Abstract

SummaryBackgroundPopulation-based estimates of prevalence, risk distribution, and intervention uptake inform delivery of control programmes for sexually transmitted infections (STIs). We undertook the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) after implementation of national sexual health strategies, and describe the epidemiology of four STIs in Britain (England, Scotland, and Wales) and the uptake of interventions.MethodsBetween Sept 6, 2010 and Aug 31, 2012, we did a probability sample survey of 15 162 women and men aged 16–74 years in Britain. Participants were interviewed with computer-assisted face-to-face and self-completion questionnaires. Urine from a sample of participants aged 16–44 years who reported at least one sexual partner over the lifetime was tested for the presence of Chlamydia trachomatis, type-specific human papillomavirus (HPV), Neisseria gonorrhoeae, and HIV antibody. We describe age-specific and sex-specific prevalences of infection and intervention uptake, in relation to demographic and behavioural factors, and explore changes since Natsal-1 (1990–91) and Natsal-2 (1999–2001).FindingsOf 8047 eligible participants invited to provide a urine sample, 4828 (60%) agreed. We excluded 278 samples, leaving 4550 (94%) participants with STI test results. Chlamydia prevalence was 1·5% (95% CI 1·1–2·0) in women and 1·1% (0·7–1·6) in men. Prevalences in individuals aged 16–24 years were 3·1% (2·2–4·3) in women and 2·3% (1·5–3·4) in men. Area-level deprivation and higher numbers of partners, especially without use of condoms, were risk factors. However, 60·4% (45·5–73·7) of chlamydia in women and 43·3% (25·9–62·5) in men was in individuals who had had one partner in the past year. Among sexually active 16–24-year-olds, 54·2% (51·4–56·9) of women and 34·6% (31·8–37·4) of men reported testing for chlamydia in the past year, with testing higher in those with more partners. High-risk HPV was detected in 15·9% (14·4–17·5) of women, similar to in Natsal-2. Coverage of HPV catch-up vaccination was 61·5% (58·2–64·7). Prevalence of HPV types 16 and 18 in women aged 18–20 years was lower in Natsal-3 than Natsal-2 (5·8% [3·9–8·6] vs 11·3% [6·8–18·2]; age-adjusted odds ratio 0·44 [0·21–0·94]). Gonorrhoea (<0·1% prevalence in women and men) and HIV (0·1% prevalence in women and 0·2% in men) were uncommon and restricted to participants with recognised high-risk factors. Since Natsal-2, substantial increases were noted in attendance at sexual health clinics (from 6·7% to 21·4% in women and from 7·7% to 19·6% in men) and HIV testing (from 8·7% to 27·6% in women and from 9·2% to 16·9% in men) in the past 5 years.InterpretationSTIs were distributed heterogeneously, requiring general and infection-specific interventions. Increases in testing and attendance at sexual health clinics, especially in people at highest risk, are encouraging. However, STIs persist both in individuals accessing and those not accessing services. Our findings provide empirical evidence to inform future sexual health interventions and services.FundingGrants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health.

Highlights

  • Diagnosed sexually transmitted infections (STIs) have increased substantially in Britain (England, Scotland, and Wales) since the 1990s1 and throughout the past decade to the end of 2012,2 emphasising the importance of sustained public health programmes to identify and treat infections, reduce morbidity and mortality, and prevent onward transmission

  • The National Surveys of Sexual Attitudes and Lifestyles (Natsal)-1 (1990–91) and Natsal-2 (1999–2001) have guided the development of sexual health programmes by providing empirical evidence to understand the heterogeneity of sexual behaviour in the British population,[3,4] the prevalence of STIs, and the drivers of transmission.[5,6]

  • We present age-specific and sex-specific estimates for the population prevalence of, and associated risk factors for, infection with Chlamydia trachomatis, high-risk human papillomavirus (HPV), Neisseria gonorrhoeae, and HIV from a probability sample of 16–44-year-olds in Britain

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Summary

Introduction

Diagnosed sexually transmitted infections (STIs) have increased substantially in Britain (England, Scotland, and Wales) since the 1990s1 and throughout the past decade to the end of 2012,2 emphasising the importance of sustained public health programmes to identify and treat infections, reduce morbidity and mortality, and prevent onward transmission. Population-based estimates of infection prevalence, risk distribution, and intervention uptake inform the design and delivery of STI control programmes. (1999–2001) have guided the development of sexual health programmes by providing empirical evidence to understand the heterogeneity of sexual behaviour in the British population,[3,4] the prevalence of STIs, and the drivers of transmission.[5,6] Surveillance of STI diagnoses does not measure the true prevalence of STIs in the population because infections are often asymptomatic and undiagnosed. Natsal links prevalence (measured with biological sampling) with population risk factors and can assess the extent to which infected and at-risk individuals access specific interventions and services.

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