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The level of need in the population

Background papers: Lifestyle and wider determinants :: Sexual health :: The level of need in the population

Local sexual health data is available through the Public Health England Fingertips website.

Chlamydia Detection in young people

After several years of increasing the proportion of the population screened and increasing detection Medway has seen a decrease in both. This may be in part to upheaval caused by the recommissioning, redesign and changes of services; the situation is being monitored through the performance management cycle.

2016 detection rate aged 15-24 / 100,000 (PHOF indicator 3.02) 2016 Chlamydia proportion aged 15-24 screened
Medway 1,754 20.50%
South East Region 1,500 19.20%
England 1,882 20.70%
Table 1: Chlamydia detection and screening rates (PHE)

Other STI prevalence

Overall STI prevalence in Medway has fallen each year since 2012. In 2014 the most commonly diagnosed STI in Medway was chlamydia (333 per 100,000) followed by genital warts at 123.9 per 100,000; genital herpes 68.6 per 100,000; gonorrhoea 28.0 per 100,000 and syphilis 3.3 per 100,000. Although reducing, the prevalence of genital herpes is higher in Medway than both the South East and England. Chlamydia detection has increased since 2012. Syphilis is almost exclusively diagnosed among MSM. Although not specifically an STI, Pelvic Inflammatory Disease (PID) can be caused by bacterial infections such as chlamydia and gonorrhoea; Medway has admission rates to hospital well in excess of regional and England rates [1].

2016 detection rate aged 15-24 / 100,000 (PHOF indicator 3.02) 2016 Chlamydia proportion aged 15-24 screened
Medway 365.0
South East Region 272.4
England 237.0
Table 2: Pelvic Inflammatory Disease rates (PHE)
2016 detection rate aged 15-24 / 100,000 (PHOF indicator 3.02) 2016 Chlamydia proportion aged 15-24 screened
Medway 652
South East Region 649
England 829
Table 3: Rates of all new STI diagnoses (PHE)

HIV

HIV prevalence in Medway has seen a slight decrease since 2014. However, late diagnosis is increasing, some of which may be attributable to increased testing opportunities. Across Medway the prevalence rate is 1.33/1,000 but that prevalence is not equally distributed. Data from the Survey of Prevalent HIV Infections Diagnosed (SOPHID) indicates that HIV diagnosis is highest in the ME4 and ME7 postcode areas. Adults aged 35-54 are more likely to be diagnosed with HIV in Medway than any other age group. The most common route of transmission was sex between men; the next more common was women who had heterosexual contact. Black Africans are the ethnic group at highest risk of HIV infection. However, the vast majority of UK HIV diagnoses are in people born in the UK as opposed to born overseas.

2015 HIV diagnosed prevalence rate / 1,000 aged 15-59 HIV late diagnosis (%) (PHOF indicator 3.04)
Medway 1.3 50.00%
South East Region 1.8 43.50%
Table 4: HIV diagnosis rates (PHE)

Unplanned pregnancy, Abortions and Repeat abortions

Not all unplanned pregnancies will lead to an abortion; outcomes for both mother and child are poorer than for a planned pregnancy [2]. Unplanned pregnancies are prevented by good access to all forms of contraception including long-acting reversible contraception (LARC). GPs are increasing the quantity of LARC they are prescribing but Medway is still below regional and England rates.

2016 Total abortion rate / 1,000 2016 Under 25s repeat abortions (%)
Medway 18.0 29.4
South East Region 15.0 25.2
England 16.7 26.7
Table 5: Abortion rates (PHE)

Other Needs


• Females aged 15-24 are at higher risk of STIs than males of the same age.[3](p31)
• Men-who-have-sex-with-other-men (MSM) are at greater risk of STIs than the general population and account of the majority of syphilis and gonorrhoea diagnoses in men. MSM are at higher risk of HIV. Diagnoses of chlamydia, syphilis and gonorrhoea are increasing among MSM.[3](p20, 21, 38)
• Individuals who are from the black and black British ethnic groups are disproportionately affected by STIs.[3](p44)
• Black Africans, and black African women, are disproportionately affected by HIV infections.[4]
• Heterosexuals are at far greater risk of a late HIV diagnosis than MSM.[4]
• There is insufficient data available to assess inequalities for those who have a physical or learning disability.


References

[1]   PHE. Fingertips - Sexual and Reproductive Health Profiles. 2015;
[2]   Wellings K, Jones K, Mercer C, et al. The prevalence of unplanned pregnancy and associated factors in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) Lancet 2013; 382: 1807-16.
[3]   PHE. Sexually Transmitted Infections in England 2015;
[4]   PHE. HIV in the UK - Situation Report 2015 2015; https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/477702/HIV_in_the_UK_2015_report.pdf .