Sexually Transmitted Infections

This topic area covers statistics and information relating to sexually transmitted infections in Hull including local strategic need and service provision. Further information relating to Sexual and Reproductive Health is given under Health Factors within Adults.

This page contains information from the Office for Health Improvement & Disparities’ Fingertips. Information is taken ‘live’ from the site so uses the latest available data from Fingertips and displays it on this page. As a result, some comments on this page may relate to an earlier period of time until this page is next updated (see review dates at the end of this page).

Headlines

• In many cases, people with a sexually transmitted infection (STI) do not have symptoms. Most STIs are treated effectively if treated early, but if left untreated can cause health problems including infertility and in a small number of cases can cause death. STIs can also have major health implications for newborns if pregnant women have an STI.
• The number of tests undertaken and the percentage of the population aged 15-24 years screened as part of the National Chlamydia Screening Programme (NCSP) have both reduced drastically in Hull over the last few years but 2021 saw largest proportion tested since 2017 and is just below the national average. In 2021, the percentage of chlamydia tests that came back positive is the ninth highest in the country at 13.4%, much higher than England (9.0%) denoting that the local NCSP is much more targeted compared to other programmes across the country.
• In 2021, the STI testing rate (excluding NCSP) in Hull was 1,154 per 100,000 population (around 1.2%) and this was a third of the rate of England (3,422), and less than half the rate seen in all other local authorities across the Yorkshire and Humber region (2,497). The rates in England and the Yorkshire and Humber region increased in 2021, returning to being only 13% and 6% down respectively on pre-pandemic 2019 rates. However in Hull the rate continued to decrease in 2021 and is 46% down on the 2019 rate of 2,148 per 100,000 population. The test positivity rate in Hull increased and was much higher than England, which suggests that there is a more targeted approach to the diagnosis of STIs in Hull compared to other areas.
• In 2021, the rate of syphilis and gonorrhoea were lower in Hull than England, and also across Yorkshire and Humber where Hull previously had the highest rate of new cases of syphilis in 2020. Since 2014, rates of syphilis and gonorrhoea have been consistently lower in Hull compared to England, although rate of genital herpes has been higher, and the rate of genital warts was higher until 2018. However, for 2021, the rate of both genital warts and genital herpes was similar in Hull to England.
• In 2021 there were 15 new cases of human immunodeficiency virus (HIV) diagnosed in Hull, and the rate of new diagnoses was higher but statistically similar to both the England rate and rates across the Yorkshire and Humber. The rate was the third highest in the region, although due to a relatively small number of cases each year the rate seems to have been affected by year-on-year variability since 2017. In 2021, it is estimated that the prevalence of HIV in Hull is 1.4 per 1,000 population aged 15-59 years compared to 2.3 for England and 1.5 for the Yorkshire and Humber region. Due to small numbers, there is year-on-year variability in the percentage of people diagnosed with HIV at a late stage of the disease, but in the last three years the percentage has been similar in Hull compared to England. For 2019-21, a higher percentage of newly diagnosed patients had prompt antiretroviral therapy (97%). Among all patients accessing HIV care in Hull 94% had virological success in that their viral load was undetectable meaning that they could not pass the disease to others, however this was lower than the percentage in England (98%) and was lowest across the Yorkshire and Humber region (97%).
• A total of 1,772 new STIs were detected during 2021 which included cases of chlamydia detected among young people aged 15-24 years as part of the NCSP. Excluding chlamydia cases picked up in the NCSP, there were 1,125 new STIs detected in 2021 which included 11 cases of syphilis, 101 cases of gonorrhoea, 129 cases of genital warts and 110 cases of genital herpes and 520 cases of chlamydia among those aged 25+ years. There were also 644 cases of chlamydia detected among 15-24s.
• More STIs were detected in 2021 for Hull with a rise from 973 new STIs in 2020 (excluding NCSP) to 1,125 in 2021 (from 375 to 434 per 100,000 population – an increase of 16%). This is due to an increase in cases of chlamydia outside of NCSP, with the rates increasing almost two and a half times from 123 to 297 per 100,000 population aged over 25 years. The diagnosis rates of cases of syphilis (-48%), gonorrhoea (-41%) and genital herpes (-16%) were all significantly reduced. The rates of genital warts remained the same, although this is a decrease of 42% from 2019.
• Access to services were significantly disrupted in March 2020 due to the COVID-19 pandemic across the country, and the decrease in the rate of STIs detected in Hull was not unique with relatively similar decreases both regionally and nationally. Whilst local Sexual and Reproductive Health Services adapted by introducing telephone triage, virtual appointments and a postal service for STI testing kits, it is likely that access to services was reduced or became problematic for some individuals particularly young people living at home. It is also possible that the prevalence of STIs and the need for STI testing was reduced with the pandemic and subsequent lockdowns as people socialised less and were more restricted in where they could go and visit. It is possible that the impact of the pandemic on the incidence and testing undertaken goes beyond the duration of the pandemic due to changes in behaviour and services during 2020 as well as changes that were made to service due to different and improved ways of working.

The Population Affected – Why Is It Important?

Information from the NHS states that many people with sexually transmitted infections (STIs) do not get symptoms, so it’s worth getting tested even if you feel fine. If you think you have an STI, the earlier you’re tested, the sooner treatment can be given if it’s needed. An STI can be passed from one person to another through sexual contact. Many STIs can be cured with antibiotics.

The NHS stated that most common STIs are chlamydia, gonorrhoea, trichomoniasis, genital warts, genital herpes, pubic lice, scabies and syphilis. Another STI is human immunodeficiency virus (HIV) which can lead to acquired immunodeficiency syndrome (AIDS). There is further information on the NHS website relating these STIs.

The severity and consequences of different STIs vary, but most can be treated relatively easily if treated early. Some of the symptoms of some STIs also can disappear by themselves, but can also result in recurrences in the infection. However, some STIs can cause long-term problems if left untreated, and can cause pelvic inflammatory disease, infertility, and even death in the case of syphilis and HIV.

Some of the STIs can be passed from mother to baby whilst pregnant, at birth or even through breastfeeding in the case of HIV. Gonorrhoea can cause permanent blindness in a newborn, trichomoniasis in rare cases can cause premature birth and low birth weight for newborns, and genital herpes can also cause problems for newborns. Syphilis can be very serious in pregnant women resulting in miscarriage, stillbirth or a serious infection in the baby (congenital syphilis) as can HIV which can be passed to the newborn.

HIV attacks and weakens the immune symptoms making it less able to fight infections and disease. Emergency anti-HIV medication called post-exposure prophylaxisis (PEP) may stop someone becoming infected if started within 72 hours of possible exposure to the virus. Early diagnosis is important to avoid life-threatening consequences of the disease and avoid passing it to others. Antiretroviral medicines are used to treat HIV which prevent the virus from replicating in the body, allowing the immune system to repair itself and prevent further damage. The goal of HIV treatment is to have an undetectable viral load in that the level of the HIV virus in the body is low enough to be not detected by a test. If the viral load has been undetectable for six months or more, then it means the person cannot pass the virus on through sex. AIDS is the final stage of an HIV infection when the body can no longer fight life-threatening infections. Men who have sex with men, Black African heterosexuals and people who share needles, syringes and other injecting equipment have an increased risk of HIV. It can also be transmitted from mother to baby during pregnancy, birth or breastfeeding. There is also pre-exposure prophylaxis (PrEP) available for those high risk groups at risk of HIV from sex or injection drug use. This prescription drug is taken before on a regular basis and is highly affective for preventing HIV.

HIV testing is integral to the treatment and management of HIV. Knowledge of HIV status increases survival rates, improves quality of life and reduces the risk of HIV transmission.

It should be noted that when examining rates of STIs across different populations, it could be assumed that a high rate is bad as it means that the prevalence is high in that population. However, as many STIs are asymptomatic, a high rate of STIs or a high detection rate can also be considered to be good as it assumed that a higher percentage of people with STIs in that population are being detected and therefore treated in that population. This is the case for chlamydia where a high rate is classified as ‘better’ by The Office for Health Improvement & Disparities (formerly Public Health England). However, because of this, the rate of STIs detected in different populations should be treated cautiously as it depends on the numerous factors, such as the willingness of the population to come forward to be tested, access to Sexual Health and Reproductive Services (SHRS), the way in which local SHRS are administered and advertised, as well as the overall prevalence in the population.

The Hull Picture

The Office for Health Improvement & Disparities’ Fingertips present some information on the number of diagnoses of STIs. The rates are presented as the numbers diagnosed within the time period per 100,000 population unless otherwise stated.

The diagnostic or detection rate is given below for the main STIs and is given as the number of positive tests or cases of the STI out of the total resident population presented as the rate of new cases per 100,000 population.

Syphilis

The number of syphilis diagnoses among people accessing sexual health services per 100,000 residents was lower in Hull compared to England for 2021, although it comparable to the Yorkshire and Humber average with Hull having the ninth highest rate in the region.

However, the rate in Hull has been quite variable due to small numbers with 11 new diagnoses of syphilis in 2021. Between 2012 and 2021, the diagnosis rate for syphilis in Hull has been consistently lower than the rate for England.

Gonorrhoea

Gonorrhoea is used as a marker for rates of unsafe sexual activity. This is because the majority of cases are diagnosed in sexual health clinics, and consequently the number of cases may be a measure of access to STI treatment. Infections with gonorrhoea are also more likely than chlamydia to result in symptoms. Despite this it is likely that there will be people with gonorrhoea with or without symptoms who do not present at a sexual health clinic.

In 2021, the number of new cases gonorrhoea diagnosed in Hull was also lower than England with 39 cases per 100,000 population in Hull compared to 90 cases diagnosed per 100,000 population for England.

However, the rate had been increasing in Hull between 2014 and 2019 with a fall in 2020. It is not known if the decrease since 2020 is due to a real decrease or because Sexual and Reproductive Health Services were disrupted in 2020 due to COVID-19. There were 101 new diagnoses of gonorrhoea in Hull during 2021 which is a further decrease from when there had been 170 the previous year whereas the diagnosis rate for England in 2021 has remained similar to the previous year. The diagnosis rate in Hull has been consistently lower than the rate for England between 2012 and 2021.

Genital Warts

In 2021, the rate of new cases genital warts diagnosed in Hull was similar to England (49.8 versus 50.0 new cases diagnosed per 100,000 population).

In contrast to syphilis and gonorrhoea, the diagnosis rate for genital warts in Hull had been consistently higher than the rate for England since 2014. The rate was 170 per 100,000 population in 2014 with 437 new diagnoses of genital warts in Hull but has fallen significantly over time with a rate of 50 per 100,000 population in 2021 with a total of 129 new diagnoses.

Genital Herpes

The number of new diagnoses for genital herpes was statistically similar in Hull compared to England, but higher when compared to the Yorkshire and Humber region with the third highest regional rate for 2021 of 42.5 new cases per 100,000 population compared to 38.3 for England and 32.5 for the Yorkshire and Humber region.

The diagnosis rate for genital warts has been consistently high in Hull compared to England since 2015, and statistically significantly so. There have been just over 70 new cases of genital warts per 100,000 population for each year 2015 to 2019 (around 190 individuals diagnosed each year). Whilst the rate has decreased significantly since 2019 (to 110 individuals diagnosed in 2021), it is likely the decrease is due to a disruption in services due to COVID-19 although could also be due to decreased prevalence following decreased social interactions.

All Sexually Transmitted Infections

The diagnosis rate for all new STIs in Hull is higher than England for 2021 with 684 new STIs diagnosed per 100,000 population compared to 551 for England. The rate in Hull is also higher than the rate across the Yorkshire and Humber region of 467, with Hull having the second highest regional rate.

A sizable percentage of all new diagnoses of STIs are due to cases of chlamydia among under 25s because of the National Chlamydia Screening Programme (NCSP). In 2021, 36.5% of all new STIs in Hull were cases of chlamydia among under 25s in Hull.

As the way the NCSP is implemented locally differs across different geographical areas, the incidence of all new STIs can be influenced by the way in which the local NCSP is run. Therefore, it is also useful to examine the rate of new STIs excluding diagnoses of chlamydia among those aged 15-24 years (the target age group for the NCSP). Furthermore, there could be changes to the way the NCSP is implemented locally over time. Between 2012 and 2017 in Hull, between 39% and 53% of new cases of STIs diagnosed were cases of chlamydia among under 25s.

In Hull, the rate of new STIs excluding chlamydia diagnoses among under 25s in 2021 was 434 new STI diagnoses per 100,000 population which was higher than the rate for England of 394. It was also higher than the rate across the Yorkshire and Humber region of 285, with Hull having the highest rate in the region.

During 2021, there were 1,772 new STIs detected in Hull, but there had been 2,099 during 2019. With the exception of 2020, the number of STIs detected in 2021 was the lowest. The highest rates occurred between 2013 and 2016 when there were over 2,700 new STIs detected in Hull each year.

The rate of new STIs was relatively constant between 2013 and 2016 with just over 1,000 new diagnoses per 100,000 population (and around 2,700 diagnoses), but the rate fell in Hull for the next four years, although the significant drop between 2019 and 2020 is likely associated with COVID-19 due to both a lower prevalence and a disruption to Sexual and Reproductive Health Services. The rate in 2021 is 684 per 100,000 population with 1,772 new STIs diagnosed which is still a significant fall from 2,700 diagnosed between 2013 and 2016.

However, the rate of new STIs diagnosed excluding chlamydia among the under 25s does not show such a fall between 2016 and 2019 (only a slight fall), and therefore it is likely that the fall in rate of all STIs including chlamydia is influenced by a change in the way the NCSP is administered locally or a change in the take-up rate for the NCSP.

Fingertips also presents the testing rate and the test positivity rate.

The testing rate is the number of people of all ages who are tested for syphilis, HIV and gonorrhoea and the number of people aged 25 to 64 years tested for chlamydia out of the total number of people tested for one or more infections for syphilis, HIV, gonorrhoea and chlamydia at a new attendance (chlamydia tests only included for people aged 25-64 years). Each episode is counted once regardless of the number of tests that were provided, and an individual may appear more than once in the denominator if they attend for more than one episode of infection during the year.

The test positivity rate is the sum of all positive diagnoses of syphilis, HIV and gonorrhoea among all ages and chlamydia diagnoses among those aged 15-64 years out of the number of people tested for syphilis, HIV, gonorrhoea and chlamydia at a new attendance. Each episode is counted once regardless of the number of tests that were provided, and an individual may appear more than once in the denominator if they attend for more than one episode of infection during the year.

For 2021, whilst the numbers tested for STIs is considerably lower than England and most other local authorities in the region, the rate of positive tests is higher. Thus it would appear that there is a more targeted approach to STI testing in Hull.

The rate of STI testing in Hull has been consistently lower than England and more recently consistently lower than the Yorkshire and Humber regional average, and while testing rates in both England and the Yorkshire and Humber region have risen in 2021 in Hull they have continued to decrease.

In contrast, the test positivity rate in Hull has steadily increased, and when the test positivity fell in the most recent period for England and across the region, the test positivity increased in Hull. This perhaps provides further support for the argument that the approach to STI testing in Hull is slightly different to other geographical areas.

Chlamydia

For 2021, the number of chlamydia diagnoses among 15-24s per 100 population aged 15-24 years was higher in Hull compared to England and across the Yorkshire and Humber, and Hull had the third highest detection rate in the region for this age range.

Between 2012 and 2016, the chlamydia detection rate among 15-24s in Hull was consistently higher than England, and at its highest more than 50% higher than England. However, the rate fell in Hull between 2016 and 2017 by a quarter, and the rate in Hull between 2017 and 2019 has been similar to the rate in England. However, the percentage of tests sent out that result in a positive result for chlamydia has increased so it appears that there is a much more targeted approach in Hull (see below).

The rate fell between 2019 and 2020 for England, across the Yorkshire and Humber region, and for Hull, but in 2021 the rate in Hull increased to be similar to the rate in 2019, and as the rates in both England and the Yorkshire and Humber region have remained similar to their 2020 level Hull’s detection rate is higher than both of them again.

There was a reasonably similar trend over time among both men and women.

The percentage of men and women who were screened for chlamydia in Hull during 2021 (that is the number of people aged 15-24 years with a positive or negative chlamydia test result out of the total population aged 15-24 years) was lower than in England and across the Yorkshire and Humber region but had increased in Hull from the previous year by two and a half times.

Over one in seven people (14.0%) aged 15-24 years in Hull were screened for chlamydia compared to 14.8% for England and 15.3% across the region. The rates in Hull were in the middle range of the rates across all other local authorities in the region which ranged from 8.8% to 20.2%.

The percentage of young people screened for chlamydia has fallen significantly over time. During 2012 and 2013, it was estimated that over 35% of people aged 15-24 years were screened for chlamydia, but this fell to 30% in 2014 and to around 20% for 2015 and 2016. At this time the rate in Hull was comparable to that of England and across the region, although the rate in Hull continued to fall compared to the rate in England and across the region remaining around 20% until 2019. There was a significant fall in the rate in Hull between 2016 and 2017 when the rate halved to around 10% and remained around 10% between 2017 and 2019. The recent halving of the rate may have been due to reduced need of the service and/or problems accessing services during the COVID-19 pandemic. In 2021, the rate in Hull has increased to the highest rate since 2017.

However, the percentage of chlamydia tests that are sent out and come back positive for chlamydia is much higher in Hull. In fact, the percentage for Hull (at 13.4%) is in the top ten of all local authorities in England for 2021 (range 4.1% to 18.9%, excluding Isles of Scilly).

From the trend tables on The Office for Health Improvement & Disparities’ Fingertips for the detection rate and the percentage screened, the number of positive tests and tests completed respectively are given. From this information, it is possible to calculate the percentage of positive tests. However, this should be used as a guide though as there are caveats associated with the data, for example, for both measures, ‘records are re-duplicated in order to prevent over-estimation’ and the table below might not take this into account.

From this information, it appears that the NCSP in Hull has used a much more targeted approach in recent years compared to other local authorities in England.

Year	Tests	Positive tests	Positive tests (%)
2012	14,319	1,068	7.5
2013	14,768	1,122	7.6
2014	11,935	1,029	8.6
2015	8,466	1,108	13.1
2016	7,463	1,050	14.1
2017	4,380	771	17.6
2018	3,663	674	18.4
2019	3,080	680	22.1
2020	1,918	346	18.0
2021	4,805	644	13.4

The diagnostic rate for chlamydia is higher in Hull compared to England and the Yorkshire and Humber region for both all ages and people aged over 25 years. The diagnostic rate for chlamydia among those aged 25+ years is statistically significantly higher than England, and highest in the region.

As the majority of chlamydia diagnoses are among those aged 15-24 years (62-77% between 2012 and 2020), the trend over time in the chlamydia detection rate among all ages follows a similar pattern to the pattern observed for those aged 15-24 years. In 2021, diagnoses among those aged 15-24 years had a 55% majority (or 647 diagnoses out of 1167) due to a large increase in diagnoses among those aged over 25 (from 215 cases in 2020 to 520 cases in 2021).

For those aged over 25 years, the number of new diagnoses of chlamydia per 100,000 population shows year-on-year variability but has generally been around 200 per 100,000 population for the majority of the period 2012 to 2019, however in 2021 it was at its highest rate of 297 per 100,000. The rate in Hull is statistically significantly higher than the England rate of 178, and the rate across the Yorkshire and Humber region of 136 where Hull’s rate was the highest.

HIV (Human Immunodeficiency Virus)

The Office for Health Improvement & Disparities’ Fingertips also presents information relating to human immunodeficiency virus (HIV).

Testing For HIV

The HIV testing covering percentage is presented. This is the percentage of ‘eligible attendees’ in whom (a maximum of) one HIV test was accepted among those accessing specialist sexual health services out of the number of ‘eligible attendees’ accessing specialist sexual health services. An ‘eligible attendee’ is defined as a patient attending a specialist sexual health service at least once during the calendar year with patients known to be HIV positive, or for whom a HIV test was not appropriate or for whom the attendance was related to Sexual Health and Reproductive Health care only are excluded.

There was a lower uptake of HIV testing among ‘eligible attendees’ of specialist sexual health services in Hull compared to England for 2021 with four in ten eligible attendees of Hull’s specialist sexual health services agreeing to a HIV test.

Over the period 2010 to 2019, the HIV testing uptake rates in Hull have been statistically significantly lower than the rate in England with the rate being higher for only the first year (2009) and the latest year (2020).

Between 2009 and 2013, the uptake rates in Hull were quite variable year-on-year, and whilst the uptake rates were below the rates in England for 2009 to 2011 and for the year 2013, the rates were considerably lower in 2012. However, since 2014 when uptake rates were 48% in Hull, the uptake rates have been increasing to just over 60% for 2018 and 2019. In 2020, whilst the rates in England dropped considerable the Hull rates were above these, remaining around 60% thus it appears services in Hull initially continued to offer this more opportunistic testing for HIV during the pandemic whereas many other services across the country did not. However, in 2021 the rates in England have remained at the same level but the Hull rates have dropped below this (similar to the level relatively to England in recent years prior to 2020).

Testing rates are also given separately for men, women, and men who have sex with men (MSM) as well as repeat HIV testing among MSM who are at the most risk of HIV.

The rate of HIV testing was similar in Hull relative to England during 2021 for these categories which the exception of testing coverage in men which is lower than the rates nationally.

Whilst the testing uptake rates among MSM has been increasing in Hull in the last 3-4 years, it has been consistently lower than England. For 2020, the percentage in Hull was similar to England for the first time since 2014. It was noted above that it would appear that the testing rates have remained relatively unchanged between 2019 and 2020 in contrast to England which dropped significantly. However, in 2021 whereas the overall testing rate in Hull had reduced 18% the testing rate among MSM only reduced by 4% and the rate is still similar to the rate in England, so it appears that as services reduced during the pandemic a more targeted approach was taken in Hull to testing those most at risk.

Among all men, the HIV testing uptake rate has been statistically significantly lower than England between 2010 and 2019, in particular for the period 2015 to 2017, although the percentage in Hull has increased since 2017. Nevertheless there is still a considerable difference in the percentage uptake between Hull and England, and this increased between 2018 and 2019 when the uptake rate in Hull fell slightly.

Whilst the testing coverage percentage remained unchanged between 2019 and 2020 among Hull men, it fell sharply between 2020 and 2021. In contrast, the rate decreased sharply for men in England between 2019 and 2020, but increased between 2020 and 2021. This could be associated with the way services were run during the pandemic and subsequently, however, the percentage in Hull is now similar – relative to England – where it was in recent years.

Among women, a similar pattern occurred until 2014, but since then the percentage uptake for HIV testing among women in Hull has consistently increased, and for 2018 and 2019 has been statistically significantly higher than England having increased from under 40% to almost 60%. The rate also reduced less in Hull than it did for England and across the region between 2019 and 2020, although there was a sharp fall in the percentage for Hull women between 2020 and 2021 compared to a very small reduction for England. In 2021, the rate in Hull is comparable to England.

The percentage of MSM who have had more than one HIV test had been lower in Hull compared to England between 2016 and 2019, but the rate has recently been slightly higher than England.

The percentage is the number of MSM who have been tested for HIV at a specialist sexual health service who have tested more than once in the year prior to their last test in each calendar year out of the number of MSM tested for HIV at specialist sexual health service.

New Cases of HIV

The new HIV diagnosis (incidence) rate per 100,000 population in Hull was slightly higher than England for 2021 (5.8 versus 4.8 new cases of HIV diagnosed per 100,000 population). The rate was second highest in the region after Leeds.

The new HIV diagnosis rate has been consistently lower than England with only the latest year 2021 having a rate slightly above England. There were 15 new cases of HIV diagnosed during 2021.

As there are a relatively small number of new cases of HIV diagnosed each year, there will be year-on-year variability and the confidence intervals are relatively wide for Hull (95% confidence interval 3.2 to 9.5 per 100,000 population in 2021).

Prevalence of HIV

The estimated prevalence of HIV is over 40% lower in Hull compared to England, and it is estimated that there are around 1.4 people diagnosed with HIV per 1,000 population aged 15-59 years.

The estimated prevalence of HIV had been increasing in Hull from 1.0 per 1,000 population aged 15-59 years in 2011 to 1.4 per 1,000 population aged 15-59 years in 2019 where it has remained since, although the increase during this time is comparable to the increase observed for both England and across the Yorkshire and Humber region.

Late Diagnosis of HIV

Early diagnosis of HIV is very important as late diagnosis is the most important predictor of morbidity and mortality, with a 10-fold risk of death among those who were diagnosed late compared to those diagnosed at an early stage of HIV.

Late diagnosis is defined as those with a CD4 count less than 350 cells per cubic millimetres. The people included in the measure need to have had their CD count available within 91 days of their diagnosis, be aged 15+ years and resident in England. It also includes all reports of HIV diagnoses made in the UK regardless of country of the first HIV positive test (i.e. including people who were previously diagnosed with HIV abroad).

The percentage diagnosed with HIV at a late state during the three year period 2019-21 was slightly higher in Hull than England (47% versus 43%).

For the three year period 2019-21, there were 32 individuals diagnosed with HIV who had their CD4 count available within 91 days of their diagnosis, and 15 (46.9%) of them were diagnosed at a late stage of HIV.

However, due to the small number of new diagnoses of HIV each year, the percentage diagnosed at a late stage can be quite variable. The percentage diagnosed at a late stage in Hull has been comparable to England.

The information on late diagnosis is also available for MSM, heterosexual men and heterosexual women, although due to small numbers the percentages are not given for all local authorities for all three groups.

It is difficult to interpret the information fully due to the small number of new diagnoses in total, however, it does appear that the percentage has improved in Hull since 2015-17 with a lower proportion of MSM diagnosed at a late stage. The 95% confidence intervals for the percentages are very wide suggesting considerable uncertainty around the percentages in Hull.

For MSM, during 2019-21 for new diagnoses of HIV where the CD4 count was available within 91 days 44.4% were diagnosed at a late stage of HIV (counts are suppressed for disclosure control due to a small denominator).

Three of the six heterosexual men who were diagnosed with HIV (and had a CD4 count available within 91 days of diagnosis) during the three year period 2019-21 were diagnosed at a late stage of HIV. The numbers of men are very small, so it is difficult to interpret the percentages, but it does appear that the percentage in Hull is similar to England.

Very few heterosexual women have been diagnosed with HIV (and had a CD4 count available within 91 days of diagnosis) over the entire period 2014-16 and 2019-21 which means it is very difficult to assess the information, although it does appear that the percentage is generally lower in Hull than for England which suggests that more women in Hull are being diagnosed early.

Treatment Success Among People with HIV

Fingertips also presents information on the percentage of patients diagnosed with HIV who start antiretroviral therapy (ART) within 91 days of their diagnosis as well as the percentage who have an undetectable viral load (<200 copies per millilitre).

The indicator measures the prompt treatment which reduces the risk of onward HIV infection among partners. Successful ART decreases a person’s viral load and HIV transmission does not occur when the viral load is undetectable, and the percentage of people who are virally suppressed (also known as an undetectable viral load) has implications in the potential for onward transmission of HIV.

For 2019-21, there is prompt initiation of ART in Hull with more than 19 in every 20 people commencing ART within 91 days of diagnosis which is higher than England (97.4% versus 83.5%). The success rate in relation to HIV viral load in Hull for 2021 is lower than to England (94.0% versus 97.8%).

Information on the trends over time is not available for prompt ART initiation although the number of individuals is given for Hull. ART was given promptly (within 91 days) to 38 of the 39 people newly diagnosed with HIV during the period 2019-21.

The viral load was successfully reduced to an undetectable level for 219 people with HIV during 2021 (out 233 people with HIV).

Strategic Need and Service Provision

People need to be aware that symptoms are not always present, and that if they think they might have been exposed or have an STI should be encouraged to seek medical help.

Locally, there are programmes in place to educate and change behaviour, not just to treat sexually transmitted infections, but to empower and allow people to make positive, informed, proactive choices about contraception. There are also specific services available for high risk groups such as sex workers and men who have sex with men (MSM).

Hull Clinical Commissioning Group (and its successor Hull’s Health & Care Partnership) and Hull City Council offer an integrated community-based range of free to access services. Over the last decade Hull has significantly changed the way it delivers sexual health services, with an increasing emphasis on prevention and health promotion to challenge perceived social norms and deliver behaviour change. Services are available throughout the area and in easy to access community settings.

Whilst it might be considered to be positive that the number of STIs has fallen, it is also possible that there has been little change to the prevalence and that the detection rate is lower and as a consequence fewer people with STIs are being treated. It is often not known which is the case. However, for chlamydia screening among young people aged 15-24 years, it is evident that the number of tests and the percentage screened has decreased significantly over time, but as the percentage of tests sent out that are positive for chlamydia is the highest in the county, this denotes a much more targeted approach in Hull compared to perhaps other geographical areas across the country. There has been a greater focus on prevention locally which could also be having an impact.

During the COVID-19 pandemic, whilst the number of STIs detected as well as access to other services such as contraception (see Sexual and Reproductive Health under Health Factors under Adults) reduced, it is difficult to ascertain whether this was due to a reduced detection rate or because the prevalence of STIs decreased or the need for the service decreased. There was clear and significant disruption to Sexual Health and Reproductive Services as the normal face-to-face service could not operate particularly at the start of the first lockdown in March 2020 when people and services were learning and working out the best way to deal with the pandemic and its lockdowns. This clearly was not unique to Hull, but it is likely that different services adapted slightly differently throughout the country. The local Sexual Health and Reproductive Health Service was disrupted initially, but quickly introduced telephone triage and virtual appointments with a postal service for testing kits. This adaptation could have made access to the service more problematic for young people who were living at home during lockdown as it might have been more difficult to have privacy for telephone calls or virtual appointments during lockdown, more problematic receiving testing kits through the post, and no access to a walk-in service for testing. However, it is also likely that the need for Sexual Health Services were reduced as people were not socialising and going out as much.

It is possible that the knock-on effects of this disruption might be felt for some time, even after services were ‘back to normal’ or almost ‘back to normal’. However, some of forced changes to the service has benefits and some of the changes were retained after the service could ‘return to normal’, and therefore the service model currently operating will differ from the service in 2019. People’s behaviours and the way in which they accessed the service could have also changed, which may be still having an impact on the number of tests undertaken and test positivity.

In recent years, it does appear that there is a more targeted approach to STI testing in Hull compared to some other local authorities.

Resources

NHS. Sexually transmitted infections: https://www.nhs.uk/

The Office for Health Improvement & Disparities’ Fingertips: https://fingertips.phe.org.uk/

HIV/STI Data Exchange (restricted access)

Updates

This page was last updated / checked on 29 November 2022.

This page is due to be updated / checked in October 2023.