Sexually transmitted infections
An update from the Board of Science
March 2008
Note: This update is based on STI data for 2006, which became available on 23 November 2007. The Health Protection Agency has yet to complete data collection for 2007. Preliminary results are expected in July 2008 and confirmed data due in late November 2008.
Introduction
In February 2002 the BMA’s Board of Science published a report on Sexually transmitted infections for healthcare professionals. It provided an up-to-date summary of the most common sexually transmitted infections (STIs) in the UK; presented new BMA recommendations to assist the profession in informing people about health risks associated with unsafe sexual activity; and called for improved services.
This update provides an indication of some recent trends and acts as a signposting resource to key publications.
Since the 2002 BMA report, there has been a continuing increase in almost all STIs. The latest report from the Health Protection Agency [reference 1] (HPA), which presents data for 2006, comments that ‘while there have been some encouraging developments in HIV and STI prevention in 2006, the overall picture has worsened.’ The report further highlights the following key points:
- The growing impact of HIV and STIs in society hasoccurred in spite of a marked improvement in clinical services aimed at curtailing transmission
- Following the success of the introduction of routine antenatal HIV testing, there has been substantial progress with HIV testing of GUM clinic attendees and with vaccinating men who have sex with men (MSM) attendees against hepatitis B
- Steady increases were apparent in the number of STI diagnoses made in general practice
- By the end of 2006 the National Chlamydia Screening Program (NCSP) for young adults was under way in 42 areas of England and 447,000 tests had been performed up to the end of September 2007, since the Programme began in 2003.
- provided almost a million (961,000) sexual health screens (up 9%from 2005)
- made over 621,000 STI diagnoses (up 2.4%)
- there was an increase in HIV tests offered from 901,000 to 972,000 and in tests accepted from 629,000 to 706,000 between 2005 and 2006
- reduced waiting times so that by the end of the year 69 per cent of attendees in England were being offered an appointment within 48 hours (by August 2007 this figure had increased to 85%).
At the end of 2006, approximately 73,000 adults were living with HIV in the UK, both diagnosed and undiagnosed. This figure is rising each year as a result of the continuing incidence of new infections which exceeds the number of deaths (much reduced in the last decade due to antiretroviral therapies). Although the percentage of the population living with HIV is low, the cost to the NHS is high. It is estimated that each HIV infection prevented saves £0.5-1.0 million in terms of individual health benefits and treatment cost [reference 3]. Over the years, especially since the introduction of combination antiretroviral therapies in 1996, total costs of in-patient treatment have declined and out-patient costs have increased. A number of studies have investigated the cost of treating a person with symptomatic HIV [reference 4] with an average of £14,000 per patient a year being accepted as reasonable. In 2005, the approximate cost in the UK per annum for those diagnosed was estimated at £400 million and, if all were diagnosed, £580 million [reference 5]. In comparison, the same report estimated the total cost to the health service of new episodes of chlamydia, gonorrhoea, syphilis, herpes and warts diagnosed in England, Wales and Northern Ireland in 2004 (taking into account both initial appointments and follow-up visits) to be approximately £165 million per annum.’[reference 6]