New diagnoses of gonorrhoea in 2022 were at their highest levels since records began in 1918, according to new statistics from the UK Health Security Agency released today.

In 2022, 82,592 new cases of gonorrhoea were diagnosed in England – 50.3% more than in 2021, when there were 54,961 new diagnoses, and 16.1% more than pre-pandemic levels, with 71,133 new cases diagnosed in 2019.

With gonorrhoea becoming increasingly resistant to antibiotics, risking it becoming untreatable in the future, the UKHSA emphasised the ‘vital’ need for early testing and diagnosis to prevent the sexually transmitted infection (STI) being passed on. Left untreated, gonorrhoea can cause infertility and pelvic inflammatory disease.

Infectious syphilis diagnoses were also at a record high, with 8,692 new cases diagnosed in England in 2022 – the largest annual number since 1948 and 15.2% more than in 2021 and 8.1% higher than pre-pandemic levels.

Syphilis can be treated with antibiotics but can cause serious, irreversible and potentially life-threatening damage to the brain, heart or nervous system if left untreated.

The UKHSA said that infection rates were particularly high among young people aged 15 to 24, with over 400 diagnoses of STIs made each day among this group.

While there had been an increase in diagnostic testing – with 13.4% more sexual health screens performed in 2022 than in 2021 – the UKHSA said that the scale of the increase in diagnoses strongly suggests that there is more transmission of STIs within the population, in addition to increased diagnoses due to increased testing.

Access to diagnostic services

Amarachi Inechi, superintendent pharmacist at Atwood Green Pharmacy in Birmingham, runs a sexual health service in collaboration with the local Umbrella service, which funds access to contraception and STI testing.

He said that pharmacy teams were able to speak to young women about STI testing and give out free condoms when they came to access other services, such as the morning after pill.

But he said that uptake was much lower among men, who accessed pharmacies much less frequently and had less incentive to overcome stigma around asking for a sexual health support, in comparison to women who wanted to access emergency contraception.

Mr Inechi also said that older people were particularly at risk of STIs like gonorrhoea and syphilis, as ‘some people get to a certain age where they feel they're not at risk at all’.

While the pharmacy advertised its services in local student halls of residence, Mr Inechi said that more awareness raising among hard-to-reach groups was needed, such as a public health campaign.

He also said that contraception and sexual health services ‘go hand in hand’ and that the Umbrella initiative was ‘a brilliant service’, but added that pharmacies were ‘stretched thin’ and needed financial support to be able to employ suitable staff to provide these services.

‘Pharmacy can do a lot of things, but pharmacy needs to be funded to do these things,’ he said.

A recent investigation by The Pharmacist found that just 4% of community pharmacies had signed up to provide the new pharmacy contraception service within the first two days of it being available.

While some community pharmacies offer chlamydia screening services, a 2019 Public Health England (PHE) report found an increase in young people choosing specialist sexual health services, particularly online providers, instead.

But David Fothergill, chairman of the Local Government Association’s Community Wellbeing Board said today that the rising demand for sexual health services as well as real-term funding cuts were putting local council-commissioned sexual health services at risk of breaking point.

He said: ‘It is encouraging to see more people visiting their local sexual health clinic, which is a testament to the work of councils with hard-to-reach communities in their areas, as well as the new cutting-edge treatments on offer.

‘However, this is becoming increasingly unsustainable without a long-term increase in councils’ public health grant, which goes towards funding vital sexual health services.’

He added: ‘The government should ensure sexual and reproductive health funding is increased to levels which matches the increases local services have seen in demand. Investment in early intervention helps to save costs to the health service and prevents problems developing further down the line.’

The Department of Health and Social Care (DHSC) said that it was providing every local authority real-terms funding protection over the next two years, through a ringfenced Public Health Grant of £3.529bn in 2023/24 and £3.575bn in 2024/25.

A DHSC spokesperson said that this would enable local authorities to ‘improve diagnosis of sexually transmitted infections and provide early treatment, helping to avoid transmission and any long-term health problems.

‘We’re also reducing the impact of HIV through our National HIV Action Plan and raising awareness of ways to prevent the spread of sexually transmitted infections among the most affected communities with our National HIV Prevention Programme,’ they added.

The DHSC also said that it was committed to improving sexual and reproductive health in England and was considering the next steps for delivering the best outcomes.

James Davies, Director for England at the Royal Pharmaceutical Society in Wales said that the escalating rates of STIs were 'a major public health concern'.

'If left untreated, they can have long-term effects on health and the risk of antibiotic resistant infections is ever-more real'.

And he added: 'We need better integration of sexual health services across primary and secondary care to provide a consistent level of service to improve patient care.'

She said that community pharmacies serve as a 'safe, accessible space where individuals can seek informal advice from trusted professionals'.

And she added that the introduction of a new contraception service would be another opportunity to discuss with patients the importance of using condoms to safeguard against the risks of STIs. 'Each interaction with community pharmacies can make a significant impact and for more complex needs and tests, community pharmacies can also signpost to GPs and sexual health clinics', she said.

Dr Hamish Mohamed, Consultant Epidemiologist at UKHSA said: 'Community pharmacists play an important role in tackling STIs and, in many local areas, provide condoms, STI self-sampling kits, and opportunistic chlamydia screening for young women.'

Policy Manager at the National Pharmacy Association, Helga Mangion, said that the convenience and relative anonymity of community pharmacies 'makes them an ideal place to access sexual and reproductive health services', as community pharmacists can provide important advice about treatments for STIs such as chlamydia - including potential side-effects - via confidential conversations in consultation rooms.