GHT Homepage Insight Sexual Health in the North West

Sexual Health in the North West
1st Apr 2004

Pete Clarke, a specialist in HIV and sexual health at Liverpool John Moores University, details some of the recent rises in sexually transmitted diseases in the North West.

In recent years there has been a rapid and unabated increase in the number of diagnosed Sexually Transmitted Infections (STIs) within Genito Urinary Medicine (GUM) clinics across the United Kingdom. Nationally the number of individuals presenting to GUM services has more than doubled during the past decade with over 1.6 million people in 2002 (HPA, 2003). Outside of London the North West of England has some of the highest rates of STIs in the United Kingdom, including gonorrhoea, chlamydia and syphilis. Of the three Strategic Health Authorities (SHA) that comprise the North West Region, Greater Manchester has the highest numbers and rates for all diagnosed STIs.

For monitoring purposes GUM departments use the KC60 report forms. These collect basic data relating to the patient. Currently KC60 do not collect information on where the patient lives, therefore using the existing reporting system we can only provide data on the number of people that use a specific hospital, and not where the patients have come from. In recent years the length of time patients have been expected to wait for a GUM appointment has increased considerably, resulting in the North West having some of the longest waiting lists in the country (Foley et al, 2002). Evidence suggests patients are travelling further a field, in an attempt to gain an earlier appointment (Clark, 2004). This then exerts pressure on smaller GUM departments to meet the extra demand in workload.

Uncomplicated Gonorrhoea
Between 1995 -2002 there has been an increase of 156% in the number of diagnosed cases of uncomplicated gonorrhoea across the North West. There has also been a significant increase in the number of gonorrhoea cases that are resistant to the usual treatment (ciprofloxacin). Within Greater Manchester reports of uncomplicated gonorrhoea have risen annually from 648 cases in 1995 to 1,393 (215% increase) in 2002. This represents an increase of 30 people per 100,000. This provides Greater Manchester with an infection rate of 56.12 per 100,000, compared to 28.44 in Cheshire & Merseyside and 28.96 in Cumbria & Lancashire.

Uncomplicated Chlamydia
Chlamydia is the most commonly diagnosed STI in the UK. Nationally, resources have been allocated towards the detection of chlamydia in various health care settings. National data suggested that as many as 1 in 12 women may be infected with uncomplicated chlamydia much of which may remain undiagnosed until it causes problems in later life.
Although still having the largest number of cases, Greater Manchester is the only area to show a decrease in the number of cases. Between 2001 and 2002 diagnosed cases fell from 4721 to 4657. This leaves Greater Manchester with an infection rate of 187.60 per 100,000 people, compared to 137.99 in Cumbria & Lancashire and 149.37 in Cheshire & Merseyside.

Syphilis
One of the most alarming developments has been the re-emergence of syphilis. Virtually eliminated in the UK throughout the 80's and 90's, there have been numerous outbreaks of syphilis across the country in recent years. A major factor contributing to the national increase has been the Manchester syphilis outbreak (Clark et al, 2001). Initially attributed to heterosexual sex, syphilis outbreaks have now been primarily confined to gay men (Bellis et al, 2003). The re-emergence of syphilis in the North West has been well documented (Clark et al, 2002, Ashton et al, 2003). Since the commencement of enhanced syphilis monitoring in North West GUM departments began (January 1999), there have been 605 diagnosed cases of primary and secondary syphilis, of which 142 (24%) cases are amongst HIV positive men.

HIV and AIDS
By the end of 2002 the cumulative total of reported HIV infections in the UK had risen to 54,193. Of this figure 4,204 were newly diagnosed that year. During 2002 the North West Region has seen the largest recorded increase of people living with HIV in treatment since regional monitoring began (Cook et al, 2003). During 2002 a total of 2429 individuals accessed statutory HIV treatment and care centres throughout the North West. This represents a 24% increase on the number reported in 2001. Since monitoring began in 1996 the total number of people living with HIV in the North West has increased by two and a half times. Each year the overall number of people living with HIV has increased.
The number of newly diagnosed people has also increased each year. In 2002 new cases represented 25% of the total number of HIV/AIDS cases seen in the North West Region. An individual is defined as a new case if they had not previously been seen in the North West statutory treatment centres prior to 2002. Therefore this figure includes individuals who may have been diagnosed with HIV earlier but have moved to the North West that year. A total of 617 new HIV and AIDS case were reported during 2002. This figure represents a 37% increase in the number of new cases last year. This is the largest number of new cases reported since regional monitoring began.

Greater Manchester Strategic Health Authority (SHA) has the highest number and rates of HIV infection in the North West. Between 1996 and 2002 the number of people living with HIV & AIDS in Greater Manchester has risen from 633 to 1371 an increase of 217%. Of the 617 new HIV cases in the North West, 358 (58%) were Greater Manchester residents. During 2002 GUM departments in Greater Manchester delivered 50,257 HIV anti-body tests and with associated counselling. This represents a rate of 400.67 tests per 100,000 people, which is the highest in the North West
Historically the majority of HIV infection in the UK has been transmitted through homosexual/bisexual sex. However, in 1999 heterosexual sex became the primary route of HIV infection amongst new cases and has continued so in subsequent years. In Greater Manchester homosexual/bisexual sex has remained the primary route of HIV infection until 2002, when for the first time there was a greater number of new cases through heterosexual transmission(146), than homosexual/bisexual sex (145).

The annual North West HIV & AIDS report for 2003 in currently in production. The Report will be launched on 8th July 2004, at the 'Sexual Health of the North West' event taking place at the Village Hotel Bury. The day long event will be delivered in partnership with the Health Protection Agency North West and provide up to date data and information regarding all aspects of HIV and sexual health.

For further information contact
Pete Clark
Senior Lecturer in Public Health
Centre for Public Health
Liverpool John Moores University
8 Marybone
Liverpool
L3 2AP

References

• Ashton M, Sopwith W, Clark P, McKelvey D, Lighton L and Mandal D (2003). An outbreak no longer: factors contributing to the return of syphilis in Greater Manchester Sexually Transmitted Infections;79:291-293
• Bellis MA, Cook PA, Clark P, Syed Q, Hoskins A. (2002) Re-emerging syphilis in gay men: A case control study of behaviour risk factors and HIV status. Journal of Epidemiology and Community Health; 56: 235-236
• Clark (2004) Access to Arrowe Park GUM Department Centre for Public Health Liverpool John Moores University
• Clark P, Cook PA, Wheater CP, Syed Q and Bellis MA (2001) Re-emerging syphilis: A case control based on the Manchester outbreak. Liverpool John Moores University Public Health Sector.
• Cook PA, Downing J, Hunt G, Syed Q Bellis MA (2003) HIV & AIDS in the North West of England 2002. North West HIV & AIDS Monitoring Unit. Liverpool John Moores University
• Foley E, Patel R, Green N, Rowen D (2001). Access to genito urinary medicine clinics in the United Kingdom. Sexually transmitted infections2001
• HPA (2003) Sexually Transmitted Infections 1995-2002 Communicable Disease Surveillance Centres.