Interim Update

• This report is a mid-year update to include the latest STI statistics published in June 2023. This means that figures for STIs relate to 2022, while other figures are from 2021.
  
• Note: Figure 4, Figure 5, Figure 6, Figure 7, Figure 9, Figure 10 and Figure 11. A regional comparison is usually shown for these figures alongside data for England but has not been updated for this interim update report. This will be fixed for the end of year refresh early in 2024. Regional comparisons for these figures can be seen in the 2023 report published in February and viewed within the Sexual and Reproductive Health profiles.
  
• The response to the COVID-19 pandemic, affected sexual behaviour and health service provision, which is reflected in sexual and reproductive health indicator data. Interpreting figures for 2020 and 2021 in particular should take this into account.
• The value may be inflated due to potential duplicate reporting between online and physical reporters for the following indicators:
  • Gonorrhoea diagnostic rate per 100,000
  • Chlamydia detection rate per 100,000 aged 15 to 24
  • Chlamydia proportion aged 15 to 24 screened
  • New STI diagnoses (excluding chlamydia aged under 25) per 100,000
  • STI testing rate (exclude chlamydia aged under 25) per 100,000
  • STI testing positivity (excluding chlamydia aged under 25)
  • Chlamydia diagnostic rate per 100,000
  • Chlamydia diagnostic rate per 100,000 aged 25 years and older
  • All new STI diagnoses rate per 100,000

Key findings

• This report summarises the latest available sexual and reproductive health data for Southampton.
• Overall, the number of new sexually transmitted infections (STIs) diagnosed among residents of Southampton in 2022 was 2,528. The rate was 1,022 per 100,000 residents, higher than the rate of 694 per 100,000 in England, and higher than the average of 784 per 100,000 among its nearest neighbours.
• Southampton ranked 28th highest out of 147 upper tier local authorities (UTLAs) and unitary authorities (UAs) for new STI diagnoses excluding chlamydia in those aged under 25 in 2022, with a rate of 607 per 100,000 residents, worse than the rate of 496 per 100,000 for England.
• The chlamydia detection rate per 100,000 females aged 15 to 24 years in Southampton was 3,210 in 2022, similar to the rate of 2,110 for England.
• The rank for gonorrhoea diagnoses (which can be used as an indicator of local burden of STIs in general) in Southampton was 35th highest (out of 147 UTLAs/UAs) in 2022. The rate per 100,000 was 159, similar to the rate of 146 in England.
• Among specialist sexual health service (SHS) patients from Southampton who were eligible to be tested for HIV, the percentage tested in 2021 was 52.0%, better than the 45.8% in England.
• The number of new HIV diagnoses in Southampton was 26 in 2021. The prevalence of diagnosed HIV per 1,000 people aged 15 to 59 years in 2021 was 2.5, similar to the rate of 2.3 in England. The rank for HIV prevalence in Southampton was 47th highest (out of 150 UTLAs/UAs).
• In Southampton, in the three year period between 2019 - 21, the percentage of HIV diagnoses made at a late stage of infection amongst those first diagnosed in the UK (all individuals with CD4 count ≤350 cells/mm³ within 3 months of diagnosis) was 37.3%, similar to 43.4% 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 Southampton was 40.0 in 2021, lower than the rate of 41.8 per 1,000 women in England. The rate prescribed in primary care was 22.2 in Southampton, lower than the rate of 25.7 in England. The rate prescribed in the other settings was 17.7 in Southampton, higher than the rate of 16.1 in England.
• The total abortion rate per 1,000 women aged 15 to 44 years in 2021 was 19.4 in Southampton, similar to the England rate of 19.2 per 1,000. Of those women under 25 years who had an abortion in 2021, the proportion who had had a previous abortion was 27.8%, similar to 29.7% in England.
• In 2021, the conception rate for under-18s in Southampton was 17.4 per 1,000 girls aged 15 to 17 years, worse than the rate of 13.1 in England.
• In 2021/22, the percentage of births to mothers under 18 years was 1.1%, worse than 0.6% in England overall.

Figure 1. Chart showing key sexual and reproductive health indicators in Southampton 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 East UKHSA Region.

Compared to England:

• Better
• Similar
• Worse
• or
• Lower
• Similar
• Higher
• or
• 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

In 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 during 2020. Testing levels largely recovered during 2021, while diagnoses overall remained lower. 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 STIs continue 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 2,528 new STIs were diagnosed in residents of Southampton in 2022. It should be noted that if high rates of gonorrhoea and syphilis are observed in a population, this suggests ongoing transmission of infections is occurring.

When interpreting trends, please note:

• The decrease in STI testing and diagnoses in 2020 due to the disruption of sexual health services during the COVID-19 pandemic response, with testing rates largely recovering during 2021, but diagnoses overall remaining lower.
• 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 STI indicators in Southampton 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 East UKHSA Region.

Compared to England:

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

Key for spine bars