Prevalence of STIs among young people

UK Health Security Agency data on sexually transmitted infections (STIs) in 2022 are deeply concerning. For particular STIs they show a return to, and acceleration of, pre-Covid-19 trends of rising rates of new infections. Rates of gonorrhoea, which almost doubled among people aged 15 to 24 years, were the highest since records began in 1918. Syphilis cases reached a peak not seen since 1948. Both infections carry substantial risks of severe illness for individuals and to public health. The data should be a wake-up call to the Government, local authorities, sexual health services, reproductive health professionals and others in the NHS, and those delivering Relationships, Sex and Health Education in schools.

The public health grant to local authorities for the commissioning of sexual health services (SHSs) has been reduced substantially during a period of increasing demand. This is not sustainable and an obvious false economy. It has left many SHSs unable to maintain sufficient staff to provide an adequate level of service. It is unacceptable that around half of SHSs have been unable to offer face-to-face consultations when contacted. This has equality impacts, for young people who need face-to-face advice and support from trusted adults, but also for other groups likely to struggle to access support online.

The Government must radically increase the public health grant to local authorities to a level that allows sexual health services to operate effectively and meet local need. This must include the provision of face-to-face consultations to those who need them, within 48 hours, and universal access to free postal STI testing. Booking appointments and access to online testing should be made available via smartphone app.

Online providers of STI tests and treatment should be accredited by the relevant regulatory body, and regularly monitored on their performance against national clinical guidelines. In response to this Report, the Government should set out the steps it will take to ensure that all children who identify online as a safeguarding risk receive the support they need.

Competition for contracts can lead to improved service provision, however repeated tendering and short-term contracts can also be destabilising and lead to the loss of experienced workers. The Government should make an assessment of the effect of repeated tendering of sexual health services on the adequacy of local SHS provision and its impact on the sexual health workforce. As part of that assessment the Government should consider whether public health grant settlements over a longer term would better support strategic service delivery.

The provision of sexual health services is fragmented across the health system and can be complex to navigate. The Government should work with providers and commissioners to improve collaboration across reproductive and sexual healthcare to ensure effective cross-system support for young people and other groups at greatest risk of contracting an STI. These measures should be underpinned by a wider national strategy on sexual health. (Paragraph 36) The prevalence of sexually transmitted infections in young people and other high risk groups 29

It is worrying that we are seeing antibiotic resistance to some STIs—particularly gonorrhoea, where the rate of diagnoses has reached record levels, and for which young people and other communities at greatest risk are most likely to experience drug resistance. In response to this Report the Government should set out the steps it is taking to develop new antibiotics for the treatment of gonorrhoea, shigella and mycoplasma genitalia, and other relevant STIs, including the level of funding it is providing to support that research. (Paragraph 39) Prevention

Condomless sex is a key risk factor for STI acquisition, and changes in condom use have been widely reported. The Government must increase its promotion of the benefits of condom use, using a tailored approach to those groups at greatest risk of STI infection. There are innovative approaches being used to promote uptake in condom use such as the inclusion of condoms with STI testing kits. The Government should review the effectiveness of these schemes and consider the merits of supporting their rollout nationally.

The Government should make funding available for public awareness campaigns focused on STI prevention among young people and other groups at high risk of infection in areas with the highest rates of sexually transmitted infections and where rates of diagnosis are rising fastest. The campaigns should be co-designed by those communities, should normalise discussion of sexual behaviour and be promoted in the online spaces where young people are currently turning to for advice.

There is compelling evidence that Relationships and Sex Education (RSE) in schools is inadequate, including in relation to contraception and sexually transmitted infections (STIs), with nearly half of children saying education in this area is so poor they rely on finding information for themselves online. This exposes children to an unacceptable risk of harm. The 2022 data on STIs are a red flag and should encourage everyone to do better.

The Government, Oak National Academy—the public body established in 2020 to provide teachers with online lesson plans and other resources—headteachers and Ofsted must place greater priority on RSE and ensuring it delivers the information and guidance that children need. The Government also needs to do more to make the positive case for sex education in schools, to help parents to see that sexually transmitted infection information is a safeguard rather than a threat.

The Government should work with the NHS and Oak National Academy to improve the teaching of sex education, and the materials available to support it, to ensure it provides an effective response to the troubling increases in the prevalence of STIs among young people. The benefits of condom use should be a key part of the curriculum. As we have previously recommended, RSE should be taught up to the age of 18.

School nurses are a valuable resource. They are a trusted adult who children can turn to, they can pick up on safeguarding concerns, and trends in problems such as STI prevalence in a community. They can also direct children to sexual health services, 30 The prevalence of sexually transmitted infections in young people and other high risk groups reducing potential demand on hospital services and risks to long term health. In response to this Report the Government should set out plans to reverse the recent substantial and damaging reductions in the number of school nurses.

The HPV vaccine is a remarkable step forwards in preventing HPV infection and the serious consequences that can result from it. It is a tragedy that not all children are receiving this vaccine. The Government must step up its efforts to increase take up of the HPV vaccine, including as a first step, by targeting the cohort of children who may have missed out on vaccination during the Covid-19 pandemic. Given the significant proportion of children who have not received the vaccine and the potential benefits the vaccine can have in treating HPV, we recommend that sexual health services be able to deliver the vaccine to all those who would benefit from receiving it.

In light of the increases in chlamydia diagnoses, the Government should review whether the shift in focus of the National Chlamydia Screening Programme to restricting the offer of opportunistic screening to young women has been effective.

The Government must ensure that the sexual healthcare system works more efficiently and effectively to arrest and reverse the trend in sexually transmitted infections. This will require longer term work to carefully consider how the different parts of the system can work together to achieve this. The Government should work with the British Association for Sexual Health and HIV, the Faculty of Sexual and Reproductive Health, NHS leaders, the Local Government Association and education bodies to develop the coherent, cross-sector strategy on sexual health it committed to in 2019. It is unacceptable that five years on, no progress has been made. Young people are at the start of their sexual journey. Such a strategy should begin by meeting their needs. (Paragraph 70) The prevalence of sexually transmitted infections in young people and other high risk groups 31