We'll be working to implement the following recommendations of this report as part of both our and BASHH’s work on sexual health:

  • Local authority sexual health commissioners must ensure funding is available to enable all sexual health services to provide the most accurate diagnostic tests for all sexually transmitted infections (STIs) including trichomoniasis and Mgen, in line with national guidelines.
  • Treatment, guidelines and surveillance measures already in place for AMR should continue for STIs across all agencies that deliver care, and be extended for STIs that may pose a newer threat to AMR, for example Mgen.
  • For too long, the inequalities that exist in regards to the burden of STIs have been ignored. Charities, community groups, sexual health services, commissioners and policy makers must now acknowledge these inequalities and no longer ignore their existence.
  • In the face of such stark inequalities, the lack of research into the structural drivers of STIs in communities who face disproportionate burdens of STIs is unacceptable. Increased focus and funding must be made available to researchers, working alongside affected communities, to fill this evidence gap. 
  • Now is the time for action. The Department for Health and Social Care, working with Public Health England, local authority commissioners and affected communities, must take affirmative action to tackle these inequalities, including through the design and delivery of tailored services and interventions.
  • The response to STIs to date has insufficiently examined the link between STI risk and wider determinants of sexual ill-health. The Governments new sexual health and reproductive health strategy must have addressing inequality at its centre, and should include actions to understand and tackle the wider socioeconomic determinants that may play a role in driving STI rates in England.
  • The erasure of identities in STI data must be reversed. Public Health England STI epidemiological data needs to better recognise the diversity of identities, providing data on transgender and non-binary people, specific ethnic minority communities and MSM who do not identify as gay or bisexual.
  • More research is needed, co-produced with individuals who engage in sex work or transactional sex to understand how their needs can be better met to ensure their sexual health, including STI prevention, and safety is ensured.
  • STI Patient information leaflets, and health promotion materials need to move beyond heteronormative and cisnormative narratives, ensuring the inclusion of other sexualities and gender identities.
  • The Government must ensure the national sexual health and reproductive health strategy is delivered as a matter of urgency. The strategy must set out ambitious targets to tackle STIs in England, providing detail on how these targets will be achieved, and setting out clearly the responsibilities of each statutory (and non statutory) organisation in working towards the ambition of the strategy. For the strategy to be a success, all stakeholders need to step up their focus and action on STIs.
  • Few charities exist focused specifically on sexual health. The charities within this sector need to increase their leadership and fully engage in the national strategy to ensure that it benefits communities at risk of STIs.
  • Local government has a key leadership role to play - locally, regionally and nationally. It must actively shape the new national strategy, and work in partnership locally to implement the strategy to the benefit of local communities affected by STIs.
  • Public Health England and the Department of Health and Social Care must prioritise sexual health including STIs. The national strategy is an opportunity for both organisations to show leadership and commitment to tackling STIs in England.
  • Public Health England should ensure the use of the new STI indicator within the PHOF is fit for purpose and provides an insight into progress on reducing specific STIs.
  • Public Health England should consider how the expansion of the HPV schools-based vaccination programme to some boys will be reflected in the HPV indicator within the PHOF.
  • Public Health England, working with local government and BASHH, should carry out return on investment modelling on the impact of investment in STI prevention and treatment interventions.
  • There is an urgent need to update the evidence base around behaviours linked to STIs. Public Health England and the Department for Health and Social Care, working with academics, clinicians and community organisations, must invest in research to provide a more up-to-date evidence base on the changing behaviours that are associated with increased risk of STIs; and work with commissioners and providers to ensure that this evidence is translated into effective targeted prevention interventions and enhanced partner notification.
  • HIV charities, services and commissioners must consider the sexual health needs of people living with HIV and work with communities to co-design targeted services and interventions that meet the diverse needs of all people living with HIV. The promotion and availability of PrEP must be better aligned with broader sexual health messaging to ensure that PrEP is seen as part of a comprehensive sexual health prevention strategy.
  • When it comes to condoms, something needs to change. Our knowledge on their use is out of date, and the marketing and promotion of condoms is dated. Funding should be provided to charities and community groups who are well placed to engage communities on why condom use is reducing and what actions could be taken to increase use and increase access.
  • Lessons should be learnt from HIV testing approaches, and actions taken by national and local commissioners to increase choice of STI tests - to make it as easy as possible to access testing.
  • Additional models of effective partner notification that take into account changing behaviours are being researched and recommendations from this should be considered by sexual health commissioners and providers.
  • It is evident that without adequate funding, there will be further reductions in the sexual health workforce, and any effective model of partner notification will be jeopardised. Funding, including for health advisor posts, must therefore ensure that sufficient workforce is in place to carry out effective partner notification.
  • A catch-up programme should be introduced for the HPV vaccine for the boys who will have missed out on this.
  • Additional options to prevent STIs are needed, with support for research into innovations urgently required from Government and research funding bodies. These options should build on current successes, learning from them, and reflect changing sexual behaviours.
  • The Department of Health and Social Care, working with local authorities, NHS England, with input from providers and community groups, must provide clarity on the future models of co-commissioning of sexual health services, ensuring transparency and accountability are core to any changes. 
  • Government must commit to fully fund sexual health services, reversing the impact of past funding cuts, and provide sufficient resource to increase efforts to tackle STIs. This funding should ensure an adequately trained workforce including health advisors, nurses, doctors, and other Allied Health Care Professionals.
  • Workforce and training should represent a key pillar within the forthcoming sexual health and reproductive health strategy. Direction in the strategy should be given to ensuring all local contracts include provisions for how they will provide the support needs of their local workforce, including training.
  • The new national sexual health and reproductive health strategy should reintroduce the mandatory 48 hour access target, ensuring that the appropriate referral is given within this timeline, and that services hold up to BASHH and NICE guidelines on STIs.
  • The new national strategy must provide solutions to the current inadequate access to sexual health services – addressing the root causes of why access is deteriorating.
  • Research, with peer and patient engagement, should be undertaken to fill the data gaps in the barriers experienced when accessing services and the impact structural inequalities can have on sexual health.
  • Primary prevention should be recognised as an integral part of sexual health services, with a mandatory requirement for provision to protect such services from cuts.
  • Online sexual health services are a welcome addition to physical services, and should continue to receive support through funding, research and development. However, it is imperative to recognise that they are not a substitute for physical services, and should not be treated or relied on as such.
  • Access to alternative providers e.g. community pharmacies which are networked with the local sexual health service and work in partnership should be explored, recognising that the providers will be required to provide the standards of care recommended by BASHH211.
  • The new national sexual and reproductive health strategy must formally recognise and support the benefits community organisations can bring to engaging and supporting communities at greatest risk of STIs, whilst community organisations need to further step into the sexual health space and play their part in working towards meeting the holistic sexual health needs of the communities they serve.
  • The appropriate funding, training, and resources need to be provided to ensure that teachers are well equipped to provide comprehensive and inclusive RSE that includes information on STIs, and that links in with local sexual health providers and services.
  • Sexual health services and programmes must ensure interventions meet the needs of older people and sexual health promotion messaging must start to represent and target older people.
  • Health promotion messaging and information must be accessible to people with low levels of health literacy or literacy in English, as well as to migrants who may not speak English.
  • Sexual health charities and community groups should increase focus on programmes and projects to support sexual health community champions to talk about STIs and sexual health publically, as part of a push for change in knowledge, perceptions and action.

Read introduction to State of the Nation

Read the executive summary