6.1 Sexually Transmitted Infections
Sexual health is an important public health issue with health, social
and economic impacts that can affect the people across the life course.
It is a fundamental aspect of human identity and life experience.
Wandsworth uses the World Health Organisation’s definition of sexual
health:
“A state of physical, mental and social well-being in relation to
sexuality. It requires a positive and respectful approach to sexuality
and sexual relationships, as well as the possibility of having
pleasurable and safe sexual experiences, free of coercion,
discrimination and violence.”
Poor sexual health can lead to sexually transmitted infections
(STIs), HIV and unintended pregnancies which can lead to further
long-lasting and costly impacts for both individuals and wider society.
However, they can be reduced through safer sex practices such as the use
of condoms, regular testing, and access to sexual health and
reproductive services . Sexual health services currently focus
on treatment for sexual health transmitted infections, HIV, unplanned
pregnancies, and prevention.
In 2018, there were 447,694 diagnoses of sexually transmitted
infections (STIs), an increase of 5% since 2017. National increases have
been seen across the spectrum of different STIs. However, in 2018
gonorrhoea had the highest STI diagnoses (56,000) representing a 26%
increase since 2017. This is most concerning as cases of drug resistant
strains of gonorrhoea have also been identified. The UK has also seen an
increase of syphilis (5%) since 2017.
Further detail regarding sexual health profiles in Wandsworth can be
found in our comprehensive Sexual
Health Needs Assessment and corresponding Strategy
and Action Plan published in 2019.
All new
STI diagnoses rate per 100,000: In 2023, Wandsworth’s rate was
2040.2 per 100,000 (n=6713), which was the 10th highest in London,
190.0% higher than the England average and 40.9% higher than the London
average. The latest Borough figure for 2023 was also 10.5% higher than
in 2012, in comparison with 16.6% decrease in England’s rate in the
equivalent time period.
Source: OHID:
Public Health Profiles
Source: OHID: Public Health
Profiles
Key Findings from Wandsworth Sexual Health Needs Assessment, 2018
(STIs):
- the 2018 STI diagnosis rate for England was784/100,000 population,
and higher in Wandsworth at 1976/100,000 population
- newly diagnosed STIs (excluding chlamydia aged <25) at
2195/100,000 population is significantly higher than both England at
851/100,000 population and London at 936/100,000
- trends have stabilised since 2012
- diagnostic rates of gonorrhoea is 328.5/100,000 population, with
recent trends showing a slow increase in diagnosis which is higher than
the London average of 279.4
- London is currently witnessing an increase in the rate of Syphilis.
In Wandsworth in 2018, the syphilis diagnostic rate was at 54.8/100,000
population which is higher than the other London boroughs and
significantly higher than the rest of England
- an HIV prevalence rate of 5.49/1000 people aged 15–59 years,
Wandsworth is now classed as an ‘extremely high’ prevalence area for HIV
in accordance with NICE guidance
- a larger proportion of white gay/lesbian are newly diagnosed with
STIs
- the 2018 chlamydia infection rate represents a 16% increase from the
previous year (3,063/100,000 population).
- on-line screening activity is beginning to grow, rising to 439 by
the end of quarter two, with positivity increasing from 4.9% to 6.2%.
This provides good evidence to suggest that the channel shift form
clinic to e-services is starting to take hold.
- national and local evidence clearly demonstrates that sexual health
need varies according to factors such as age, gender, sexuality and
ethnicity with inequalities in sexual health disproportionately
affecting Black & Asian, Minority Ethnic (BAME) communities, those
identifying as LGBTQ+, men who have sex with men (MSM).
MSM are among the largest groups diagnosed with a new STI diagnosis.
BAME communities in Wandsworth also experience a significantly higher
proportion of STI infection compared to the proportion of the population
from other ethnic groups. Moreover, with an HIV prevalence rate of
5.49/1000 people aged 15–59 years, Wandsworth is classed as an
‘extremely high’ prevalence area for HIV in accordance to NICE guidance.
This compares with an England rate of 2.4/1000, and 5.7/1000 across
London. While this rate has remained stable over the last 5 years
universal testing is recommended for high prevalence areas .
National analysis shows that two-thirds of late HIV diagnoses occur in
high-and extremely-high-prevalence local authorities . More intensive
testing is recommended in areas exceeding the 5/1000 threshold.
Age and Gender Distribution of New STI Diagnoses
The age and gender distribution of new STI diagnoses (chlamydia,
gonorrhoea, herpes, syphilis, warts) in Wandsworth residents in 2018
highlights that the largest number of newly diagnosed STI’s are in the
25 to 34-year-old age cohort (figure below).
Source:
GUMCAD Extracted Feb 2020
Sexual Orientation
People identifying as LGBTQ+ can experience a greater degree of
health inequalities, including sexual health . National data shows
where gender and sexual orientation are known. MSM account for 29% of
London residents diagnosed with a new STI in a specialist health clinic.
90% have syphilis and 63% have gonorrhoea. In line with the national
picture, the amount of diagnoses of gonorrhoea and syphilis are higher
in gay men compared to heterosexual men (figure below).
Count of STI diagnoses in Wandsworth by sexual
orientation
Source: GUMCAD Sep ’18–Oct ’19
When comparing new diagnosis of STIs by ethnic origin and sexual
orientation a larger proportion of white gay/lesbian are newly
diagnosed.
New STI Diagnoses (Excluding Chlamydia) in People Aged Under 25
Years
New STI
diagnoses (excluding chlamydia aged under 25) per 100,000: In
2023, Wandsworth’s rate was 1745.7 per 100,000 (n=5744), which was the
10th highest in London, 235.8% higher than the England average and 42.1%
higher than the London average. The latest Borough figure for 2023 was
also 15.5% higher than in 2012, in comparison with 8.5% decrease in
England’s rate in the equivalent time period.
Source: OHID:
Public Health Profiles
Source: OHID: Public Health
Profiles
Genital chlamydia trachomatis is the most commonly reported bacterial
STI in England. Infection is asymptomatic in at least 70% of women and
50% of men. As a result, most infections remain undiagnosed .
Untreated chlamydia infection has significant health consequences. It
is associated with considerable health risks in women of reproductive
age, including pelvic inflammatory disease, ectopic pregnancy and
infertility. In men, complications can include urethritis, epididymitis
and Reiter’ Syndrome. The chlamydia detection rate is one of the Health
Protection, part the Public Health Outcomes Framework (PHOF). In 2013
the department of Health set a recommended chlamydia detection rate of
≥2300 per 100.000 population requiring high volumes of screening and
diagnosis.
Gonorrhoea Diagnostic Rate
Gonorrhoea diagnostic rate per 100,000: In 2023, Wandsworth’s
rate was 540.1 per 100,000 (n=1777), which was the 11th highest in
London, 261.9% higher than the England average and 35.9% higher than the
London average. The latest Borough figure for 2023 was also 172.0%
higher than in 2012, in comparison with 196.9% increase in England’s
rate in the equivalent time period.
Source: OHID:
Public Health Profiles
Source: OHID: Public Health
Profiles
Syphilis Diagnostic Rate
Syphilis
diagnostic rate per 100,000: In 2023, Wandsworth’s rate was 52.0
per 100,000 (n=171), which was the 12th highest in London, 212.0% higher
than the England average and 4.8% higher than the London average. The
latest Borough figure for 2023 was also 184.7% higher than in 2012, in
comparison with 195.7% increase in England’s rate in the equivalent time
period.
Source: OHID:
Public Health Profiles
Source: OHID: Public Health
Profiles
HIV Prevalence
HIV
diagnosed prevalence rate per 1,000 aged 15 to 59: In 2022,
Wandsworth’s rate was 4.9 per 1,000 (n=1139), which was the 16th highest
in London, 108.4% higher than the England average and 7.6% lower than
the London average. The latest Borough figure for 2022 was also 2.6%
higher than in 2011, in comparison with 19.1% increase in England’s rate
in the equivalent time period.
Source: OHID:
Public Health Profiles
Source: OHID: Public Health
Profiles
The rate of new HIV diagnosis per 100,000 population among people
aged 15 years and above was 25.9% compared to 20.9% across London, and
8.7% in England. This year, 70 adult residents were newly diagnosed with
HIV. Since 2015, Wandsworth has seen a 34.4% decrease in new HIV
diagnoses. The decrease implies the success of a combination HIV
prevention which includes condom provision, pre-exposure prophylaxis
(PrEP), expanded HIV testing, and prompt initiation of treatment after
diagnosis.
In Wandsworth the E-Service during this period had HIV detection
rates for over 24 year olds of non-reactive 7,018 (99.7%) and reactive
21 (0.3%) while the numbers of postal test kits sent out by the newly
commissioned SH:24 service totalled 26 with 11 being processed. Most of
these kits were requested by people in the 25-34 age group (48.39%) and
by males (64.34%). 2 reactive results were produced from those kits
processed.
The vast majority (79.6%) of newly diagnosed patients with HIV in the
borough were put on Antiretroviral treatment (ART) within 91 days of
their diagnosis. Successful ART decreases a person’s viral load,
significantly reduces the risk of future transmission and transforms HIV
from a fatal infection to a chronic but manageable condition. However,
between 2016 and 2018, 34.5% HIV diagnoses were made at a late stage of
infection (CD4 count =<350 cells/mm 3). Late diagnosis is the most
important predictor of HIV-related morbidity and short-term mortality
and is a key component of valuating the success of HIV testing
efforts.
5.2 Social Factors
Employment of Mental Health Service Users
Gap in the employment rate for those who are in contact with secondary mental health services and the overall employment rate: In 2021/22, Wandsworth’s rate was 76.9 percentage points, which was the 4th highest in London, 10.8% higher than the England average and 8.0% higher than the London average. Time series data were not available for this indicator.
Source: OHID: Public Health Profiles
Mental Health Service Users Living In Stable Accomodation
Adults in contact with secondary mental health services who live in stable and appropriate accommodation: In 2020/21, Wandsworth’s rate was 77.0%, which was the 9th highest in London, 32.8% higher than the England average and 26.2% higher than the London average. The latest Borough figure for 2020/21 was also 4.7% lower than in 2011/12, in comparison with 6.2% increase in England’s rate in the equivalent time period.
Source: OHID: Public Health Profiles
Source: OHID: Public Health Profiles