There has been a significant worsening in the sexual health of
gay and other men who have sex with men in England, new surveillance data
released by the Health Protection Agency shows.
remained high among heterosexual young people, aged between 15 and 24.
Overall, there was a
2% increase in the number of reported sexually transmitted infections in 2011
compared to 2010. But cases of gonorrhoea and syphilis were up by 25 and 10%
Although the increase in diagnoses is
partly attributed to improved testing and surveillance, doctors believe that
high rates of unprotected sex are leading to the continued transmission of
sexually transmitted infections.
Investigators from the HPA are especially
concerned about the 25% increase in gonorrhoea diagnoses. The infection is
becoming increasingly difficult to treat due to the emergence of strains which
are resistant to antibiotics.
Analysis of longer-term trends showed that
rates of syphilis, genital herpes and genital warts have all increased
significantly since 2002. This year’s increase follows a modest fall in the
number of infections diagnosed in 2010.
As in previous years, gay and other men who
have sex with men had high rates of sexually transmitted infections.
Three-quarters of syphilis cases in 2011 were in this group, as were 50% of
The number of gonorrhoea cases in gay and
bisexual men increased by 61% compared to 2010, chlamydia by 48%, genital
herpes by a third, syphilis by over a quarter and genital warts by 23%.
A substantial proportion of gonorrhoea cases in
this population involved extragenital sites. Some 16% of infections
were in the throat, with 20% located in the rectum. The authors believe that
these figures are likely to represent an underestimate.
Several factors appear to have contributed
to the upsurge of diagnoses in gay men. The large increase in gonorrhoea is
partly attributed to improved testing and surveillance. Highly sensitive nucleic acid amplification tests
(NAATs) are now used to diagnose infections. Reporting of sexual orientation
has also improved.
investigators are convinced that the increase is at least partly due to ongoing
high rates of unprotected sex. The researchers highlight the continuing LGV
epidemic continues in older HIV-positive gay and bisexual men and recent
outbreaks of Shigella.
Younger heterosexual people also had high rates of
infections. Overall, two-thirds of chlamydia diagnoses involving heterosexuals
involved patients aged between 15 and 24. This age group also accounted for 57%
of gonorrhoea and 56% of genital wart diagnoses.
The only apparent good news in the report was a 2%
fall in cases of chlamydia. However, the investigators believe that was simply
due to a decline in the number of young people being screened.
Inner London had the highest overall rates of
sexually transmitted infections. Investigators believe this is due to the
concentration of at-risk populations in this area.
Doctors are especially alarmed by the large
increase in gonorrhoea diagnoses: “The emergence of decreased susceptibility to frontline antimicrobials
used for treating gonorrhoea and depletion of effective treatment options
suggest that the prospect of untreatable gonorrhoea is a real threat.”
recommend that sexual health prevention campaigns and services should continue
to be focused towards high-risk populations.
and education remain the cornerstones of STI prevention, through improving
awareness and encouraging safer sexual behaviour,” write the investigators.
“Men who have sex with men having unprotected sex with casual or new partners
should have an HIV/STI screen at least annually, and every three months if
changing partners regularly. Consistent condom use, reducing the number of
sexual partners and the avoidance of overlapping sexual relationships all
reduce the risk of being infected with an STI.”