Official Statistics

Sexually transmitted infections and screening for chlamydia in England: 2022 report

Updated 25 October 2023

The annual official statistics data release (data to end of December 2022).

Main points

This report provides a descriptive analysis of data on sexually transmitted infections (STIs) diagnoses and screening for chlamydia in England from January to December 2022. It focuses primarily on the changes between 2021 and 2022 and also contains some trend data from 2018 to 2022. Data on STI tests and diagnoses between 2013 and 2022 are available in the accompanying data tables and slide set as well as the Sexual and Reproductive Health Profiles.

The main points of this report are as follows:

• in 2022, there was a total of 4,394,404 consultations at sexual health services (SHSs), an 8.2% increase compared to 2021 (4,059,608)
• in 2022, there were 2,195,909 sexual health screens (diagnostic tests for chlamydia, gonorrhoea, syphilis or HIV) performed by SHSs, an increase of 13.4% compared to 2021 (1,936,455)
• in 2022 there were 392,453 diagnoses of new STIs among England residents, an increase of 23.8% compared to 2021 (317,022)
• both gonorrhoea and syphilis have returned to the high levels reported in 2019 (prior to the coronavirus (COVID-19) pandemic)
• gonorrhoea is increasing in people of all ages, but the rise is highest among young people aged 15 to 24 years
• infectious syphilis (primary, secondary and early latent) is increasing both among gay, bisexual or other men who have sex with men (GBMSM), and heterosexual people

Among the main infections contributing to this overall total of new STIs:

• chlamydia diagnoses (all ages) increased 24.3% from 160,279 diagnoses in 2021 to 199,233 in 2022
• gonorrhoea diagnoses increased to 82,592 diagnoses in 2022, an increase of 50.3% compared to 2021 (54,961)
• infectious syphilis diagnoses increased to 8,692 diagnoses in 2022, up 15.2% compared to 2021 (7,543)
• first episode genital warts diagnoses decreased in 2022 with 26,079 (8.5% compared to 28,497 in 2021)
• the impact of STIs remains greatest in young people aged 15 to 24 years, GBMSM, and some black ethnic groups

Among young women aged 15 to 24 years screened through the National Chlamydia Screening Programme (NCSP):

• 690,531 chlamydia tests were carried out in 2022, a 1.2% decrease compared to 2021 (698,979)
• there were 68,882 chlamydia diagnoses, an increase of 21.8% compared to 2021 (56,562) – test positivity increased from 8.1% to 10.0% over the same period

Main STI prevention 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 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
  • 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 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 Sexwise, NHS.UK and from the national sexual health helpline on 0300 123 7123

Overall trends

While this report primarily focuses on the trend between 2021 and 2022, 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 and disruption to service provision in 2020 and 2021. The numbers of consultations, sexual health screens and STI diagnoses in 2020 and 2021 are lower than preceding years, so the trend in diagnoses between 2021 and 2022 must be interpreted in that context.

Overall there was an increase in the number of consultations (including face-to-face consultations at physical clinics and those delivered via telephone or internet) delivered by SHSs in England in 2022 compared to 2021 (8.2%, from 4,059,608 to 4,394,404), which is a 13.6% increase compared to 2019 (3,869,728). Of all consultations in 2022, 50.2% (2,204,790) were delivered face-to-face, 39.2% (1,721,132) via the internet and 10.7% (468,482) via telephone.

Compared to 2021 the number of face-to-face consultations increased (8.2%, from 2,037,468 to 2,204,790) as did the number of online consultations (19.0%, from 1,446,001 to 1,721,132), while the number of telephone consultations decreased (18.7%, from 576,139 to 468,482). The number of online consultations may be underreported where physical SHSs provide both face-to-face and online consultations. Full details are provided in the Appendix.

The number of sexual health screens (diagnostic tests for one or more of chlamydia, gonorrhoea, syphilis and HIV) in 2022 increased by 13.4% (1,934,347 to 2,193,801) compared to 2021 but was 2.7% lower than 2019 (2,255,992). Compared to 2021, the number of new STIs also increased by 23.8% (317,022 to 392,453), but was 16.2% lower compared to 2019 (468,260). The most commonly diagnosed STIs in 2022 were chlamydia (199,233, 50.8% of all new STI diagnoses), gonorrhoea (82,592, 21.1%), first episode genital warts (26,079, 6.7%) and first episode genital herpes (24,910, 6.4%).

In 2022 there were large increases in the numbers of gonorrhoea (50.3%, from 54,961 to 82,592), chlamydia (24.3%, from 160,279 to 199,233), and infectious syphilis (primary, secondary and early latent stages) diagnoses (15.2%, from 7,543 to 8,692) compared to 2021. In line with the increasing trend over the past decade, diagnoses of both gonorrhoea and syphilis exceeded the high levels reported in 2019 (before the COVID-19 pandemic), which were 71,133 (16.1% increase) and 8,040 (8.1% increase) respectively.

The number of gonorrhoea diagnoses in 2022 was the largest annual number reported since records began, while the number of syphilis diagnoses was the largest annual number reported since 1948 (1).

Diagnoses of first episode genital herpes increased 13.8% (21,892 to 24,910) between 2021 and 2022, but remained 27.7% lower than 2019 (34,464). Diagnoses of first episode genital warts decreased (8.5%, from 28,497 to 26,079) between 2021 and 2022 in line with the decreasing trend over the past decade due to the HPV vaccination programme.

Trends in diagnoses of STIs since 2013 are presented in Appendix Figure A2 and Table 1 of the data tables. Data on HIV testing and diagnoses are published separately on GOV.UK.

Figure 1. Number of new STI diagnoses and sexual health screens [Note 1] among England residents accessing sexual health services, 2013 to 2022

[Note 1] Sexual health screen – tests for one or more of chlamydia, gonorrhoea, syphilis and HIV.
[Note 2] The ‘New STI diagnoses’ group was expanded in 2015 to include STI diagnoses not previously reported via GUMCAD (Shigella spp and Mycoplasma genitalium infections). Therefore counts of new STIs before and after 2015 are not directly comparable.
[Note 3] Figures reported in 2020 and 2021 are notably lower than previous years due to the disruption to SHSs during the national response to the COVID-19 pandemic.

Source: Data from routine returns to the GUMCAD STI and CTAD Chlamydia Surveillance Systems.

Figure 2. Number of new diagnoses of chlamydia, gonorrhoea, genital warts, genital herpes (primary y-axis), and syphilis (secondary y-axis) among England residents accessing sexual health services, 2013 to 2022

Different scales are used on the primary and secondary y-axes.

[Note 1] First episode.
[Note 2] Includes diagnoses of primary, secondary and early latent syphilis.
[Note 3] Figures reported in 2020 and 2021 are notably lower than previous years due to the disruption to SHSs during the national response to the COVID-19 pandemic.

Source: Data from routine returns to the GUMCAD STI and CTAD Chlamydia Surveillance Systems.

Populations with greater sexual health needs

Black ethnic groups

There was a total of 36,747 diagnoses of new STIs among people of black ethnicity in 2022 (9.4% of the total number of new STI diagnoses). However, people of black ethnicity had the highest diagnosis rates of all ethnic groups, although this varied among the black ethnic groups. In 2022, people of black Caribbean ethnicity had the highest diagnosis rates of chlamydia, gonorrhoea, infectious syphilis, trichomoniasis, and genital herpes, while people of black African ethnicity had relatively lower rates of STIs (Figure 3).

Previous research found, when compared to all other ethnic groups, there were no unique clinical or behavioural factors explaining the disproportionately high rates of STI diagnoses amongst people of black Caribbean ethnicity – this ethnic disparity in STIs is therefore likely influenced by underlying socio-economic factors and the role they play in the structural determinants of the health of this community (2).

Figure 3. Rates of selected STI diagnoses among England residents accessing sexual health services by ethnicity and STI, 2022

[Note 1] Primary, secondary and early latent stages.
[Note 2] First episode.

Source: Data from routine sexual health services’ returns to the GUMCAD STI Surveillance System.

The ethnic categories above are as specified by the Office for National Statistics (ONS). Data is presented by disaggregated ethnic groups among people of black ethnicity to highlight the variability in rates among the ethnic group experiencing the highest rates of the most commonly diagnosed STIs. People of Asian, mixed, other and white ethnicity are presented as aggregated ethnic groups for comparison (3).

Gay, bisexual and other men who have sex with men

The number of bacterial STI diagnoses among GBMSM increased from 2013 to 2019 before dropping in 2020. In keeping with the recovery of sexual health service provision and increased STI testing in 2021 and 2022, there were increases in bacterial STI diagnoses amongst GBMSM over this period: gonorrhoea increased 41.3% (27,545 to 38,923), chlamydia increased by 25.3% (15,267 to 19,129) and infectious syphilis increased 12.9% (5,316 to 6,003).

Note that due to incomplete reporting of some sexual orientation data in 2021, STI diagnosis numbers for GBMSM from 2021 presented in this paragraph and in Figure 4 have been adjusted. Full details are provided in the ‘Technical note’ in the Appendix.

Figure 4. Number of diagnoses of selected STIs among gay, bisexual and other men who have sex with men accessing sexual health services, 2013 to 2022

[Note 1] Includes diagnoses of primary, secondary and early latent syphilis.
[Note 2] First episode.
[Note 3] Figures reported in 2020 and 2021 are notably lower than previous years due to the disruption to SHSs during the national response to the COVID-19 pandemic.
[Note 4] The number of STI diagnoses in GBMSM in 2021 was adjusted to account for incomplete reporting of some sexual orientation data (see ‘Technical note’ in the Appendix for more details).

Source: Data from routine returns to the GUMCAD STI and CTAD Chlamydia Surveillance Systems.

There have also been increases in less frequently reported STIs such as lymphogranuloma venereum (LGV) (82.8%, from 570 in 2021 to 1,042 in 2022) (4), as well as an increase in cases of shigellosis and recent outbreaks in 2022 of extensively drug-resistant Shigella sonnei and S. flexneri (5). There is evidence of a rebound in sexual mixing among GBMSM between 2020 and 2021, and this is likely to have contributed to the rise in STIs within this population in 2022 (6).

The National HPV Vaccination Programme for GBMSM aged up to and including 45 years attending specialist SHSs and HIV clinics started across England in April 2018 following a 2 year pilot (7). From the pilot start in 2016 to the end of 2022, the reported data shows 34.8% of eligible attendees have started their HPV vaccine course, and of these, 54.9% have received at least 2 doses. Very few GBMSM (0.9% in 2022) have not accepted this vaccine when offered it. HPV vaccination may be under-reported – please refer to the Appendix.

In May 2022, an international outbreak of mpox (monkeypox) was detected with cases reported concurrently from many countries where the disease is not endemic. The outbreak has involved mainly, but not exclusively, GBMSM. Over 3,500 individuals were diagnosed in England during 2022. Mpox figures using laboratory surveillance data have been published (8, 9).

Young people aged 15 to 24 years

Young people experience the highest diagnosis rates of the most common STIs, and this may be due to higher rates of partner change among those aged 16 to 24 years (10). Young women may be more likely to diagnosed with an STI due to disassortative sexual mixing by age and gender (11). Compared to 2021, the number of new STI diagnoses in 2022 among young people aged 15 to 24 years increased by 26.5% (129,938 to 164,337), largely due to the near doubling of cases of gonorrhoea over the same period (91.7% increase from 16,191 to 31,037, as shown in Figure 5). Diagnoses of chlamydia also increased and this is discussed further in the following section of this report.

Figure 5: Number of gonorrhoea diagnoses by age group, 2013 to 2022

[Note 1] Figures reported in 2020 and 2021 are notably lower than previous years due to the disruption to SHSs during the national response to the COVID-19 pandemic.

Source: Data from routine returns to the GUMCAD STI and CTAD Chlamydia Surveillance Systems.

The quadrivalent HPV vaccine that protects against HPV 16 and 18 (the main causes of cervical cancer) and HPV 6 and 11 (the main causes of genital warts) has been offered as part of a national vaccination programme to young women aged 12 to 13 years from 2012 and extended to young men from September 2019.

In 2022, the rate of first episode genital warts diagnoses among young women aged 15 to 17 years attending SHSs was 67.9% lower than the rate in this age band in 2018, (7.0 versus 21.8 per 100,000 population in 2022 vs 2018 respectively). 2018 is the first year that all young women aged 15 to 17 years attending SHSs would have been offered the quadrivalent vaccine when aged 12 to 13 years in the National HPV Vaccination Programme. A decline of 71.5% (3.1 vs 10.9 per 100,000 population) was seen in heterosexual young men of the same age over the same period, suggesting a combination of substantial herd and direct protection within this age group overall.

Declines were also seen in both men and women aged 18 to 20 years and 21 to 24 years. These are all age groups with direct or indirect protection from the quadrivalent HPV vaccine. A substantial decline of 79.3% (34.5 vs 167.1 per 100,000 population in 2022 vs 2018 respectively) was seen in GBMSM aged 15 to 17 years, which is likely due to both protection from vaccination of young GBMSM in SHSs and herd protection from the adolescent vaccination programme.

National Chlamydia Screening Programme

National trends

In June 2021, the primary aim of the National Chlamydia Screening Programme (NCSP) changed to focus on reducing reproductive harm of untreated infection in young women. The programme has the secondary aims of reducing re-infections and onward transmission of chlamydia and raising awareness of good sexual health (12). With the change in policy, opportunistic screening (the proactive offer of a chlamydia test to young people without symptoms) should now focus on young women and other young people with a womb or ovaries. Services provided by SHSs, which include chlamydia testing as part of routine sexual health screens for people of any gender and at any age, remain unchanged.

This report relates to 2022, the first full calendar year during which the proactive, opportunistic offer of chlamydia screening was recommended for young women and other people with a womb or ovaries aged 15 to 24 years only. As chlamydia is a largely asymptomatic infection, increases in the number of infections detected and treated is an indication of improved chlamydia control. The chlamydia detection rate is a Public Health Outcomes Framework (PHOF) indicator and UKHSA recommends that local authorities should be working towards the revised female-only minimum detection rate of 3,250 per 100,000 women aged 15 to 24 years.

In 2022, 690,531 chlamydia tests were carried out in England among young women aged 15 to 24 years, which was 1.2% lower than in 2021 (698,979) (Table 1). However, there was a 21.8% increase in the number of diagnoses made in 2022 (68,882) compared to 2021 (56,562). The detection rate also increased by 22.2% in 2022 (2,110 per 100,000 population) compared to 2021 (1,733 per 100,000 population) (Figure 6). Test positivity also increased to 10.0% in 2022 compared to 8.1% in 2021 (Table 1).

In 2022, there were 277,107 chlamydia tests carried out in England among young men aged 15 to 24 years, which was 6.8% higher than in 2021 (259,425). Further data on chlamydia tests and diagnoses in young men is provided in Appendix Table A2, and data for all genders is included in the NCSP data tables.

Table 1. Chlamydia tests, diagnoses, testing coverage and test positivity among women aged 15 to 24 years, 2021 and 2022, England

Indicator	2021	2022
Total tests	698,979	690,531
Total diagnoses	56,562	68,882
Coverage	21.4	21.2
Test positivity	8.1%	10.0%
Detection rate (per 100,000 population)	1,733	2,110

Source: Data from routine returns to the GUMCAD STI and CTAD Chlamydia Surveillance Systems.

Figure 6. Chlamydia testing coverage, detection rates and test positivity among women aged 15 to 24 years, 2018 to 2022, England

[Note 1] Figures reported in 2020 and 2021 are notably lower than previous years due to the disruption to SHSs during the national response to the COVID-19 pandemic.

Source: Data from routine returns to the GUMCAD STI and CTAD Chlamydia Surveillance Systems.

Characteristics of young women screened for chlamydia

By ethnicity, the majority of testing occurred among young women of white ethnicity, accounting for 57.0% (393,554) of all tests in 2022 (Figure 7a). Diagnoses were also highest among those of white ethnicity, with 41,704 diagnoses in 2022, accounting for 60.5% of diagnoses. The distribution of tests and diagnoses is influenced by the underlying population distribution of young people by ethnicity (3). Positivity was highest among those of black ‘Other’ (non-African or Caribbean) ethnicity (12.7%, 576 out of 4,546) followed by those of black Caribbean ethnicity (12.0%, 1,996 out of 16,663) compared to those of white ethnicity (10.6%, 41,704 out of 393,554) (Figure 7b).

Figure 7a. Chlamydia tests [Note 1] among women aged 15 to 24 years by ethnicity, 2018 to 2022, England

Figure 7b. Chlamydia test positivity [Note 1] among women aged 15 to 24 years by ethnicity, 2018 to 2022, England

[Note 1] The distribution of tests and diagnoses is influenced by the underlying population distribution of young people by ethnicity.
[Note 2] Figures reported in 2020 and 2021 are notably lower than previous years due to the disruption to SHSs during the national response to the COVID-19 pandemic.

Source: Data from routine returns to the GUMCAD STI and CTAD Chlamydia Surveillance Systems.

The ethnic categories above are as specified by the ONS. Data is presented by disaggregated ethnic groups among people of black ethnicity to highlight the variability in rates among the ethnic group experiencing the highest rates of the most commonly diagnosed STIs. People of Asian, mixed, other and white ethnicity are presented as aggregated ethnic groups for comparison (3).

Chlamydia testing and diagnoses differ by level of socioeconomic deprivation. Deprivation is measured using the Index of Multiple Deprivation (IMD), a residential area-level measure of socioeconomic status (14). The first (Q1) quintile represents the most deprived 20% of lower super output areas (LSOAs – small geographical areas with 1,000 to 3,000 residents) (15) and the fifth (Q5) quintile the least deprived 20% of LSOAs. As was the case in 2021, chlamydia detection rates were highest among those living in Q1 (most deprived quintile) in England (2,479 per 100,000 population) in 2022. The detection rate increased across all quintiles between 2021 and 2022 (Figure 8).

Figure 8. Chlamydia detection rates among women aged 15 to 24 years by IMD quintile [Note 1], 2021 and 2022, England

[Note 1] NCSP data presented by IMD quintile is based on the location of residence of the person tested

Source: Data from routine returns to the GUMCAD STI and CTAD Chlamydia Surveillance Systems

Testing service type

The number of tests conducted in a physical (face-to-face) setting among young women aged 15 to 24 was 3.6 % lower in 2022 (389,592) compared to 2021 (404,240). There was a 2.1 % increase in the testing conducted using self-sampling kits via the internet between 2021 (294,739) and 2022 (300,939) (Figure 9, Table 2 ) (see the ‘Data sources’ section of the Appendix for further information on the different types of testing services).

Figure 9. Chlamydia tests from internet and face to face [Note 1] testing and total diagnoses among women aged 15 to 24 years, 2018 to 2022, England

[Note 1] Face to face testing includes sexual health services, GP, pharmacy, termination of pregnancy, unknown, and other.
[Note 2] Figures reported in 2020 and 2021 are notably lower than previous years due to the disruption to SHSs during the national response to the COVID-19 pandemic.

Source: Data from routine returns to the GUMCAD STI and CTAD Chlamydia Surveillance Systems.

Table 2a. Chlamydia tests among women aged 15 to 24 years by test setting, 2021 and 2022, England

Test setting	Number of tests in 2021	Percentage of total in 2021	Number of tests in 2022	Percentage of total in 2022	Percentage change 2021 to 2022
Specialist STI related care	165,882	23.7	165,827	24	0
Non-specialist STI related care	13,356	1.9	12,610	1.8	-5.6
Internet	294,739	42.2	300,939	43.6	2.1
GP	119,639	17.1	118,945	17.2	-0.6
Pharmacy	4,526	0.6	3,433	0.5	-24.1
Termination of pregnancy	4,666	0.7	5,744	0.8	23.1
Unknown	10,014	1.4	7,024	1	-29.9
Other	86,157	12.3	76,009	11	-11.8
Total	698,979	100	690,531	100	-1.2

Table 2b. Chlamydia diagnoses among women aged 15 to 24 years by test setting, 2021 and 2022, England

Test setting	Number of diagnoses in 2021	Percentage of total in 2021	Number of diagnoses in 2022	Percentage of total in 2022	Percentage change 2021 to 2022
Specialist STI related care	19,314	34.1	22,941	33.3	18.8
Non-specialist STI related care	1,244	2.2	1,422	2.1	14.3
Internet	23,189	41	29,960	43.5	29.2
GP	5,305	9.4	6,406	9.3	20.8
Pharmacy	406	0.7	411	0.6	1.2
Termination of pregnancy	315	0.6	498	0.7	58.1
Unknown	554	1	516	0.7	-6.9
Other	6,235	11	6,728	9.8	7.9
Total	56,562	100	68,882	100	21.8

Table 2c. Chlamydia test positivity among women aged 15 to 24 years by test setting, 2021 and 2022, England

Test setting	Test positivity 2021 (percentage)	Test positivity 2022 (percentage)
Specialist STI related care	11.6	13.8
Non-specialist STI related care	9.3	11.3
Internet	7.9	10
GP	4.4	5.4
Pharmacy	9	12
Termination of pregnancy	6.8	8.7
Unknown	5.5	7.3
Other	7.2	8.9
Total	8.1	10

Source: Data from routine returns to the GUMCAD STI and CTAD Chlamydia Surveillance Systems.

Between 2021 and 2022, the number of tests remained stable in services providing specialist STI related care, while testing declined in all other testing services with the exception of internet services, where tests increased by 2.1% (Table 2a) This increase in internet testing reflects the scale up of online sexual healthcare provision across England since 2020.

Local and regional differences in chlamydia detection rates are due to a combination of differences in overall chlamydia testing coverage, variations in the settings used to offer chlamydia testing, the underlying prevalence of infection, and variations in level of disruption to the screening programme due to COVID-19, including an increase in online self-sampling kits. Data on chlamydia detection rates at region and upper- and lower-tier local authority levels is available in the Sexual and Reproductive Health Profiles .

Conclusions

Since the cessation of COVID-19 lockdown measures in summer 2021, there is clear evidence of a rebound in service provision at SHSs and an increase in STI diagnoses. While the number of sexual health screens at SHSs increased by 13% between 2021 and 2022, there were larger increase in diagnoses of gonorrhoea (50%) and chlamydia (24%), which may either reflect more targeted testing of people more likely to have an STI, or an increase in STI transmission in the community.

While the increase in STI diagnoses between 2021 and 2022 is partially explained by the rebound in service provision at SHSs, the numbers of diagnoses of both gonorrhoea and syphilis exceed those reported in 2019 (prior to the COVID-19 pandemic). Of all age groups, the largest increase in gonorrhoea was among young people, a trend which was also detected in Scotland (16). In the case of syphilis, diagnoses increased both among GBMSM and heterosexual people.

STIs continue to show socioeconomic variation and disproportionately impact GBMSM, people of black Caribbean ethnicity, and young people aged 15 to 24 years. The scale up of online sexual health provision continued in 2022, and the increase in overall consultations at SHSs since 2021 was largely driven by a 19% increase in online consultations. Within the NCSP, internet services remained the most common option for chlamydia testing of young women and, of all settings, this was the only one for which there was in increase in the number of tests between 2021 and 2022. However, it remains important to continue to monitor and understand whether these changes have affected equity of access to SHS (17).

To address the increase in syphilis diagnoses in England, UKHSA published a Syphilis Action Plan (18) which focuses on key interventions to control and prevent this infection, such as more frequent testing for GBMSM at higher risk of syphilis, partner notification, and raising awareness about this infection. UKHSA actively monitors and rapidly responds to cases of gonorrhoea with resistance to ceftriaxone, the current first-line therapy (19, 20). UKHSA also contributed to the NICE Reducing STIs guideline (21), and conducts research with academic partners through the National Institute for Health and Care Research funded Health Protection Research Unit (HPRU) to better understand risk and risk reduction for STIs.

Additionally, UKHSA supports local areas to interpret and utilise data to inform local action to improve public health and address health inequalities, including through care pathway workshops for chlamydia, syphilis and HIV – these workshops provide local commissioners and providers with a comprehensive case management pathway to improve service delivery.

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Appendix

Sexually transmitted infection (STI) testing in England

SHSs offer free, open-access HIV and STI testing, diagnosis and management services.

The term ‘test’ is used to signify both asymptomatic screens and symptomatic tests.

Data sources

Data on STI tests and diagnoses are submitted by SHSs to the GUMCAD STI Surveillance System. Data on chlamydia tests and diagnoses are submitted by laboratories to the CTAD Chlamydia Surveillance System. Both of these surveillance systems are managed by UKHSA and, in combination, provide a comprehensive picture of STI trends in England. These systems are detailed below.

GUMCAD

The GUMCAD STI Surveillance System was established in 2008 as an electronic surveillance system to collect disaggregated, patient-level data from Level 2 and 3 SHSs. Collected data includes:

• STI tests and diagnoses from specialist SHSs
• sexual behaviour
• alcohol and recreational drug use
• outcomes of partner notification
• provision of PrEP

Reporting services to GUMCAD

This report presents data on the recent trends and epidemiology of STIs in England. It was compiled using data on STI tests and diagnoses made in SHSs, which include:

• sexual health services providing Level 2 and Level 3 STI related care – these services may also provide SRH care as an integrated service
• online services providing non-specialist Level 2 STI related care (only)

Details on the levels of sexual health service provision are provided in Appendix B of the BASHH Standards for the Management of STIs.

CTAD

The CTAD Chlamydia Surveillance System is a universal disaggregate data set that collects chlamydia data from all laboratories commissioned by local authorities or the NHS to carry out chlamydia testing. This report includes the chlamydia data from tests and diagnoses occurring in community-based testing services.

Reporting services to CTAD

There are 4 categories of ‘testing service type’:

Service type	Definitions
1. Sexual health services (specialist STI related care)	Services providing specialist Level 3 STI related care (required to report GUMCAD). They may also provide SRH care as an integrated service.
2. Sexual health services (non-specialist STI related care)	Services providing non-specialist Level 2 STI related care (required to report GUMCAD). They may also provide SRH care as an integrated service.
3. Internet	Online services providing non-specialist Level 2 STI related care (required to report GUMCAD) or Level 1 chlamydia testing only (not required to report GUMCAD).
4. Community services	Community services providing chlamydia testing (not required to report GUMCAD) – including GPs, Termination of Pregnancy (ToP) and Pharmacies, as well as Other and Unknown.

Service type ‘Internet’ includes testing from self-sampling kits sourced from online sexual health services providing non-specialist Level 2 STI related care or Level 1 chlamydia testing only.

Service types ‘GP’, ‘ToP’ and ‘Pharmacy’ includes testing from community services providing Level 1 chlamydia testing.

Service types ‘Other’ and ‘Unknown’ includes testing from other community services providing Level 1 chlamydia testing, such as outreach settings, prisons, education settings and any other settings (that do not fall into one of the other categories) – as well as from services where a service type cannot be assigned (unknown).

Further details on the levels of STI related care are provided in the BASHH Standards for the Management of STIs (Appendix B).

Data definitions and population data

Trends in ‘New STIs’ are discussed in this report. ‘New STIs’ include the following:

• chancroid
• chlamydia
• donovanosis
• gonorrhoea
• genital herpes (first episode)
• HIV
• Lymphogranuloma venereum (LGV)
• molluscum contagiosum
• Mycoplasma genitalium
• non-specific genital infection
• pediculosis pubis
• pelvic inflammatory disease and epididymitis
• scabies
• Shigella flexneri, sonnei, spp (unspecified)
• infectious syphilis (primary, secondary, early latent stages)
• trichomoniasis
• genital warts (first episode)

Data is included on those who identify with a different gender to the gender they were assigned at birth. Data on transgender men are included in ‘men’, transgender woman are included in ‘women’ and gender diverse (non-binary and those identifying in other ways) are included in the ‘total’. Data on ‘men’ and ‘women’ refer to young people and adults.

The total may include those who are gender diverse or those reported with an unknown gender. Therefore the total may not equal the sum of data presented for men and women.

People reported with an unknown sexual orientation have been excluded from analyses on sexual orientation. Additionally, those reported with an unknown ethnicity have been excluded from analyses on ethnicity.

Population denominators are sourced from current estimates from the Office for National Statistics (ONS). Rates are calculated using population estimates from the 2011 census (2018 to 2020) and 2021 census (2021 to 2022).

Categorisation of online or internet services in the report

Online or internet data is sourced from dedicated (standalone) online services reporting GUMCAD. GUMCAD is in the process of being updated to also include data from satellite online services provided by face-to-face SHSs. This option is included in the GUMCAD guidance documents.

Technical note on imputing the STI diagnosis totals in GBMSM for 2021

Every effort is made to ensure that data quality standards are maintained by conducting regular analysis and data quality assessments. In the event that data quality issues are identified, they are followed-up directly with data reporters and their associated software providers to identify and resolve any issues – which may result in the resubmission of corrected data.

Please note that GUMCAD data included in official statistics publications are updated on an annual basis, therefore numbers may differ from previous publications – where resubmissions of corrected data have been subsequently received and included. Furthermore, please also note that, where corrected data cannot be resubmitted in time for an official statistics release, data may be imputed.

The number of diagnoses of chlamydia, gonorrhoea, infectious syphilis, genital herpes and genital warts in GBMSM was imputed in 2021 to account for under-reporting of diagnoses in this key population due incomplete reporting of sexual orientation from a large SHS in 2021.To impute the number of STI diagnoses in GBMSM in 2021 from this SHS, we did the following:

• using GUMCAD data from January to December 2019, we determined the proportion of each STI diagnosis in men attending that SHS that was reported in men who were gay or bisexual – 2019 data was used because this is the most recent year for which sexual orientation was reported with over 90% completion by this SHS
• assuming that the same proportions of men diagnosed with each STI at this SHS in 2021 were gay or bisexual, we then used that proportion to derive an adjusted number of STI diagnoses in GBMSM from that SHS in 2021
• this adjusted total was then used to derive the total number of STI diagnoses in GBMSM for that clinic (data not shown) and for all of England

No further adjustments were made to data from that SHS for any other year up to and including 2020. No adjustments were applied to data from any other SHSs as they had high data completion for sexual orientation.

Had we not applied this adjustment, the figures would suggest a decrease in several bacterial STI diagnoses in GBMSM in 2021 (see Figure A1). However, this would have solely been due to an artefact of the incompleteness of the data.

Figure A1. Adjusted and unadjusted number of new diagnoses of selected sexually transmitted infections among gay, bisexual and other men who have sex with men accessing sexual health services, England, 2019 to 2022.

[Note 1] Includes diagnoses of primary, secondary and early latent syphilis.
[Note 2] First episode.
[Note 3] Figures reported in 2020 and 2021 are notably lower than previous years due to the disruption to SHSs during the national response to the COVID-19 pandemic.
[Note 4] The number of STI diagnoses in GBMSM in 2021 was adjusted to account for incomplete reporting of some sexual orientation data (see ‘Technical note’ in the Appendix for more details).

Source: Data from routine returns to the GUMCAD STI and CTAD Chlamydia Surveillance Systems.

Data quality

GUMCAD

The number of STI diagnoses among GBMSM in 2021, as presented in the accompanying data tables, is unadjusted and underestimated because of incomplete data quality that year – but the overall trend in diagnoses in all people (irrespective of gender and sexual behaviour) is unaffected.

Table A1 shows the data completeness for key demographic characteristics 2018 to 2022.

Table A1. Data completeness from GUMCAD submitters in England with regards to 4 key demographic variables: gender, age, sexual orientation, and ethnicity

Demographic variables	2018	2019	2020	2021	2022
Gender	98.7	98.3	97.5	95.7	93.6
Age	99.9	99.9	100	100	100
Sexual orientation	86.4	88.6	90.8	90.2	91.4
Ethnicity	91.5	91.0	90.0	92.0	92.8

The table shows trends in data quality by showing the percentage complete (reported with a specified value as compared to ‘not known’ or ‘not specified’) for each demographic variable by year.

A data quality issue in the South East region of England has impacted the number of gonorrhoea diagnoses in 2021 leading to over-reporting of diagnoses that year, which also impacts the New STIs total in 2021. No other data, for any other region or for any other year, is affected.

HPV vaccination

Based on an ongoing clinical chart audit, the number of HPV vaccinations is under-reported due to miscoding or delayed software upgrades in the electronic patient management systems of some SHSs.

CTAD

Birmingham Women’s Laboratory did not submit data for Q4 (October to December) 2018. This will affect the data for the areas where these laboratories are commissioned for chlamydia testing.

Updates to surveillance data set

The ‘New STI diagnoses’ group was expanded in 2015 to include STI diagnoses that were not previously reported via GUMCAD (Shigella spp and Mycoplasma genitalium infections). Therefore, data from 2015 is not directly comparable to data from previous years.

The number of online consultations may be underreported where SHSs provide both face-to-face and online consultations: these online consultations may be misclassified as face-to-face. The continued implementation of the latest GUMCAD specification will allow SHSs to more accurately report online consultations.

Resources on the UKHSA website

Further STI data is available on the UKHSA STI annual data tables web page in the form of tables, an infographic, and a slide set.

Further data on chlamydia tests and diagnoses in adults aged 15 to 24 years are available on the UKHSA NCSP annual data tables web page.

Interactive tables, charts, and maps showing local-area STI data is available on the Sexual and Reproductive Health Profiles.

Further selection of provisional STI data up to September 2022 are available from the Wider Impacts of COVID-19 on Health (WICH) Monitoring tool.

Further information on the GUMCAD and CTAD Surveillance Systems.

Further information on the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP).

Further information on trends in mpox.

Further information on trends in HIV diagnoses in the UK.

For the latest LGV surveillance data for the UK.

For the latest guidance and data on Shigella spp.

Additional analyses

Figure A2 shows the trends in the number of diagnoses of infectious syphilis, gonorrhoea, genital herpes and genital warts, by women and men residing in England, 2013 to 2022.

Figure A2a. New diagnoses of infectious syphilis (primary, secondary and early latent stages) by gender among England residents accessing sexual health services, 2013 to 2022

Figure A2b. New diagnoses of gonorrhoea by gender among England residents accessing sexual health services, 2013 to 2022

Figure A2c. New diagnoses of genital herpes (first episode) by gender among England residents accessing sexual health services, 2013 to 2022

Figure A2d. New diagnoses of genital warts (first episode) by gender among England residents accessing sexual health services, 2013 to 2022

[Note 1] Figures reported in 2020 and 2021 are notably lower than previous years due to the reconfiguration of SHS during the national response to the COVID-19 pandemic.

Source: Data from routine sexual health services’ returns to the GUMCAD STI Surveillance System.

Table A2a: Chlamydia tests among men aged 15 to 24 years by test setting, 2021 and 2022, England

Test setting	Number of tests in 2021	Percentage of total in 2021	Number of tests in 2022	Percentage of total in 2022	Percentage change 2021 to 2022
SHSs – specialist STI related care	81,786	31.5	90,056	32.5	10.1
SHSs – non-specialist STI related care	4,005	1.5	4,337	1.6	8.3
Internet	127,640	49.2	138,240	49.9	8.3
GP	13,908	5.4	15,501	5.6	11.5
Pharmacy	1,242	0.5	1,031	0.4	-17.0
Termination of pregnancy	17	0.0	53	0.0	211.8
Unknown	1,724	0.7	1,713	0.6	-0.6
Other	29,103	11.2	26,176	9.4	-10.1
Total	259,425	100	277,107	100	6.8

Table A2b: Chlamydia diagnoses among men aged 15 to 24 years by test setting, 2021 and 2022, England

Test setting	Number of diagnoses in 2021	Percentage of total in 2021	Number of diagnoses in 2022	Percentage of total in 2022	Percentage change 2021 to 2022
SHSs – specialist STI related care	12,255	41.8	15,413	41.2	25.8
SHSs – non-specialist STI related care	609	2.1	728	1.9	19.5
Internet	12,238	41.7	16,308	43.6	33.3
GP	1,152	3.9	1,616	4.3	40.3
Pharmacy	186	0.6	162	0.4	-12.9
Termination of pregnancy	4	0.0	13	0.0	225.0
Unknown	153	0.5	179	0.5	17.0
Other	2,720	9.3	2,985	8.0	9.7
Total	29,317	100	37,404	100	27.6

Table A2c: Chlamydia test positivity among men aged 15 to 24 years by test setting, 2021 and 2022, England

Test setting	Test positivity 2021 (percentage)	Test positivity 2022 (percentage)
SHSs – specialist STI related care	15.0	17.1
SHSs – non-specialist STI related care	15.2	16.8
Internet	9.6	11.8
GP	8.3	10.4
Pharmacy	15.0	15.7
Termination of pregnancy	23.5	24.5
Unknown	8.9	10.4
Other	9.3	11.4
Total	11.3	13.5

Source: Data from routine returns to the GUMCAD STI and CTAD Chlamydia Surveillance Systems.

Acknowledgments

Contributors

Tika Ram, Stephen Duffell, Lana Drisdale-Gordon, Freddy Green, Holly Fountain, Dolores Mullen, James Bell, Natasha Ratna, Debbie Mou, Suzy Sun, Prarthana Narayanan, Hannah Charles.

Authors

Stephanie J Migchelsen, Qudsia Enayat, Ana Karina Harb, Ubah Daahir, Lucinda Slater, Anja Anderson, Alireza Talebi, Jon Dunn, Erna Buitendam, Deborah Shaw, Norah O’Brien, Marta Checchi, Helen Fifer, John Saunders, Kate Soldan, Kate Folkard, Katy Sinka, Hamish Mohammed.

Suggested citation

Stephanie J Migchelsen, Qudsia Enayat, Ana Karina Harb, Ubah Daahir, Lucinda Slater, Anja Anderson, Alireza Talebi, Jon Dunn, Erna Buitendam, Deborah Shaw, Norah O’Brien, Marta Checchi, Helen Fifer, John Saunders, Kate Soldan, Kate Folkard, Katy Sinka, Hamish Mohammed and contributors. Sexually transmitted infections and screening for chlamydia in England, 2022. June 2023, UK Health Security Agency, London