Key findings

• This report summarises the latest available sexual and reproductive health data for East Sussex. 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 East Sussex in 2021 was 1,966. The rate was 352 per 100,000 residents, lower than the rate of 551 per 100,000 in England, and similar to the average of 361 per 100,000 among its nearest neighbours.
• East Sussex ranked 92nd 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 261 per 100,000 residents, better than the rate of 394 per 100,000 for England.
• The chlamydia detection rate per 100,000 young people aged 15 to 24 years in East Sussex was 946 in 2021, worse than 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 East Sussex was 97th highest (out of 150 UTLAs/UAs) in 2021. The rate per 100,000 was 41.7, better than the rate of 90.3 in England.
• Among specialist sexual health service (SHS) patients from East Sussex who were eligible to be tested for HIV, the percentage tested in 2021 was 19.3%, worse than the 45.8% in England.
• The number of new HIV diagnoses in East Sussex was 17 in 2021. The prevalence of diagnosed HIV per 1,000 people aged 15 to 59 years in 2021 was 1.9, better than the rate of 2.3 in England. The rank for HIV prevalence in East Sussex was 69th highest (out of 150 UTLAs/UAs).
• In East Sussex, 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 38.5%, 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 East Sussex was 47.9 in 2020, higher than the rate of 34.6 per 1,000 women in England. The rate prescribed in primary care was 29.1 in East Sussex, higher than the rate of 21.1 in England. The rate prescribed in the other settings was 18.8 in East Sussex, higher than the rate of 13.4 in England.
• The total abortion rate per 1,000 women aged 15 to 44 years in 2021 was 17.6 in East Sussex, lower 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 26.7%, similar to 29.7% in England.
• In 2020, the conception rate for under-18s in East Sussex was 11.0 per 1,000 girls aged 15 to 17 years, similar to the rate of 13.0 in England.
• In 2020/21, the percentage of births to mothers under 18 years was 0.5%, similar to 0.6% in England overall.

Figure 1. Chart showing key sexual and reproductive health indicators in East Sussex 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 1,966 new STIs were diagnosed in residents of East Sussex in 2021. 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, 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 key STI indicators in East Sussex 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

Table 1. Rates per 100,000 population of new STIs in East Sussex and England: 2020-2021

Diagnoses	2020	2021	% change 2020 to 2021*	Rank among 16 similar UTLAs/UAs†	Rank within England: 2021‡	Value for England: 2021
New STIs	361.8	351.8	-2.8%	9	114	551.0
New STIs (exc chlamydia aged <25)	256.1	260.7	1.8%	4	92	394.5
Chlamydia	206.5	182.5	-11.6%	10	115	282.0
Gonorrhoea	48.7	41.7	-14.3%	7	97	90.3
Syphilis	5.5	9.7	74.2%	1	64	13.3
Genital warts	38.1	45.3	18.8%	7	77	50.0
Genital herpes	27.0	31.3	15.9%	11	93	38.3
Mycoplasma genitalium1	1.3	3.0	142.9%	10	100	9.0
Trichomoniasis1	2.3	4.1	76.9%	9	102	10.4
As a response to the COVID-19 pandemic, in March 2020 the Government implemented national and regional lockdowns and social and physical distancing measures. 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.
* Percent change not provided where the value in 2020 was 0.
† These are East Sussex and its 15 statistical nearest neighbours, excluding those where values were suppressed due to small numbers. First rank has the highest value. Nearest neighbours are derived from CIPFA’s Nearest Neighbours Model.
‡ Out of 149 UTLAs/UAs in England, excluding those where values were suppressed due to small numbers. City of London and Isles of Scilly are always excluded. First rank has the highest value. Where the value was 0, ranks are based on order of local authority names.
1 Data for Mycoplasma genitalium and trichomoniasis were included for the first time in 2022. Testing for these infections is not included as part of a standard sexual health screen, but is advised for those with symptoms and the partners of those diagnosed (see BASHH guidelines for Mycoplasma genitalium and trichomoniasis).

Table 2. Number of new STIs by year, East Sussex

Diagnoses	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021
New STIs	3,016	2,952	3,087	2,895	2,899	3,050	3,164	3,134	2,022	1,966
New STIs (exc chlamydia aged <25)	1,996	1,919	1,946	1,952	1,948	2,015	2,178	2,202	1,431	1,457
Chlamydia	1,373	1,383	1,541	1,293	1,408	1,576	1,601	1,623	1,154	1,020
Gonorrhoea	106	105	151	164	137	262	277	343	272	233
Syphilis	8	14	23	18	24	26	32	33	31	54
Genital warts	694	680	636	622	589	484	511	468	213	253
Genital herpes	218	251	240	271	279	292	321	286	151	175
Mycoplasma genitalium1	-	-	-	-	-	-	-	17	7	17
Trichomoniasis1	20	20	16	21	28	28	24	39	13	23
1 Data for Mycoplasma genitalium and trichomoniasis were included for the first time in 2022. Testing for these infections is not included as part of a standard sexual health screen, but is advised for those with symptoms and the partners of those diagnosed (see BASHH guidelines for Mycoplasma genitalium and trichomoniasis).

Figure 4. Rates per 100,000 population of new STIs (excluding chlamydia in under 25-year olds) in 16 similar local authorities and the South East UKHSA Region, compared to England: 2021

Similar refers to statistical nearest neighbours, derived from CIPFA’s Nearest Neighbours Model

Figure 5. Rates per 100,000 population by diagnosis by year in East Sussex compared to rates in the South East UKHSA Region and England: 2012 to 2021

Please note the charts have different y axis scales.

Figure 6. Rates per 100,000 population of gonorrhoea in 16 similar local authorities and the South East UKHSA Region, compared to England: 2021

Similar refers to statistical nearest neighbours, derived from CIPFA’s Nearest Neighbours Model

Figure 7 shows rates of syphilis per 100,000 population for East Sussex, compared to national, regional, and neighbouring rates. The UKHSA has conducted an in-depth examination of the national epidemiology of syphilis from 2010-2019,⁴ in alignment with the Syphilis Action Plan (2019).⁵

Figure 7. Rates per 100,000 population of syphilis in 16 similar local authorities and the South East UKHSA Region, compared to England: 2021.

Similar refers to statistical nearest neighbours, derived from CIPFA’s Nearest Neighbours Model

Chlamydia detection

In June 2021, the National Chlamydia Screening Programme (NCSP) changed to focus on reducing the harms from untreated chlamydia infection.⁶ These harms occur predominantly in young women and other people with a womb or ovaries - this includes transgender men, non-binary people assigned female at birth, and intersex people with a womb or ovaries. Therefore, opportunistic screening should focus on these groups, combined with reducing time to test results and treatment, strengthening partner notification and re-testing after treatment.

In practice this means that chlamydia screening in community settings (e.g. GP and Community Pharmacy) will only be proactively offered to young women and other people with a womb or ovaries. Services provided by sexual health services remain unchanged and everyone can still get tested if needed.

Given the change in programme aim, the Public Health Outcome Framework (PHOF) Detection Rate Indicator (DRI) benchmarking thresholds have been revised and will be measured against females only. A new female-only PHOF benchmark DRI will be included in the PHOF from January 2022 (to be reported in 2023).

This report covers 2021 data and benchmarks against the rate for England. Since chlamydia is most often asymptomatic, a high detection rate reflects success at identifying infections that, if left untreated, may lead to serious reproductive health consequences.

The chlamydia detection rate in 15 to 24 year olds in 2021 in East Sussex was 946 per 100,000 population (508 positives out of 8,141 screened), lower than the 2,300 target. 15.2% of 15 to 24 year olds were tested for chlamydia, compared to 14.8% nationally. The detection rate per 100,000 and its rank among CIPFA nearest neighbours and England are shown in Table 3.

Table 3. Chlamydia detection rate per 100,000 population and percentage screened in 15 to 24 year olds in East Sussex and England: 2021

	2020	2021	% change 2020 to 2021*	Rank among 16 similar UTLAs/UAs†	Rank within England: 2021‡	Value for England: 2021
Detection rate
Total	1,094.4	945.5	-13.6%	14	122	1,334.2
Women	1,453.5	1,286.8	-11.5%	13	121	1,762.5
Men	726.8	590.8	-18.7%	13	117	859.8
Percentage screened
People aged 15-24	16.5	15.2	-8.3%	4	56	14.8
As a response to the COVID-19 pandemic, in March 2020 the Government implemented national and regional lockdowns and social and physical distancing measures. 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.
* Percent change proportional to the value in 2020, not a change in percentage points. Percent change not provided where the value in 2020 was 0.
† These are East Sussex and its 15 statistical nearest neighbours, excluding those where values were suppressed due to small numbers. First rank has the highest value. Nearest neighbours are derived from CIPFA’s Nearest Neighbours Model.
‡ Out of 149 UTLAs/UAs in England, excluding those where values were suppressed due to small numbers. City of London and Isles of Scilly are always excluded. First rank has the highest value. Where the value was 0, ranks are based on order of local authority names.

Variation in rates of chlamydia detection (Figure 8) may represent differences in prevalence, but are influenced by screening coverage and whether most at risk populations are being reached (i.e. the proportion testing positive).

Figure 8. Map of chlamydia detection rate per 100,000 population in 15 to 24 years in East Sussex by Middle Super Output Area: 2021

Please note that this data is not available on the online Sexual and Reproductive Health Profiles. Data is sourced from the CTAD Chlamydia Surveillance System (CTAD). As a response to the COVID-19 pandemic, in March 2020 the Government implemented national and regional lockdowns and social and physical distancing measures. 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 this reconfiguration, especially when comparing with data from pre-pandemic years.

New Chlamydia diagnoses in East Sussex by MSOA

Contains Ordnance Survey data © Crown copyright and database right 2021
Contains National Statistics data © Crown copyright and database right 2021

Figure 9. Chlamydia detection rate per 100,000 population in 15 to 24 year olds in 16 similar local authorities and the South East UKHSA Region, compared to England: 2021

Similar refers to statistical nearest neighbours, derived from CIPFA’s Nearest Neighbours Model

In the five years from 2016 to 2021, there was a 43% decrease in the chlamydia detection rate among 15 to 24 year olds in East Sussex. From 2020, the decrease was 14%.

Figure 10. Chlamydia detection rate per 100,000 population in 15 to 24 year olds by year in East Sussex, the South East UKHSA Region and England

Other infections transmitted sexually

Some bloodborne viruses can be spread through sex as well as by other routes, e.g. hepatitis B, hepatitis C. Some gastro-intestinal infections, typically linked to contaminated food or water can also be spread faecal-orally during sexual activity: these are called sexually transmissible enteric infections (STEIs) e.g. hepatitis A and Shigella.

Over the last decade, the number of cases of sexually-transmitted Shigella among MSM in England has increased,⁸ with concerning increases in antimicrobial resistance. Cases of shigellosis can be severe, leading to dehydration and sepsis. Due to its presentation as an enteric illness, most symptomatic cases present to primary care (GPs, A&E) rather than SHS. Only a minority of MSM are thought to be aware of Shigella and how to avoid it, however, surveillance shows transmission of these infections is commonly associated with high-risk behaviours such as sexualised drug-use (including ‘chemsex’) and multiple casual sex partners.

Lymphogranuloma venereum (LGV), an invasive form of chlamydia, is a sexually transmitted infection which disproportionately affects MSM. In the past decade, the number of LGV diagnoses has increased substantially in England. Historically, LGV was mainly concentrated among MSM living with HIV. However, in recent years, a greater proportion of cases have been among MSM who are HIV negative.⁹

Hepatitis A vaccination is available for MSM in SHS. In 2016 an outbreak of hepatitis A was identified among MSM in England and across Europe. Between July 2016 and April 2017 266 cases associated with the outbreak had been identified in England, 74% of these among MSM.¹⁰ This resulted in work to raise awareness of how to prevent infection through hygiene measures (e.g. washing hands after sex)¹¹ and recommendations around hepatitis A vaccination of MSM attending SHS. This outbreak highlights how quickly and widely an infection can become established in key populations if prevention measures such as vaccination are not undertaken.

In England, hepatitis B is most often acquired sexually. Where information on risk exposures was recorded on acute and probable acute cases of hepatitis B, the most commonly reported risk was heterosexual exposure (50%), followed by sex between men (17%).¹² Vaccination can prevent infection and is recommended for MSM, for individuals with multiple sexual partners and for individuals who place themselves at risk through sexual activity when travelling to high prevalence countries.

Most people in England acquire hepatitis C through injecting drug use.¹³ However, MSM are also a risk group for hepatitis C transmission. MSM living with diagnosed HIV, especially those reporting high risk sexual practices, are disproportionately affected by hepatitis C compared to HIV-negative MSM; therefore guidance for hepatitis C testing in SHS has been targeted towards this group.

In May 2022, an international outbreak of mpox (monkeypox) was detected with cases reported concurrently from many countries where the disease is not endemic. To date, most reported cases in the outbreak have involved mainly, but not exclusively, men who have sex with men. Over 3,500 individuals have been diagnosed in England. Vaccines developed to protect against smallpox have been approved and used for prevention of mpox and were used as part of the response. Numbers of new cases fell to very low levels by the end of 2022.

HIV

Free and effective antiretroviral therapy (ART) in the UK has transformed HIV from a fatal infection into a chronic but manageable condition. People living with HIV in the UK can now expect to have a near normal life expectancy if diagnosed promptly and they adhere to treatment. In addition, those on treatment are unable to pass on HIV, even if having unprotected sex (undetectable=untransmissible [U=U]).

In 2021, 2,692 people were newly diagnosed with HIV in England. This is a 0.7% rise from 2,673 (in 2020) and a 33% fall from 4,017 (in 2019). The impact of the COVID-19 pandemic on services and patient access means that it remains difficult to interpret the changes observed between 2019 and 2021.¹⁴

Among the 2,023 new diagnoses that were first made in England, men exposed through sex between men accounted for 36% (721), women exposed by heterosexual contact for 21% (429), men exposed by heterosexual contact for 18% (369), injecting drug use for 2% (45).

More than half those first diagnosed in England in 2021 were diagnosed at a late stage (with a CD4 count below 350 cells per mm³). Median CD4 at diagnosis was especially low in men exposed by heterosexual contact, people of Black African ethnicity, and those over the age of 65, all having fallen since 2019.

Of the estimated 95,900 (credible interval (CrI) 94,700 to 97,700) people living with HIV in 2021, an estimated 4,400 (95% CrI 3,500 to 6,100) were undiagnosed. In 2021, England again achieved the UNAIDS 95-95-95 target nationally, with 95% of people living with HIV being diagnosed, 99% of those diagnosed being on treatment and 98% of those on treatment having an undetectable viral load.

For 2022, HIV surveillance data includes two new indicators on HIV Pre-exposure prophylaxis (PrEP):

• Determining PrEP need Proportion of all HIV negative individuals with estimated PrEP need who had this need identified (%)
• Initiation or continuation of PrEP among those with PrEP need: Proportion of all HIV negative individuals with estimated PrEP need who started or continued PrEP (%)

In 2021, 7% (87,828 of 1,180,923) of HIV-negative people accessing specialist SHSs in England were defined as having PrEP need. Among these, 69.6% (61,092 out of 87,828) initiated or continued PrEP.

England has set an ambition to end HIV transmission, AIDS and HIV-related deaths by 2030. The England HIV Action Plan 2022-2025 set out intermediate commitments for the next 4 years to achieve the 2030 ambition, including how HIV transmission will be reduced by 80% by 2025.¹⁵ The monitoring and evaluation framework published in December 2022 sets out the indicators that will be used to monitor the progress towards this goal¹⁶

Figure 12. Chart showing key HIV indicators in East Sussex 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

HIV treatment and care

In 2021, there were 555 East Sussex residents aged 15 to 59 years and 792 residents aged 15 years and over who were seen at HIV services (the prevalence of diagnosed HIV). The diagnosed prevalence per 1,000 residents aged 15 to 59 years was 1.9, better than 2.3 per 1,000 in England. The rank of East Sussex was 69th highest (out of 150 UTLAs/UAs). Since 2020, the increase in East Sussex was 3%; in the 5 years since 2016, the increase was 8%.

In 2021, 4.6% (572 out of 12,363) of HIV-negative people accessing specialist SHSs in East Sussex were defined as having PrEP need. Among these, 58.4% (334 out of 572) initiated or continued PrEP.

Figure 13. Diagnosed HIV prevalence per 1,000 population aged 15 to 59 years by year in East Sussex compared to rates in the South East UKHSA Region and England: 2011 to 2021.

Figure 14. Diagnosed HIV prevalence per 1,000 population aged 15 to 59 years in 16 similar local authorities and the South East UKHSA Region, compared to England: 2021

Similar refers to statistical nearest neighbours, derived from CIPFA’s Nearest Neighbours Model

The percentage of people (aged 15 years and over) in East Sussex accessing HIV care who were prescribed ART in 2021 was 98.9%, similar to 98.4% in England. The percentage of people in East Sussex newly diagnosed with HIV in the three-year period between 2019 - 21 who started antiretroviral therapy (ART) promptly (within 91 days of their diagnosis) was 97.7%, better than 83.5% in England.

The percentage of adults in East Sussex accessing HIV care in 2021 who were virally suppressed (undetectable viral load) was 98.6%, similar to 97.8% in England.

The Sexual and Reproductive Health Profiles also provides these data at lower tier local authority geographies.

Figure 15. Map of diagnosed HIV prevalence among people of all ages in East Sussex by Middle Super Output Area: 2021

Please note that this data is not available on the online Sexual and Reproductive Health Profiles. Data is sourced from the UKHSA HIV and AIDS Reporting System (HARS). As a response to the COVID-19 pandemic, in March 2020 the Government implemented national and regional lockdowns and social and physical distancing measures. 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.

HIV prevalence in East Sussex by MSOA

Contains Ordnance Survey data © Crown copyright and database right 2021
Contains National Statistics data © Crown copyright and database right 2021