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 an 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. However, for 2020, the percentage of chlamydia tests that came back positive is the highest in the county at 18.1% and almost twice as high as England (9.9%) denoting that the local NCSP is much more targeted compared to other programmes across the country.
• In 2020, the STI testing rate (excluding NCSP) in Hull was 2,236 per 100,000 population (around 2.2%) and whilst this was half the rate of England (4,549), it was comparable to other local authorities across the Yorkshire and Humber region. The rate in Hull had decreased by 31% from 3,223 per 100,000 population in 2019, but there had also been decreases for England (-26%) and across the Yorkshire and Humber (-24%) due to the COVID-19 pandemic.
• In 2020, the rate of syphilis and gonorrhoea were lower in Hull than England, although the rate of new cases of syphilis was the highest in Hull across Yorkshire and Humber. 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. For 2020, the rate of genital warts was similar in Hull to England, but the rate of genital herpes was statistically significantly higher in Hull compared to England.
• In 2020, there were nine new cases of Human Immunodeficiency Virus (HIV) diagnosed among those aged 15+ years in Hull, and the rate of new diagnoses was lower than both England and across the Yorkshire and Humber. The rate was particularly high in 2019 in Hull, but this could have been random variation. The rate fell between 2019 and 2020 for England and the region, and it is likely associated with the COVID-19 pandemic. In 2020, 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 lower in Hull compared to England. For 2018-20, a higher percentage of newly diagnosed patients had prompt antiretroviral therapy, and among all patients accessing HIV care a similar high percentage (97%) had virological success in that their viral load was undetectable meaning that they could not pass the disease to others in Hull compared to England.
• A total of 1,319 new STIs were detected during 2020 which included cases of chlamydia detected among young people aged 15-24 years as part of the NCSP. There were 975 new STIs detected excluding the NCSP. In 2020, there were 21 cases of syphilis, 171 cases of gonorrhoea, 129 cases of genital warts and 131 cases of genital herpes. There were 337 cases of chlamydia detected among 15-24s, and 212 cases of chlamydia among those aged 25+ years. The numbers will not sum to the total as there are other STIs not included in the list and there may also be technical reasons in relation to multiple diagnoses within a year, etc.
• Fewer STIs were detected in 2020 in Hull with a fall from 1,401 new STIs in 2019 (excluding NCSP) to 975 in 2020 (from 819 to 573 per 100,000 population – a decrease of 30%). The diagnosis rate of cases of gonorrhoea (-29%), genital warts (-42%), genital herpes (-31%) and chlamydia (-47%) were all significantly reduced, although the diagnosis rate of syphilis increased (by 50% from a rate of 5.4 to 8.1 per 100,000 population) although numbers were small (from 14 to 21 cases).
• 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.

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.

Syphilis

The number of syphilis diagnoses among people accessing sexual health services per 100,000 residents was lower in Hull compared to England for 2020, although it was highest in the Yorkshire and Humber region and considerably higher than the Yorkshire and Humber average.

However, the rate in Hull has quite variable due to small numbers with 21 new diagnoses of syphilis in 2020. Between 2012 and 2020, 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 2020, the number of new cases gonorrhoea diagnosed in Hull was also lower than England with 66 cases per 100,000 population in Hull compared to 101 cases diagnosed per 100,000 population for England.

However, the rate had been increasing in Hull over the last 2-3 years with a fall in 2020. It is not known if the decrease in 2020 is due to a real decrease or because Sexual and Reproductive Health Services were disrupted in 2020 due to COVID-19. There were 171 new diagnoses of gonorrhoea in Hull during 2020, although there had been 241 during 2019 and 228 the previous year. The diagnosis rate in Hull has been consistently lower than the rate for England between 2012 and 2020.

Genital Warts

In 2020, the rate of new cases genital warts diagnosed in Hull was similar to England (49.8 versus 48.6 new cases diagnosed per 100,000 population).

In contrast to syphilis and gonorrhoea, the diagnosis rate for genital warts in Hull has 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 2020 with a total of 129 new diagnoses.

Genital Herpes

The number of new diagnoses for genital herpes was higher in Hull compared to England, and second highest across the Yorkshire and Humber region for 2020 with 50.6 new cases per 100,000 population compared to 36.3 for England and 33.5 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 decreased significantly in 2020 (to 131 individuals and a rate of 50 per 100,000 population), 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 is lower than England for 2020 with 509 new STIs diagnosed per 100,000 population compared to 562 for England. Despite being lower than England, the rate in Hull is among the highest across the Yorkshire and Humber.

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). During 2018 and 2019, between 31% and 33% of all new STIs in Hull were cases of chlamydia among under 25s in Hull and although the percentage was lower in 2020 at 26%, chlamydia cases still represent a significant number of STI diagnoses.

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. So this percentage has changed dramatically in Hull over time reflecting changes in the way the service is run in Hull.

In Hull, the rate of new STIs excluding chlamydia diagnoses among under 25s is also lower than the rate for England, and among the highest across the Yorkshire and Humber region. The rate is given as the number of new STI diagnoses per 100,000 population.

During 2020, there were 1,319 new STIs detected in Hull, but there had been 2,099 during 2019. With the exception of 2012 and 2020, the number of STIs detected in 2019 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 2019 was 808 per 100,000 population with 2,099 new STIs diagnosed which is 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. It 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.

In 2020, the overall testing rate for STIs per 100,000 population (excluding chlamydia among 15-24s) is significantly lower than England, although all local authorities in Yorkshire and Humber also have a significantly lower testing rate too when compared with England.

When examining the rates in Yorkshire and Humber, the rate in Hull for 2020 is ranked approximately in the middle.

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.

The test positivity 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.

The testing positivity is higher in Hull than England for 2020. Thus it appears that more cases of STIs are detected among people attending sexual health clinics in Hull, and the rate is the highest among local authorities across the Yorkshire and Humber region in 2020 with the exception of North East Lincolnshire.

The percentage of STI testing which results in positive test results is considerably higher in Hull than England or the region, and has been higher since 2016.

Chlamydia

For 2020, the number of chlamydia diagnoses among 15-24s per 100 population aged 15-24 years was considerably lower in Hull compared to England and across the Yorkshire and Humber, although the rate in East Riding of Yorkshire was even lower than Hull.

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 the decrease in Hull (-50%) was greater than England (-31%) or the region (-32%).

There was a similar trend over time among both men and women, although a lower rate of chlamydia diagnoses among women for 2014.

There was a lower percentage of men and women were screened for chlamydia in Hull during 2020 (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).

One in twenty people aged 15-24 years in Hull were screened for chlamydia compared to 14% for England and 15% across the region. The rates in Hull were considerably lower than all other local authorities across the region except East Riding of Yorkshire which had a slightly lower percentage.

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 be due to reduced need of the service and/or problems accessing services during the COVID-19 pandemic.

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 is highest in Hull (at 18.4%) across all 149 upper-tier local authorities in England for 2020 (range 5.2% to 17.9%) and there are only six other local authorities with test positivity rates above 15% (Middlesbrough, Hartlepool, Wolverhampton, Stockton-on-Tees, Redcar and Cleveland, and Portsmouth).

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.

So it appears that the NCSP in Hull has used a much more targeted approach in the last couple of 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	1,866	337	18.1

The diagnostic rate for chlamydia is lower in Hull compared to England for both all ages and people aged over 25 years.

As the majority of chlamydia diagnoses are among those aged 15-24 years (61% or 338 diagnoses out of 550), 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.

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.

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 higher uptake of HIV testing among ‘eligible attendees’ of specialist sexual health services in Hull compared to England for 2020 with six 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. Whilst there has been a decrease in the percentage in Hull for 2020, the fall in the percentage was relatively small compared to a large increase for England and across the region. Thus it appears services in Hull continued to offer this more opportunistic testing for HIV during the pandemic whereas many other services across the country did not.