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STD diagnoses at GUM (genitourinary medicine) clinics in the UK: 1997-2006¹

Year	Syphilis (primary and secondary)	Gonorrhea (uncomplicated)	Chlamydia (uncomplicated)	Herpes (first attack)	Genital Warts (first attack)	All new diagnoses
1997	162	13,063	42,668	16,615	68,883	231,185
1998	139	13,212	48,726	17,248	70,291	244,282
1999	223	16,470	56,991	17,509	71,748	261,406
2000	342	21,800	68,332	17,823	71,317	284,035
2001	753	23,705	76,515	18,944	73,458	303,169
2002	1,258	25,599	87,592	19,426	74,991	324,196
2003	1,652	24,965	96,151	19,231	76,598	346,126
2004	2,282	22,321	104,733	19,073	80,055	363,248
2005	2,804	19,248	109,418	19,830	81,201	368,341
2006	2,766	19,007	113,585	21,698	83,745	376,508
% change (2005-2006)	-1%	-1%	4%	9%	3%	2%
% change (1997-2006)	1,607%	46%	166%	31%	22%	63%

Chlamydia and Gonorrhea

Over the past decade there has been a substantial increase in diagnoses of most Sexually Transmitted Diseases (STDs) in the UK, and reports of two of the most common STDs have shown massive rises. Cases of uncomplicated gonorrhea increased by 46% between 1997 and 2006, while genital chlamydia increased by 166%. Chlamydia has been the most commonly reported sexually transmitted disease since 2001, overtaking genital warts. This is the first time that a bacterial infection has held this title.

The rapid increase in reports of bacterial STDs is probably in part due to a general deterioration in sexual health amongst young people and men who have sex with men. However, the greater acceptability of using GUM services and new campaigns to encourage testing have also made a contribution.

Certain ethnic minority groups are disproportionately affected by some STDs. In 2005, the GRASP survey found that black Caribbeans accounted for 18% of gonorrhoea diagnoses at the clinics studied.²

Screening for chlamydia

Chlamydia can have serious side-effects, one of which is Pelvic Inflammatory Disease (PID) which can lead to infertility in women. However the disease can often be symptomless and therefore many people do not come forward to be tested – they often have no idea that they're infected.

New initiatives such as the National Chlamydia Screening Programme (NCSP) aim to control STDs through early detection and treatment. In particular, the NCSP targets sexually active people who might not normally have been tested for chlamydia. Since it began in April 2003, the NCSP has expanded the number of places offering chlamydia screening to include more non-GUM health centres. The total number of tests increased from 36,089 in the first year to 96,890 between April 2005 and March 2006. Nevertheless, there remains a vast number of people with chlamydia who do not know they are infected.³

(Note that the statistics in the table above represent GUM clinics only and do not include cases diagnosed through the NCSP unless they are referred to GUM clinics for management.)

What proportion of young people have chlamydia?

Recent surveys of young women attending GP clinics have found a chlamydia prevalence of 8.1% among those under 20 years old, and 5.2% among those 20-24 years old. However, rates vary widely according to the setting in which surveys take place.

For example, among women under 20 years old, surveys have found a chlamydia prevalence of 17.3% in GUM clinics, 12.6% in antenatal clinics, 12.3% in termination of pregnancy clinics, 10.7% in youth clinics, 10.0% in family planning clinics, and 5.0% in the general population. In each setting chlamydia prevalence is lower in higher age groups.⁴

Between April 2005 and March 2006, the NCSP found a chlamydia prevalence of 10.2% among women under 25 years old, and 10.1% among men in the same age group. The NCSP uses a wide variety of non-GUM screening venues, including family planning clinics, GP surgeries, prisons and military establishments. The rate peaked in the 16-19 age group.⁵

LGV infection

LGV (lymphogranuloma venereum) is a sexually transmitted infection caused by bacteria closely related to the bacteria that cause genital chlamydia. Until recently LGV was very rare in the UK and the rest of Western Europe, but the situation changed in 2003 and 2004 when there were a series of outbreaks among men who have sex with men.

To the end of March 2006, 344 confirmed cases of LGV have been reported from across the UK, the majority in London (72%) and Brighton (13%). Almost all of the diagnoses have been among white men who have sex with men, and 80% of these men were also infected with HIV. LGV causes inflammation of the rectum; left untreated it can lead to severe damage and even death.⁶

Syphilis, Genital Warts and Genital Herpes

One of the less common STDs in the UK, infectious syphilis increased in reports by a factor of seventeen between 1997 and 2006. To a large extent, this rise has been fuelled by syphilis outbreaks among men who have sex with men, particularly in Greater Manchester and London - in 2006 some 51% of diagnosed syphilis infections were acquired through sex between men.

Nevertheless the most dramatic recent increases in syphilis cases have been among women and heterosexual men. Though the numbers involved are considerably lower than in the case of chlamydia, this is still a worrying trend, as syphilis can have serious health implications and had been thought for years to be under control in the UK.

Between 1997 and 2006, diagnoses of genital herpes and genital warts rose by 31% and 22% respectively. The introduction of a vaccine against HPV, the main cause of genital warts (and cervical cancer), offers new hope for reducing the number of infections.

GUM clinics can't cope

There were 1.8 million attendances at genitourinary medicine clinics in the UK in 2006 - more than double the number recorded in 2002.⁷ This increase in people using GUM services has inevitably put pressure on their ability to deal with infections.

The pressure on GUM services was highlighted in a House of Commons Health Committee report on sexual health, published in 2003. They said that, "England is currently witnessing a rapid decline in its sexual health… Sexual health services appear ill-equipped to deal with the crisis that confronts them. Median waiting times to services are currently around 10-12 days and some services are turning hundreds of people away each week."⁸

Waiting times rise, infections rise

If people are not being treated quickly then this has inevitable effects on the spread of infection. STD infection can have grave consequences for an individual's health and, even if it can be successfully treated, is likely to be traumatic. No-one wants to be told that they have a serious, often disfiguring sexually transmitted infection and then be told to come back next week, or the week after.

A national audit of GUM clinics, conducted in November 2006, found that only 57% of clinic attendees were seen within 48 hours. Although this represents a considerable improvement since May 2004, when the proportion was just 38%, it still means that more than one in three attendees are having to wait at least two days to be seen. This is a consequence of the government advising people to get tested for STDs and then not providing the resources to enable them to get help.⁹

Long waiting times for treatment at clinics are increasing the spread of STD epidemics. The worst aspect of the soaring STD levels in this country is that they are entirely preventable.

The government's response

In November 2004, UK Health Secretary John Reid announced proposals for a £300 million campaign to tackle the rapidly increasing rates of sexually transmitted infections. "Prevention messages are not getting through," he said, "We need to act now on sexual health - and make it a priority." It was hoped that this money would help to achieve the government's 2008 goal of having all patients seen at GUM clinics within 48 hours.

£130 million of the funding was meant to go towards the modernisation of GUM clinics, with £40m devoted to contraceptive and other preventative services. Another £50m was to be spent on a TV awareness campaign aimed at young people, supposed to be the largest campaign of its kind since the 1980s "Tombstone" adverts.¹⁰

Whether the planned modernisation actually occurs is highly dependent on the money being spent wisely by NHS Primary Care Trusts (PCTs). Unfortunately, this does not appear to be happening. In August 2006, The Independent Advisory Group (IAG) on Sexual Health and HIV released a report¹¹ detailing how much of the £130 million given to PCTs had been used to pay off debts rather than improve sexual health services. Of 191 NHS PCTs surveyed, only 30 were actually spending the money exclusively on sexual health services. The rest were using some or all of their allocation to fill funding gaps and combat overspending on hospitals, drugs and GP services.

The TV campaign was delayed, and its budget slashed from £50 million to just £7.5 million.¹² It is believed that its postponement was at least partly due to concern among politicians and healthcare officials that a general increase in STD awareness would cause more people to seek testing, putting extra pressure on the already overwhelmed and underfunded GUM clinics. The campaign, with the slogan "Condom Essential Wear", was eventually launched in November 2006. Around £12 million had been spent on television, cinema, radio, press and digital advertising by March 2008.¹³

In a 2006 survey of PCTs and sexual health clinicians, conducted by the Terrence Higgins Trust, nearly half of respondents identified an increase in financial resources as the change that would most enhance their ability to reduce the incidence of STDs. Many of these experts said that government money should be "ringfenced" to prevent it being diverted to other areas. In the same survey, two thirds of clinicians said that HIV and sexual health were given insufficient priority within their local health services.¹⁴

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