Key findings

• This report summarises the latest available sexual and reproductive health data for Coventry. 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 onwards 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 Coventry in 2021 was 2,323. The rate was 612 per 100,000 residents, higher than the rate of 551 per 100,000 in England, and higher than the average of 510 per 100,000 among its nearest neighbours.
• Coventry ranked 50th highest out of 150 upper tier local authorities (UTLAs) and unitary authorities (UAs) for new STI diagnoses excluding chlamydia in those aged under 25 in 2021, with a rate of 378 per 100,000 residents, similar to the rate of 394 per 100,000 for England.
• The chlamydia detection rate per 100,000 young people aged 15 to 24 years in Coventry was 1,349 in 2021, similar to the rate of 1,334 for England.
• The rank for gonorrhoea diagnoses (which can be used as an indicator of local burden of STIs in general) in Coventry was 39th highest (out of 150 UTLAs/UAs) in 2021. The rate per 100,000 was 94.9, similar to the rate of 90.3 in England.
• Among specialist sexual health service (SHS) patients from Coventry who were eligible to be tested for HIV, the percentage tested in 2021 was 41.9%, worse than the 45.8% in England.
• The number of new HIV diagnoses in Coventry was 34 in 2021. The prevalence of diagnosed HIV per 1,000 people aged 15 to 59 years in 2021 was 3.2, worse than the rate of 2.3 in England. The rank for HIV prevalence in Coventry was 32nd highest (out of 150 UTLAs/UAs).
• In Coventry, 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 53.8%, 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 Coventry was 27.9 in 2020, lower than the rate of 34.6 per 1,000 women in England. The rate prescribed in primary care was 18.6 in Coventry, lower than the rate of 21.1 in England. The rate prescribed in the other settings was 9.2 in Coventry, lower than the rate of 13.4 in England.
• The total abortion rate per 1,000 women aged 15 to 44 years in 2021 was 21.3 in Coventry, higher than 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 30.2%, similar to 29.7% in England.
• In 2020, the conception rate for under-18s in Coventry was 19.5 per 1,000 girls aged 15 to 17 years, worse than the rate of 13.0 in England.
• In 2020/21, the percentage of births to mothers under 18 years was 1.0%, worse than 0.6% in England overall.

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).