,000 respectively.

Rates of new STI diagnoses generally fell with a decrease in deprivation, with the lowest rate of 332 per 100,000 population found in the least deprived decile.

Figure 10. Diagnoses of the 5 main STIs among GBMSM [note 5][note 6], South West residents, 2019 to 2023

Data sources: GUMCAD data only.

Note 5: 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.

Note 6: it is important to consider whether there have been any changes to testing or vaccination practices when interpreting increases or decreases in STIs:

• 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 10 is a line chart showing the trends of the 5 main STIs among GBMSM South West residents from 2019 to 2023.

Gonorrhoea and chlamydia remained the most frequently diagnosed STIs among GBMSM between 2019 to 2023. Cases of these STIs have continued to increase in 2023, with gonorrhoea diagnoses increasing to 1,723 and chlamydia to 860. Chlamydia diagnoses in GBMSM remain below pre-COVID-19 pandemic levels, whilst gonorrhoea and syphilis are now both at higher levels than before the pandemic. Syphilis cases have increased by more than a quarter from 2022.

There is an overall decreasing trend for genital warts diagnoses among GBMSM, from 231 in 2019 to 132 in 2023. Genital herpes diagnoses are at similar levels to 2019.

Table 3. Percentage change in new STI diagnoses in GBMSM residents in the South West

Diagnoses	2023	Percentage change 2019 to 2023	Percentage change 2022 to 2023
New STIs	3,504	3%	20%
Syphilis	285	10%	27%
Gonorrhoea	1,723	36%	17%
Genital warts	132	-43%	2%
Genital herpes	104	5%	33%
Chlamydia	860	-21%	17%

Data sources: GUMCAD data only See notes for Figure 10.

Table 3 summarises the trends in the number of diagnoses shown in Figure 10 and for all new STIs as a percentage change from 2019 to 2023, and from 2022 to 2023.

A total of 3,504 new STI diagnoses were observed among GBMSM South West residents in 2023, which represents a 20% increase since the previous year and a 3% increase since 2019. 

Among the 5 most common STIs, increases since 2022 were greatest for genital herpes (33%) and syphilis (27%).

Diagnoses of genital warts (-43%) and chlamydia (-21%) have decreased among GBMSM within the last 5 years, although chlamydia has increased by 17% in the last year. Counts of gonorrhoea (36%) and syphilis (10%) are higher than in 2019, while genital herpes counts are similar to pre-COVID-19 pandemic levels.

Figure 11. Rate of new STI diagnoses per 100,000 population by upper-tier local authority of residence, South West residents, 2023

Data sources: GUMCAD, CTAD

Figure 11 is a column chart showing the rate of new STI diagnoses per 100,000 South West residents in 2023 by upper-tier local authority (UTLA). 95% confidence intervals are displayed in yellow. The overall South West rate and England rate are represented by the orange and blue lines respectively.

Rates of new diagnoses were highest in Bristol (760 per 100,000) and Plymouth (755 per 100,000) UTLAs, both above the national rate for England. The rate for Bournemouth, Christchurch and Poole (703 per 100,000) was similar to England’s. All other UTLAs in the South West reported diagnosis rates significantly lower than England’s.

Bristol, Plymouth, and Bournemouth, Christchurch and Poole are largely urban UTLAs with younger, denser, and more diverse populations when compared to other UTLAs in the South West. Rates of new diagnoses in Bristol or Plymouth were over twice those of predominantly rural UTLAs like Wiltshire and Somerset.

Figure 12. Map of new STI rates per 100,000 residents by upper-tier local authority in the South West, 2023

Data sources: GUMCAD, CTAD

Figure 12 is a map of UTLAs in the South West shaded by the new diagnosis rate of all STIs per 100,000 residents in 2023. The data depicted in this figure is identical to Figure 11 but more clearly illustrates that new STI diagnoses are concentrated among urban areas, as well as Devon, which includes the city of Exeter. No UTLA in the South West fell within the 3 highest incidence rate categories for England.

Figure 13. Rate of new STI diagnoses (excluding chlamydia diagnoses in residents aged under 25 years) per 100,000 population by upper-tier local authority of residence, the South West, 2023

Data sources: GUMCAD, CTAD

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 13 is a column chart showing the data contained in Figure 11, but excluding chlamydia diagnoses among residents aged under 25 years. The National Chlamydia Screening Programme (NCSP) actively targets this age group for screening, and variations in the implementation of screening may affect the new STI rate and thus distort the chart.

After removing chlamydia diagnoses in residents under 25 years of age, rates of new STI diagnoses in Bristol (534 per 100,000) and Plymouth (514 per 100,000) were similar to the England national rate (520 per 100,000). Diagnosis rates for all other UTLAs remained lower than the English rate. The ordering of local authorities does not change markedly, with urban UTLAs having higher rates than the predominantly rural UTLAs (for example, Cornwall and Isles of Scilly, Somerset, Wiltshire).

Chlamydia as a proportion of total STI diagnoses among under-25s is highest in Devon (42.9%), Torbay (42.2%), and Cornwall and Isles of Scilly (40.7%), and lowest in Swindon (22.7%), Dorset (27.1%), and Wiltshire (29.6%).

Figure 14. Chlamydia detection rate per 100,000 female residents aged 15 to 24 years by upper-tier local authority of residence, the South West, 2023

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

Figure 14 is a column chart showing the chlamydia detection rate per 100,000 female residents aged 15 to 24 years old by UTLA in the South West. This population group is disproportionately affected by untreated chlamydia infection and are proactively offered screening for chlamydia in community settings, such as GPs and pharmacies, under the NCSP. This programme aims to improve re-testing rates following treatment, to reduce the time to test results and treatment, and to strengthen partner notification. Rates in this figure may be affected by sub-regional differences in NCSP implementation.

The detection rate for chlamydia among females aged 15 to 24 was highest in Torbay (3,466 per 100,000), followed by Bournemouth, Christchurch and Poole (2,603 per 100,000) and Devon (2,399 per 100,00). The detection rate in Torbay was a third higher than the rate of the next highest UTLA of Bournemouth, Christchurch and Poole. Chlamydia detection rates were lowest in Bath and North East Somerset (1,114 per 100,000), Wiltshire (1,227 per 100,000), and Swindon (1,417 per 100,000).

Figure 15. Rate of gonorrhoea diagnoses per 100,000 population by upper-tier local authority of residence, South West residents, 2023

Data sources: GUMCAD

Figure 15 displays the 2023 rates of gonorrhoea diagnoses per 100,000 residents in the South West by UTLA. The highest rates were observed in Bristol (151 per 100,000), Plymouth (147 per 100,000), and Bournemouth, Christchurch and Poole (141 per 100,000). Rates in these UTLAs were significantly higher than others in the region. These 3 UTLAs have a low median age relative to the region and are largely urban and densely populated, with more demographic diversity than other areas of the South West.

Gonorrhoea diagnoses rates were lowest in Wiltshire (46 per 100,000), Somerset (49 per 100,000), and North Somerset (51 per 100,000 residents).

When compared to overall STI diagnosis rates, excluding chlamydia among residents aged under 25 years due to regional differences in NCSP implementation (Figure 13), gonorrhoea as a proportion of new STI diagnoses was highest in:

• Bournemouth, Christchurch and Poole (30.5%)
• Gloucestershire (29.2%)
• Plymouth (28.6%)

Excluding chlamydia diagnoses among residents aged under 25 years, gonorrhoea made up only 17.2% of new STI diagnoses in Torbay and 18.0% in Swindon.

Figure 16. STI testing rate (excluding chlamydia in under 25 year olds) per 100,000 population in South West residents aged 15 to 64 years, 2012 to 2023

Data sources: GUMCAD, CTAD

Figure 16 is a line chart showing the trends in STI testing rates in England and the South West from 2012 to 2023, per 100,000 residents aged between 15 and 64. Chlamydia tests in individuals aged under 25, who are targeted by the NCSP, have been excluded from this figure.

Annual STI testing rates have continually increased since 2012 in both England and the South West, with the exception of 2020, when testing rates decreased during the first year of the COVID-19 pandemic. In 2023, STI testing rates have surpassed pre-pandemic levels in England and the South West.

Testing rates in the South West have remained lower than those of England within the last decade. Since the start of the COVID-19 pandemic, the gap between national and regional testing rates is widening.

Figure 17. STI testing positivity rate (excluding chlamydia in under 25 year olds) in South West residents, 2012 to 2023 [note 7]

Data sources: GUMCAD, CTAD.

Note 7: 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 17 is a line chart showing trends in STI testing positivity from 2012 to 2023, represented as a proportion of tests that were positive, for England and the South West. As with the previous chart, chlamydia tests in individuals aged under 25, who are targeted by the NCSP, have been excluded.

As the testing rate was, the South West test-positivity rate is consistently lower than that of England’s. Both the South West and England showed a decline in 2020 during the COVID-19 pandemic, which has rebounded in 2022. The positivity rate in 2023, at 5.2%, is similar to that of 2022 at 5.0%.

Table 4. Number of diagnoses of new STIs by UKHSA region of residence, data source and data subset 2023

UKHSA region of residence	GUMCAD specialist SHSs	GUMCAD non-specialist SHSs [note 8]	CTAD [note 9]	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

Data sources: GUMCAD, CTAD

Note 8: diagnoses from enhanced GPs reporting to GUMCAD are included in the ‘Non-specialist sexual health services (SHSs)’ total.

Note 9: including site type 12 chlamydia from GUMCAD.

Table 4 summarises the number of new STI diagnoses by reporting pathway for each UKHSA region in 2023.

Out of 27,917 new STI diagnoses in the South West, almost two-thirds (17,956; 64.3%) were reported by specialist SHSs via GUMCAD, 14.1% (3,994) were reported through non-specialist SHSs via GUMCAD, and a fifth (6,017; 21.6%) through CTAD. 

The proportion of new STI diagnoses reported by specialist SHSs via GUMCAD in the South West was lower compared to most regions. Only the East of England (59.6%) and the East Midlands (52.8%) had a lower proportion

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

Five main STIs	GUMCAD specialist SHSs	GUMCAD non-specialist SHSs	CTAD	Total
Chlamydia	6,285	2,484	6,017	14,786
Genital herpes	2,077	19	-	2,096
Genital warts	2,104	9	-	2,113
Gonorrhoea	3,281	1,402	-	4,683
Syphilis	under 400	under 5	-	394

Data sources: GUMCAD, CTAD. See notes on table 4 for more information on GUMCAD and CTAD.

Table 5 compares the number of diagnoses and reporting pathways for the 5 most common STIs for the South West in 2023. CTAD only collects information on diagnoses of chlamydia, so that is the only STI entry in that column. Count data on individuals diagnosed with syphilis by service type have been masked to preserve data privacy conventions surrounding the small numbers of cases within this group.

CTAD accounted for 40.7% of all chlamydia diagnoses, whilst a similar proportion (42.5%) were reported though specialist SHSs on GUMCAD.

The vast majority of syphilis (99.7%), genital warts (99.6%), and genital herpes (99.1%) diagnoses reported through GUMCAD were identified through specialist SHSs. In comparison, a lower proportion of gonorrhea diagnoses were reported through specialist SHSs (70.1%), with almost a third reported through non-specialist SHSs. This reflects the fact that diagnoses from non-specialist SHSs largely originate from online screening services that include gonorrhoea testing; samples returned from online screening kits are not tested for genital herpes and genital warts, and syphilis is largely diagnosed after symptomatic presentation.

Figure 18. Consultations by service medium: South West residents, 2019 to 2023

Data sources: GUMCAD

Figure 18 is a column chart showing counts of sexual health consultations by service medium for South West residents between 2019 and 2023.

There were almost 10,000 more consultations in 2023 (323,155) compared to 2022 (313,229), a rise of 3.2% from the previous year. In terms of numbers, telephone consultations decreased by 8.5%, online consultations increased by 0.4% and face-to-face consultations increased by 8.8%. The proportion of all consultations that were face-to-face increased from to 47.1% to 49.6%.

The number of telephone and online consultations increased substantially between 2019 to 2020 and 2021, likely due to limited availability of face-to-face appointments during the COVID-19 pandemic. Since 2021, the number of telephone consultations has continued to fall, and the number of online consultations has continued to rise.

Proportionally, GBMSM experienced a slightly greater increase in total consultations (12%) than MSW (8%) and WSM (5%) between 2022 and 2023. Additionally, a larger proportion of consultations among GBMSM were completed face-to-face (60%) in comparison to MSW (42%) and WSM (43%). The contrast in service access between GBMSM and heterosexual residents may reflect differences in availability of services, population-specific clinical needs, or preferences of contact types.

Information on data sources

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

This report is based on data from the GUMCAD and CTAD surveillance systems published on 6 June 2024 (data to the end of calendar year 2023).

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 (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
• 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.

Office for National Statistics (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.

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 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.

For an Annual Epidemiological Spotlight on HIV in the South West, contact FES.SouthWest@ukhsa.go.uk

About the Field Service

The Field Service (FS) 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.SouthWest@ukhsa.gov.uk.

Acknowledgements

We would like to thank the:

• 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

References

1. UKHSA. HIV: South West annual data spotlight (accessed 7 July 2025)
2. Mohammed H, Blomquist P, Ogaz D, Duffell S, Furegato M, Checchi M and others. ‘100 years of STIs in the UK: a review of national surveillance data’ Sexually Transmitted Infections December 2018: volume 94, issue 8, pages 553 to 558
3. Office For Health Improvement and Disparities. Public Health Outcomes Framework (accessed 7 July 2025)
4. Bardsley M, Wayal S, Blomquist P, Mohammed H, Mercer CH, Hughes G. ‘Improving our understanding of the disproportionate incidence of STIs in heterosexual-identifying people of black Caribbean heritage: Findings from a longitudinal study of sexual health clinic attendees in England’ Sexually Transmitted Infections 2022: volume 98, issue 1, pages 23 to 31