Effectiveness of sexual health services

We look at the effectiveness of sexual health services in England.



Last updated: 15/02/2024


Sexual health promotion and the provision of sexual and reproductive health and HIV services make an important contribution to both individual and population health. Sexually transmitted infections (STIs) are often asymptomatic, but if left untreated, can cause pelvic inflammatory disease or infertility and may be transmitted to others. This highlights the need for early detection and treatment.

The uneven distribution of STIs is also a manifestation of inequality, as some communities including people living in poverty, specific ethnic minority communities, and people living with HIV, are more affected than others.

STI diagnoses

In 2022, there were 392,453 diagnoses of new sexually transmitted infection (STI) made at sexual health services in England. Of these, the most commonly diagnosed STIs were chlamydia (199,233; 51% of all new STI diagnoses), gonorrhoea (82,592; 21%) and genital warts (26,079; 7%). The number of screening tests conducted in 2022 were still 2.7% lower than in 2019, the latest pre-pandemic year, but represents a recovery from the disruptions caused due to the Covid-19 pandemic where decreased number of screens led to a decrease in rates of new diagnoses for all STIs.

In the decade between 2012 and 2022, rates of gonorrhea and syphilis diagnosis saw an increase. In 2022, the number of gonorrhea diagnoses was the highest since records began, which is especially concerning in the context of antimicrobial resistance for this STI. Similarly, the number of syphilis diagnoses in 2022 was the highest since 1948, with most of the infections occurring in men who have sex with men.

Conversely, the rate of diagnosis for genital warts fell from 142 per 100,000 population in 2012 to 46 per 100,000 population in 2022. Chlamydia rates in 2022 (353 per 100,000 population) were lower than in the period between 2012 and 2019. As chlamydia is an infection which doesn’t result in any visible symptoms, increases in infections detected is a sign of better chlamydia control. 

Chlamydia in adolescents and young adults

The National Chlamydia Screening Programme (NCSP) provides screening to sexually active young people aged 15 to 24 years, with the aim of increasing the detection of chlamydia and reducing the prevalence of associated health outcomes. In 2022, more than 967,000 chlamydia tests were carried out among young people aged 15 to 24 years in England, slightly lower than in 2021.

Assuming one test per person, the proportion of the population aged 15 to 24 screened for chlamydia decreased from 27% in 2012 to 15% in 2022. The number of diagnoses per 100,000 people aged 15 to 24 years (the chlamydia detection rate) slightly declined from 1,420 in 2020 to 1,334 in 2021 (data for 2022 not reported).

In June 2021, the focus of the NCSP shifted to women in order to reduce the reproductive harm caused by untreated infection in young women. While chlamydia testing for people of any gender continues to be offered, the UKHSA proposed a revised female-only minimum detection rate target of 3,250 per 100,000 women aged 15 to 24 years. Between 2018 and 2022, the proportion of the female population aged 15 to 24 screened for chlamydia decreased from 30% to 21%, and the chlamydia detection rate slid from 2,662 to 2,110—significantly lower than the proposed target.

Late HIV diagnoses

A key strategic priority is to decrease HIV-related morbidity and mortality by reducing the proportion and number of HIV diagnoses made at a late stage of infection. People who are diagnosed late are estimated to have lived unknowingly with HIV for 3-5 years and have a ten-fold increase in risk of death compared with those diagnosed promptly. Historically, the definition for a late-stage HIV diagnosis is a CD4 (a type of white blood cell crucial to your immune system) count of less than 350 cells/mm3 within 91 days of diagnosis and no evidence of recent seroconversion, an illness that can happen six weeks after initial infection which also lowers a person’s CD4 count.

Between 2012 and 2022, the proportion of people in the UK diagnosed with HIV at a late stage of infection fluctuated slightly, moving down by a few percentage points overall from 41% to 34%. However, the absolute number fell by 56% from 1,978 to 1,080.

There were reductions in late HIV diagnoses among heterosexual men (from 60% in 2012 to 46% in 2022), heterosexual women (from 49% to 33%), and intravenous drugs users (53% to 48%). The group with the highest number of people diagnosed late is men who have sex with men, as HIV cases that are diagnosed at a late stage of infection remain a significant concern among gay and bisexual men and people of Latin American and West African ethnic origin. 

About this data

The diagnosis rate of an STI is defined as the number of diagnoses among people accessing sexual health services (SHS) in England who are also residents in England, expressed as a rate per 100,000 population.

The data represents the number of diagnoses reported and not the number of people diagnosed. Rates were calculated using Office for National Statistics (ONS) population estimates for 2016. The diagnosis totals for all the STIs, except for chlamydia, from 2012 onwards include data from specialist SHS (level 3) and non-specialist SHS (level 2).

The chlamydia tests data includes those carried out on people aged 15-24 years inclusive. The data represents the number of tests and diagnoses reported, and not the number of unique people tested or diagnosed. A maximum of one chlamydia test per individual is counted within a six-week period, and the data presented is based on tests with confirmed positive and negative results only.

Late diagnosis of HIV in adults is defined as those aged 15 years and above who are diagnosed with a CD4 cell count <350 within 91 days of diagnosis and no recent evidence of seroconversion in the UK.

For more information on these statistics, please see the UK Health Security Agency’s Sexual and Reproductive Health Profiles.

This indicator uses data from the UKHSA on sexual health services and diagnoses of sexually transmitted infections (STIs).

Data on consultations carried out by sexual health services during the Covid-19 pandemic are provisional. During the pandemic, the number of sexual health services that submitted data decreased, and only consultations for services with complete data for January to June 2019 and January to June 2020 are presented here. For more information, see the Public Health England report Impact of COVID-19 on STIs, HIV and viral hepatitis in England: 2020 report (provisional data) and the appendix.