HIV rates are dropping but gay and bi men in England are suffering big jumps in chlamydia, gonorrhoea and syphilis.
The latest figures from Public Health England (PHE), show chlamydia is up 83% between 2015 and 2019. There were 23,187 new diagnoses of the STI last year alone.
Meanwhile, in the same period, gonorrhoea is up 51% to 33,853 new cases and syphilis has risen by 40% to 5,875 diagnoses. Genital herpes cases are also up, but by a smaller amount.
Part of that may be because more gay and bi men are taking STI tests. But the health officials say the ‘rise in diagnoses of these STIs exceed [the rise in] testing’.
Moreover they add ‘men who have sex with men’ (MSM) have changed their sexual behavior, leading to the spikes.
This, says PHE, includes ‘more partners and condomless anal intercourse, and, for some
MSM, “chemsex” and group sex facilitated by [dating] applications’.
Good news on HIV and genital warts
However, there is also some good news.
While the figures aren’t included in the new report out today, HIV rates have plummeted among gay and bi men.
PHE agrees with other experts that this is due to a range of factors. These include more men testing and getting effective treatment for HIV.
Once on effective treatment, HIV positive people have ‘undetectable’ levels of the virus. That means they can’t pass it on, even if they have unprotected sex. This is called ‘treatment as protection’ or ‘TasP’ and ‘undetectable equals untransmittable’ or ‘U=U’.
Moreover, PrEP – a drug you can take to avoid getting HIV – has also dramatically lowered HIV transmission.
Meanwhile a lesser-known program has helped tackle genital warts.
Many gay and bi men in England can now get a vaccine for HPV – the virus that causes warts. The result is a 10% drop in genital warts cases in the four years to 2019. That figure may fall further as the national vaccination program only started in 2018.
How COVID may have changed STIs
However, the big unknown is the effect of COVID-19 on sexual health.
The new PHE report only covers 2019. But when the UK’s coronavirus lockdown started, sexual health services saw a big drop in new diagnoses.
Sex venues closed and many men refused hook-ups. The result was a sharp decline in the number having sex with people they don’t live with.
One leading clinic, 56 Dean Street in London, which is particularly popular with gay and bi men, saw a 86% drop in gonorrohea cases, which usually has painful symptoms.
The clinic therefore encouraged gay and bi men to take an STI test before lockdown ended. Doctors described it as a ‘once in a lifetime opportunity’ to slash HIV and STI rates.
Meanwhile some sexual health clinics have urged people to order home testing kits online. This saves clinics money and makes testing easier for many men. Early testing and treatment is a vital tool to cutting STIs.
While lockdown has eased, sex venues have remained closed. Moreover, many men are still avoiding casual sex hook-ups. It is not yet clear what impact that will have on STI rates.
Adding to the unknowns, Public Health England has also become a victim of coronavirus. The government has decided to scrap it, merging it into a new organization to tackle COVID-19.
However, that has left a lot of unanswered questions about PHE’s other roles – including its leadership in tackling HIV and STIs.
‘Lack of vision’ from UK Government
Ian Green is chief executive of sexual health charity Terrence Higgins Trust. He highlighted some of the challenges the government and whatever replaces PHE will face:
‘Today’s new STI figures clearly show the impact of the government’s ongoing inaction and lack of vision for improving the nation’s sexual health.
‘Rates of sexually transmitted infections like gonorrhoea and syphilis are rising significantly while sexual health services are overburdened and under-funded.
‘This data is for 2019 and so doesn’t account for the COVID-19 pandemic, impact of lockdown or social distancing. It’ll be some time before the impact of coronavirus is known – good or bad – but a pandemic is not a sustainable solution for tackling soaring rates of STIs.
‘Covid has driven innovation in sexual health services with the welcome scaling up of digital services and STI testing by post.
‘But digital services don’t work for everyone and we know digital poverty is a big challenge for many.
‘We need long term solutions. Now, as people start to have sex again following lockdown, it’s vital services and access to testing and treatment are scaled up in parallel.’
Meanwhile Terrence Higgins Trust and National AIDS Trust are among over 80 organizations to have signed a joint statement today expressing concern about the reorganization of PHE.
National AIDS Trust tweeted: ‘No clarity and lack of information on HIV and sexual health risks undoing the progress we have made.’