Thoughts on UKHSA's 2023 STI Spotlight Report

The UK Health Security Agency have recently released statistics on STI tests across London.  We asked our Lead Commissioner, Adrian Kelly, to look into the details and tell us what he thinks they tell us. 

These new insights from the 2023 STI Spotlight report for London give us a good snapshot picture of where we are at and suggest a clear direction for the future of sexual health service planning and STI prevention.

The headlines are:

·         STI Testing is up by 10% compared to 2022, and up 19% compared to 2019

·         The positivity rate remains at 8.5% from 2022 to 2023, but is down from just 9% in 2019

·         Consultations in sexual health services are up 6% from 2022, to over 1.5m.  This includes asymptomatic screening via the internet

What does this tell us?

Firstly, the rise in testing is undoubtedly due to factors such as expanded online and remote testing options, the effectiveness of public health campaigns aimed at the public and targeted at people with elevated odds of acquiring an STI and the resulting reduced stigma around testing.   This is all positive as we know that more people getting tested can lead to earlier detection and treatment, interrupting the chains of transmission rates over time.

Second, the positivity rate remaining stable means that testing is now able to meet the demand that exists for testing.  We can also be confident that prevention efforts (e.g., condom use, PrEP for HIV) may be having an effect and that the overall STI prevalence may be stabilising or declining slightly.

Thirdly, it is reassuring that the increase in sexual health services (SHS) evidences a shift toward digital health delivery.  We know that online services improve access for people with limited mobility or time and those in stigmatised or underserved communities who are too embarrassed to visit the clinic - especially for routine check ups

In essence, digital health is becoming a core component of sexual health services and is widely accepted by clinicians and the public.  

For us at the London Sexual Health Programme this is very encouraging.  These statistics reinforce our vision for Londoner’s sexual health, one that puts user needs first, delivers at scale, and supports a hybrid model of care that’s both flexible and inclusive.

So, what now?

A lot has been achieved.  We set out with great ambitions and have broadly. But there is lots still do, and we cannot be complacent.  We need to work together across local government, NHS and the voluntary sector to push on with policies and innovations that help to continue this trend.  There is much more that can be done. 

NHS England has announced the rollout of the world’s first routine gonorrhoea vaccination programme, which will start in August 2025 with eligible individuals being offered the 4CMenB vaccine through local authority-commissioned sexual health services.

And BASHH has published national clinical guidelines on the use of doxycycline post-exposure prophylaxis (doxyPEP), making the UK one of the first countries globally to offer formal clinical direction on this STI prevention strategy. 

There is clear positive momentum in STI prevention and control, but the fact that positivity rates are stable rather than reducing mean that STIs remain prevalent, and continued vigilance is needed.  We should maintain and expand accessible testing, target populations where the need is greatest with specific, tailored interventions and keep close monitoring for any emerging STI trends or outbreaks. 

Actions should include focussed prevention strategies such as safer sex education and outreach, targeted support for groups with greater need, greater access to condoms and PrEP and effective partner notification and treatment.