Rolling the dice with sexual health? New challenges for STI services
Today is the start of Sexual Health Week, which aims to raise awareness about services for the testing and treatment of sexually transmitted infections (STIs). The UK has a strong track record in the provision of STI services. But they are now facing new challenges, including a rise in demand, significant cutbacks in public health funding, and the emergence of infections that are resistant to treatment.
A historical perspective
STIs go back a long way. Syphilis first became widely reported in Europe during the late fifteenth century, while gonorrhoea was first described 3,500 years ago. For a long time, these diseases were incurable, afflicting millions of people and leading to infertility, disfigurement and insanity. Early attempts at treatment with mercury often proved fatal. With the development of penicillin in the 1940s, along with improvements in sex education, the rates of STIs fell dramatically. More recently, new drugs have revolutionised the treatment of people living with HIV.
A growing problem
Today, the instances of STIs are rising. In Australia, rates of syphilis, gonorrhoea and chlamydia are the highest since the 1990s. It’s a similar story in the United States and Canada, while in the European Union reported syphilis cases have continued to grow. HIV remains a major public health concern, with recent data indicating a significant number of new infections in eastern Europe.
In the UK, a 2019 report by the House of Commons Health and Social Care Committee found that overall STIs fell between 2013 and 2017. But more recent figures have revealed worrying developments:
- In 2017 there was a 20% increase in cases of syphilis in England, and a 22% increase in gonorrhoea.
- In Scotland, the number of cases of syphilis recorded has reached a 15-year high.
- Public Health Wales has reported a 79% increase in syphilis cases in the country between 2016 and 2018.
- The number of people in Northern Ireland diagnosed with gonorrhoea in 2018 was the highest on record.
The Committee found that the impact of STIs in England is greatest among young people. Men who have sex with men are also disproportionately affected by STIs, while in black and minority ethnic populations, the rates of STI are higher than in the general population.
Along with the rise in the number of infections, the demand for sexual health services is increasing. At the same time, sexual health services say they are facing unprecedented threats from government cuts to local authority public health budgets.
In 2017, a Public Health England survey highlighted the concerns of commissioners of sexual health services. Respondents raised concerns about a decrease in capacity and an increase in demand, in both primary care and specialist services. They believe the consequences could include a worsening of health inequalities and a shift from prevention to treatment.
Debbie Laycock from the Terence Higgins Trust HIV charity told BBC News:
“The number of people accessing sexual health services has continued to rise, demand is on the increase and we’re hearing day-to-day more and more people are saying they’re being turned away from sexual health clinics. When it becomes harder to get an appointment, this is likely to deter people who don’t have symptoms, but just want a routine test. Those routine tests pick up infections at an early stage and stop them being spread to too many other people.”
Services at “breaking point”
There are concerns that this situation will worsen: from April 2020, previously ring-fenced sexual health, drug and alcohol services, which in England are funded by local authorities, will be competing for increasingly scarce funds alongside other council services such as social care.
The Health and Social Care Committee argues that budget cutbacks are not only bad for individuals’ health, but also increase overall costs to the NHS:
“Cuts to spending on sexual health, as with other areas of public health expenditure, are a false economy because they lead to higher financial costs for the wider health system. Inadequate sexual health services may also lead to serious personal long-term health consequences for individuals and jeopardise other public health campaigns such as the fight against antimicrobial resistance.”
This last point refers to a worrying new issue in the treatment of STIs. In recent months, several cases have been reported of new infections that have developed resistance to antibiotics.
Dr Tim Jinks, head of Wellcome’s Drug Resistant Infection programme, believes that increasing resistance to antibiotics will make treating and curing STIs harder:
“Untreatable cases of gonorrhoea are harbingers of a wider crisis, where common infections are harder and harder to treat. We urgently need to reduce the spread of these infections and invest in new antibiotics and treatments to replace those that no longer work.”
Some health professionals, such as Duncan Stephenson from the Royal Society for Public Health have warned that sexual health services are already at breaking point:
“With continued increases in rates of STIs such as syphilis… and the future threats posed by issues such as drug resistant gonorrhoea, the government is rolling the dice with the public’s sexual health.”
Sexual health services for people with disabilities
This year, Sexual Health Week is focused on people with disabilities, who often face barriers that prevent access to information and support. To overcome these obstacles, sexual health services need to make changes, such as providing longer consultation periods for people with learning disabilities, and training for health professionals in advising and treating patients with special needs. With sexual health services already under pressure, the challenges of meeting the particular needs of people with disabilities are all the greater.
In its report, the Commons Health and Social Care Committee recommended that Public Health England should collaborate with the sectors involved in commissioning and providing sexual health services to develop a new strategy. The report’s authors believe that this strategy:
“… should help both providers and commissioners in their attempts to deliver sexual health services to a high quality and consistent level, in the face of the challenges of fragmented structures and reduced funding.
The Committee also identified priority areas to be addressed by the strategy, including:
- the provision of services which meet the needs of vulnerable populations
- testing for the full range of sexually transmitted infections
- access to pre-exposure prophylaxis (PrEP) for those at risk of contracting HIV
- preventative interventions within all aspects of sexual health
Sexual health is an important part of physical and mental health, as well as ensuring emotional and social well-being. Modern, rapid testing can reduce the rate of onward transmission, and ensure that patients receive the right care, leading to long and healthy lives. Ensuring that those benefits continue will be the greatest challenge facing sexual health services now and in the future.
Effective clinical management for sexual health services
Effective record-keeping is an understated, but fundamentally important element of sexual health services. Increasingly, sexual health clinics are turning to electronic systems to maintain records, improve services and deliver cost savings.
Lilie is a clinical management software system specifically designed by Idox Health for sexual health services. Its electronic patient record (EPR) system provides fast access to patient information and greatly reduces administrative functions.
The system also provides sexual health services with a range of options, including:
- patient communication via SMS
- modules for contraceptive and reproductive health, chlamydia screening, HIV, and prescribing services
- laboratory test results automatically received and entered into the electronic patient record
This market-leading software is now in use in more than 140 sites.
Further information about Lilie is available from Idox Health.
Read more in the whitepaper ‘Protecting the unprotected: How a digital approach to sexual health screening can help clinics sustain service levels amidst funding cuts’