Article

Calculating the cost and impact of common sexually transmitted infections

doctor-patient-office
Optimising sexual health service delivery

Sexual health service planning aims to reduce adverse health outcomes across the population whilst also ensuring that unequal provision is addressed. 1

The mainstay of management for those diagnosed with a sexually transmitted infection (STI) is testing and treatment. 1 Timely and accurate detection of STIs has been shown to help guide appropriate treatment, prevent complications, reduce antimicrobial resistance (AMR) and decrease onward transmission. 1

The British Association for Sexual Health and HIV have published guidelines that emphasise: 

  • Rapid assessment for those in clinical need
  • Minimum testing standards, including for chlamydia, gonorrhoea, syphilis and HIV
  • Timely availability of results for discussion with the patient and to allow action to be taken 2

Most tests for STIs are performed in sexual health clinics and genitourinary medicine (GUM) settings. 3 Current guidelines are that patients should receive a result within eight days and start treatment within three weeks, leading to potentially long waits for diagnosis and definitive therapy. 2

The World Health Organisation (WHO) has identified improved access to diagnostics as essential for universal access to sexual and reproductive health services. 4

 

Tackling the growing prevalence of STIs

In 2023, there were a total of 401,800 new diagnoses of STIs made by sexual health services in England. 1 These rates continue to climb despite a slight decline during the COVID-19 pandemic. 1

The burden of STIs is not felt equally across the population, with young heterosexuals aged 15 to 24 years, black ethnic populations, gay and bisexual men who have sex with men, and people residing in the most deprived areas having the highest rates of diagnosis. 1

Despite the increasing prevalence of STIs, the funding available to sexual health services was reduced by £171m from 2016/17 to 2022/23. 5

Three of the most common STIs in the UK are Chlamydia, gonorrhoea and Mycoplasma genitalium.6

NG bacteria

Chlamydia

Chlamydia is a very common diagnosis for patients seeking sexual health service support, making up 48.5% of all new STI cases in England – a total of 194,970 in 2023.1

Between 2015 and 2019, Chlamydia cases in England increased by 14%.7

Gonorrhoea

Diagnoses of gonorrhoea make up 21.5% of all new STI cases in England.1 Rates are rapidly increasing, with a rise of 72% over 4 years.7

In 2023, the number of gonorrhoea diagnoses reached their highest level since records began in 1918.1

Whilst gonorrhoea infection is significant to the patient, there are global health consequences as well. Neisseria gonorrhoeae is listed as one of the WHO’s high-priority pathogens.1 This is because there are limited treatment options, diagnoses are increasing, and it can potentially lead to severe health consequences.1

Mycoplasma genitalium

M. genitalium is one of the ten most commonly diagnosed STIs in England.1

This is a significant concern, as nearly 5% of infections in women may progress to pelvic inflammatory disease, with the potential for severe health consequences.1

The impact of common STIs on the health service

Sexually transmitted infections have a significant impact on patients, communities and organisations that provide health services.1

Issues in diagnosis can exacerbate this, as inappropriate or unnecessary treatment can lead to excess costs, continuing symptoms, development of complications, evolution of drug resistance, and a delay in providing the most appropriate treatment.8

The overall cost of STIs to the health service

The increasing incidence of STIs are a cause for significant concern, primarily because of increased health service costs.1

Undetected or untreated STIs can, in a small proportion of cases, lead to complications that have a long-lasting impact on the health and well-being of the individual, while also being costly to the health service.1

Examples of potential complications include fertility issues, adverse outcomes in pregnancy and birth, infections in newborn children, systemic infections in adults, neurological and cardiovascular damage, and treatment complications related to antimicrobial resistance.1

Chlamydia, gonorrhoea and Mycoplasma genitalium may be particularly associated with adverse pregnancy outcomes when untreated, including low birth weight, miscarriage, and preterm birth.1

Individuals who are unaware of their infection may go on to infect partners and run the risk of developing complications during the delay between testing and definitive treatment.8

couple-holding-hands
Antibiotic

The impact of antimicrobial resistance

The World Health Organisation identifies antimicrobial resistance (AMR) as one of the top ten global public health threats.9

AMR is an increasing problem, especially for pathogens such as gonorrhoea species and M. genitalium.1 Antibiotic stewardship is vital to prevent the increasing AMR seen globally associated with the treatment of STIs.1

Surveillance conducted by the UK Health Security Agency demonstrated AMR in M. genitalium to macrolide antibiotics in 62.2% of cases, in 12.1% to fluoroquinolone, and in 10.1% of cases resistance was seen to both classes.10

The correct choice of antibiotics is crucial, as cases of N. gonorrhoea have been observed with resistance to every class of antibiotic used for the treatment of this infection.1

The broader economic cost of STIs

STIs have a significant impact on society. This can include losses to economic productivity, the costs of which have been suspected to outweigh even the medical costs of treatment.1

In 2011 in the UK, estimated costs for STI treatment (excluding HIV) ran to £620 million.11

 

Urgent action on sexual health testing

Evidence shows that diagnosing and treating sexual health conditions, including Chlamydia, gonorrhoea and Mycoplasma genitalium, could help to improve patient outcomes, play a role in reducing antimicrobial resistance and cut costs.12

 

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References

1. UK Health Security Agency. STI prioritisation framework. Available at: https://assets.publishing.service.gov.uk/media/67376f07abe1d74ea7dade2d/STI-prioritisation-framework.pdf. Accessed: March 2025.

2. British Association for Sexual Health and HIV (BASHH). Standards for STI management. Available at: https://www.bashh.org/_userfiles/pages/files/bashhstandardsforstimanagement2019.pdf. Accessed: Jan 2025.

3. UK Health Security Agency (UKHSA). Sexually Transmitted Infections and Screening for Chlamydia in England: 2023 Report. Available at: www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables/sexually-transmitted-infections-and-screening-for-chlamydia-in-england-2023-report. Accessed: Jan 2025.

4. World Health Organisation (WHO). Point-of-care tests for sexually transmitted infections. Available at: https://iris.who.int/bitstream/handle/10665/371294/9789240077102-eng.pdf. Accessed: Jan 2025.

5. Darzi, A. Independent investigation of the National Health Service in England. Available at: https://www.gov.uk/government/publications/independent-investigation-of-the-nhs-in-england Accessed: Jan 2025.

6. UKHSA Official Statistics, Sexually transmitted infections and screening for chlamydia in England: 2023 report, Updated 17 July 2024. https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables/sexually-transmitted-infections-and-screening-for-chlamydia-in-england-2023-report

7. UK Health Security Agency. New STIs and rates in England by gender. Available at: https://assets.publishing.service.gov.uk/media/66598cdfd470e3279dd3343e/2023-Table-1-New-STIs-and-rates-in-England-by-gender.ods. Accessed: Jan 2025.

8. Turner KM, et al. An early evaluation of clinical and economic costs and benefits of implementing point of care NAAT tests for Chlamydia trachomatis and Neisseria gonorrhoea in genitourinary medicine clinics in England. Sex Transm Infect. 2014;90(2):104-11.

9. World Health Organisation (WHO). Antimicrobial resistance. Available at: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance. Accessed: Jan 2025.

10. UK Health Security Agency. Mycoplasma genitalium antimicrobial resistance surveillance. Available at: https://www.gov.uk/government/publications/mycoplasma-genitalium-antimicrobial-resistance-surveillance-mars/mycoplasma-genitalium-antimicrobial-resistance-surveillance-mars-report-2023. Accessed: Jan 2025.

11. Health matters: preventing STIs. Published 2019. Available at: https://www.gov.uk/government/publications/health-matters-preventing-stis/health-matters-preventing-stis Accessed: April 2025.

12. Jensen, Jorgen S., and Magnus Unemo. “Antimicrobial Treatment and Resistance in Sexually Transmitted Bacterial Infections.” Nature News, Nature Publishing Group, 20 Mar. 2024, www.nature.com/articles/s41579-024-01023-3. Accessed 21 Jan. 2025.