Key findings

• This report summarises the latest available sexual and reproductive health data for Bristol. As a response to the COVID-19 pandemic, the Government implemented national and regional lockdowns and social and physical distancing measures since March 2020. These measures affected sexual behaviour and health service provision, which is reflected in sexual and reproductive health indicator data. Interpreting data from 2020 should consider these factors, especially when comparing with data from pre-pandemic years.
• Overall, the number of new sexually transmitted infections (STIs) diagnosed among residents of Bristol in 2020 was 3,263. The rate was 700 per 100,000 residents, higher than the rate of 562 per 100,000 in England, and similar to the average of 692 per 100,000 among its nearest neighbours.
• Bristol ranked 35th highest out of 149 upper tier local authorities (UTLAs) and unitary authorities (UAs) for new STI diagnoses excluding chlamydia among young people aged 15 to 24 years in 2020, with a rate of 718 per 100,000 residents aged 15 to 64, worse than the rate of 619 per 100,000 for England.
• The chlamydia detection rate per 100,000 young people aged 15 to 24 years in Bristol was 1,126 in 2020, worse than the rate of 1,408 for England.
• The rank for gonorrhoea diagnoses (a marker of high levels of risky sexual activity) in Bristol was 59th highest (out of 149 UTLAs/UAs) in 2020. The rate per 100,000 was 80.5, better than the rate of 101 in England.
• Among specialist sexual health service (SHS) patients from Bristol who were eligible to be tested for HIV, the percentage tested in 2020 was 54.6%, better than the 46.0% in England.
• The number of new HIV diagnoses among people aged 15 years and above in Bristol was 26 in 2020. The prevalence of diagnosed HIV per 1,000 people aged 15 to 59 years in 2020 was 2.4, similar to the rate of 2.3 in England. The rank for HIV prevalence in Bristol was 49th highest (out of 148 UTLAs/UAs).
• In Bristol, in the three year period between 2018 - 20, the percentage of HIV diagnoses made at a late stage of infection (all individuals with CD4 count ≤350 cells/mm³ within 3 months of diagnosis) was 40.7%, similar to 42.4% in England.
• The total rate of long-acting reversible contraception (LARC) (excluding injections) prescribed in primary care, specialist and non-specialist SHS per 1,000 women aged 15 to 44 years living in Bristol was 51.5 in 2020, higher than the rate of 34.6 per 1,000 women in England. The rate prescribed in primary care was 44.0 in Bristol, higher than the rate of 21.1 in England. The rate prescribed in the other settings was 7.4 in Bristol, lower than the rate of 13.4 in England.
• The total abortion rate per 1,000 women aged 15 to 44 years in 2020 was 15.1 in Bristol, lower than the England rate of 18.9 per 1,000. Of those women under 25 years who had an abortion in 2020, the proportion who had had a previous abortion was 28.1%, similar to 29.2% in England.
• In 2019, the conception rate for under-18s in Bristol was 12.7 per 1,000 girls aged 15 to 17 years, similar to the rate of 15.7 in England.
• In 2019/20, the percentage of births to mothers under 18 years was 0.7%, similar to 0.7% in England overall.

Figure 1. Chart showing key sexual and reproductive health indicators in Bristol compared to the rest of England

The local result for each indicator is shown as a circle, against the range of results for England shown as a grey bar. The line at the centre of the chart shows the England average, the diamond shows the average for the South West UKHSA Centre.

Compared to England:

• Better
• Similar
• Worse
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• Lower
• Similar
• Higher
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• Not compared

Key for spine bars

Introduction

STIs

As STIs are often asymptomatic, frequent STI screening of groups with greater sexual health needs is important and should be conducted in line with national guidelines. Early detection and treatment can reduce important long-term consequences, such as infertility and ectopic pregnancy. Vaccination is an intervention that can be used to control genital warts, hepatitis A and hepatitis B, however, control of other STIs relies on consistent and correct condom use, behaviour change to decrease overlapping and multiple partners, ensuring prompt access to testing and treatment, and ensuring partners of cases are notified and tested.

There was an increasing trend in diagnoses of chlamydia, gonorrhoea and syphilis in England from 2010 until 2019, while diagnoses of genital warts have decreased since 2013 due to the protective effect of HPV vaccination.¹ Increasing diagnosis rates for chlamydia among people aged 15 to 24 years are largely driven by changes in testing activity through the National Chlamydia Screening Programme (NCSP), although ongoing high levels of condomless sex will have played a role. The NCSP data tables provide additional data on chlamydia testing coverage, positivity and diagnostic rates (for those aged 15 to 24 years).²

Since March 2020, in response to the Coronavirus Disease 2019 (COVID-19) pandemic, the UK Government implemented strict non-pharmaceutical interventions (NPIs) in the form of national and regional lockdowns, as well as social and physical distancing measures including an emphasis on staying at home. Sexual health services (SHS) in England had substantially reduced capacity to deliver face-to-face consultations but underwent rapid reconfiguration to increase access to STI testing via telephone or internet consultations. STI testing and diagnoses decreased across all infections between 2019 and 2020. Over this period, larger decreases in diagnoses were observed for STIs that are usually diagnosed clinically at a face-to-face consultation, such as genital warts or genital herpes, when compared to those that could be diagnosed using remote self-sampling kits such as chlamydia and gonorrhoea.³ In 2020, STIs continued to disproportionately impact gay, bisexual and other men who have sex with men (MSM), young people aged 15 to 24 years, and people of Black Caribbean ethnicity.

This report has been compiled using data from SHS and ‘community-based’ settings routine returns to the GUMCAD STI and CTAD Chlamydia surveillance systems.

‘Sexual health services’ refer to services offering specialist (level 3) STI-related care such as genitourinary medicine (GUM) and integrated GUM and sexual and reproductive health (SRH) services. They also include other services offering non-specialist (level 1 or level 2) STI-related care and community-based settings such as young people’s services, internet services, termination of pregnancy services, pharmacies, outreach, and general practice. Further details on the levels of sexual healthcare provision are provided in the BASHH Standards for the Management of STIs (Appendix B).

Burden and trend of new STIs

A total of 3,263 new STIs were diagnosed in residents of Bristol in 2020. It should be noted that if high rates of gonorrhoea and syphilis are observed in a population, this reflects high levels of risky sexual behaviour.

When interpreting trends, please note:

• The decrease in STI testing and diagnoses in 2020 due to the reconfiguration of sexual health services during the COVID-19 pandemic response
• Recent decreases in genital warts diagnoses are due to the protective effect of HPV vaccination, and are particularly evident in the younger age groups (25 and younger) who have been offered the vaccine since the national programme began

Figure 2. Chart showing key STI indicators in Bristol compared to the rest of England

The local result for each indicator is shown as a circle, against the range of results for England shown as a grey bar. The line at the centre of the chart shows the England average, the diamond shows the average for the South West UKHSA Centre.

Compared to England:

• Better
• Similar
• Worse
• or
• Lower
• Similar
• Higher
• or
• Not compared

Key for spine bars