Sexual health services (SHS) are a vital mechanism to control the transmission of sexually transmitted infections (STIs) across the UK. Unfortunately, during the COVID-19 pandemic, SHS were disrupted by strict lockdown restrictions that meant in-person consultations were significantly reduced, and SHS were forced to rely on telephone and internet consultations to diagnose new infections. Therefore, new diagnoses of STIs decreased by 32% in 2020 compared to 2019, according to Public Health England (PHE). However, as COVID-19 restrictions lifted, it was assumed that the annual testing rates, sexual-health consultations, and incident cases of STIs, such as chlamydia, gonorrhea, herpes, and genital warts, would increase back to pre-pandemic levels—but that has not yet been the case.
Throughout 2020, a year of lockdown measures and social distancing, there was a 25% reduction in sexual health screens according to PHE. As face-to-face consultations fell by 35% compared to 2019, PHE found that STIs that require physical examination for diagnosis, such as genital warts and herpes, saw a greater drop in new diagnoses (46% and 40% decline, respectively), as shown in Figure 1.
SHS were fortunately able to conduct most consultations online through questionnaires and telephone appointments and were then able to dispatch self-sampling kits that test for STIs such as chlamydia and gonorrhea. This was reflected in the slightly lower reduction in diagnoses of these diseases to 29% and 20%, respectively. The reduced testing capacity, as well as constraints of social distancing, are likely responsible for the reduced incident cases of STIs throughout this period.
However, in 2021 most lockdown restrictions were lifted, and there was a return to pre-COVID-19 pandemic levels of social and sexual mixing. This was not reflected in the number of new diagnoses reported by the UK health security agency. There has been recovery in the number of consultations since the pandemic, with a 15.7% increase since 2020, and a 3.9% increase since 2019, as well as an 18.7% increase in the number of self-sampling sexual health screens delivered for chlamydia, gonorrhea, syphilis, and HIV, compared with 2020. However, this remains 13.2% fewer tests than in 2019.
As shown in Figure 1, there were 311,604 new diagnoses of STIs across England in 2021, which is a reduction of 33.2% when compared to 2019. The figure also shows that there were fewer cases in 2021 than in 2020, which is unexpected given the increased likelihood of casual sexual relations. This suggests that there is less engagement with testing regimes, which needs to be upscaled as soon as possible to prevent a spike in the incidence of STIs.
GlobalData epidemiologists initially forecast that the incident cases of gonorrhea would increase from 2019 to 2022 in the UK (from 57,000 cases to 58,000 cases), and incident cases of genital herpes would increase from 33,000 to 34,000 in the same period—the cases were expected to slowly rise. But the disruption caused by COVID-19 and the number of consequential undiagnosed STIs likely means that there will be a spike of undiagnosed STIs across the UK, especially in vulnerable younger groups, those under the age of 25 years. To prevent this, it is essential that there is increased promotion of regular STI testing among all groups, but especially in vulnerable groups.