Epidemiology of STIs: UK

The epidemiology of STIs in the UK has undergone marked changes over the last century. After two major peaks in syphilis and gonorrhoea coinciding with the two World Wars, the incidence of these STIs decreased dramatically after World War II, with the advent of penicillin. The 1960s and 1970s saw a resurgence of gonorrhoea and syphilis, and the male:female ratio of reported syphilis cases increased, suggesting that transmission among men who have sex with men (MSM) was increasing. STI incidence again declined in the 1980s with the advent of the HIV/AIDS epidemic, suggesting that widespread changes in sexual risk behaviour patterns were occurring. These decreases were not sustained, however, and during the mid-to-late 1990s both viral and bacterial acute STIs increased substantially. This trend has been most marked in young people and MSM. Numbers of reported gonococcal infections more than doubled to between 1995 and 2003, to 24,157 cases in England, Wales and Northern Ireland; syphilis increased more than tenfold to 1580 cases as a consequence of localised outbreaks, particularly in MSM. Data from 2003 compared with 2002 indicate stabilization or slowing of some STIs, including gonorrhoea and genital herpes, numbers of which decreased by 4% and 3% respectively. Rates of genital warts, chlamydial infection and syphilis continued to increase. Delivery of appropriate, effective STI preventive interventions targeted to those at highest risk, including young people and MSM, continues to be a public health priority.