Expert Comment – Sexually-transmitted infection rates increasing

LSHTM experts explain why changing sexual behaviours and lack of funding could be behind rise in STI diagnoses
"The data suggest the demographics of STI infection spread is changing and further support the urgent need for renewed sexual health campaigns." Emma Harding-Esch, Associate Professor, LSHTM

In 2023, there were over 400,000 new sexually-transmitted infection (STI) diagnoses in England - an increase of almost 5% on the previous year - according to the latest figures released by the UK Health Security Agency (UKHSA).

UKHSA’s analysis of recorded STI diagnoses and sexual health screens across England showed that between 2022 and 2023, recorded gonorrhoea and syphilis diagnoses increased by 7.5% and 9.4%, respectively.

In women aged 15-24 years, while chlamydia diagnoses were stable between 2022 and 2023 (9.8% and 9.6%, respectively), there was a 2.1% decrease in the number of tests carried out.

Compared to 2019, the year prior to the COVID-19 pandemic, there were also fewer attendances to screening consultations both in-person and virtually.

Commenting on the report, Associate Professor Emma Harding-Esch at the London School of Hygiene & Tropical Medicine (LSHTM) said:

“One reason for the increased rates may be the increased popularity of dating apps, which has enabled people to find sexual partners a lot more easily than previous generations, both locally and internationally, and across ages.

“There is therefore a greater diversity of partners, with more sexual mixing and bridging between “key populations”, leading to more complex sexual networks.

“In addition, we have seen changes in sexual behaviour, for example, a rise in the use of recreational drugs during sex, known as chemsex. This can increase high risk behaviours, such as having condomless sex and multiple sex partners. There may also be less partner notification following a positive STI diagnosis, leading to further onward transmission.

“Research projects, such as Natsal-4, are currently looking into how our sexual behaviours have changed, to gain insight into the complex and multifaceted reasons behind this continuing rise in STIs.

“There have also been great advances in medicines that can help prevent HIV transmission, so while the fear of contracting HIV has minimised, it’s important to remember that there are still many STIs circulating that can be passed from person-to-person and lead to reproductive and sexual health complications.

“It’s also important to note that the UK is not the only country seeing these trends – they are a global phenomenon. There are examples of STIs across the globe that should have already been eliminated but haven’t been due to a lack of policy and funding.

“One such example is congenital syphilis. While we have effective tests and treatments, a lack of routine screening and treatment regimens means mother-to-child transmission continues, with devastating consequences. We’re at risk of seeing more examples develop if we don’t tackle this challenge now.

“The data suggest the demographics of STI infection spread is changing and further support the urgent need for renewed sexual health campaigns.”

Associate Professor Emma Slaymaker at LSHTM said:

“It’s well-known that STIs disproportionally affect marginalised groups and predominantly impact young people aged 15 to 24 years.

“While previous reports have shown a higher incidence of STI diagnoses among gay, bisexual and other men who have sex with men, the latest figures from the UKHSA now show a larger increase in syphilis diagnoses among heterosexual men and women.

“The way we test for STIs is also evolving. While the scale up of online consultations has increased the number of people seeking advice and support, we must recognise that this can also perpetuate inequalities, as some people may not have access to these services.

“In the UK, public health budgets have been relentlessly cut, but sexual health services are still being asked to do more. Patients are struggling to access the care they need and if they’re unable to determine their own STI status, how can we expect rates across communities to decrease?

“The latest STI figures must be a wakeup call, and funding for sexual health services across the UK needs to be prioritised.”


Associate Professors Emma Harding-Esch and Emma Slaymaker are both co-directors of LSHTM’s WHO Collaborating Centre for STIs, and LSHTM’s STI Research Interest Group (STIRIG).

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