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.