Sexual health services in England are at breaking point, according to a new report by the Local Government Association.

It found that three-quarters of local councils have seen an increase in syphilis diagnoses, rates of chlamydia have risen by over a third, and almost every area in England and Wales is dealing with higher rates of gonorrhoea. 

These latest figures are further evidence that, when it comes to sexual health, England is going backwards. Last year, the number of syphilis cases rose to 8,700, which is the highest level since 1948. Most syphilis cases involve gay and bisexual men but there’s also been an increase in diagnosis among heterosexual people. As a bacterial infection, syphilis is easily sorted with antibiotics, but if it goes untreated then it can lead to serious problems. 

Rates of gonorrhoea have also been steadily rising, and many of the new cases are affecting young people: in 2022, there was a 26 per cent increase in new STI diagnoses among people aged 15 to 24, which was partly due to rates of gonorrhoea almost doubling. Both diseases can be asymptomatic, which means that testing is vital. Unfortunately, after a decade of austerity under the Tory party, the process of doing this is nowhere near as easy as it should be.

“Disinvestment in sexual health has made it harder for some people to access these services,” Dr Will Nutland the founder of sexual heath non-profit The Love Tank, tells Dazed. “Gay and bisexual men under 25, in particular, find it hard to access PrEP clinic appointments, which means it’s also hard for them to access check-ups and treatment.” Even people who have symptoms, or who think they may have been exposed to an STI, are being forced to wait for several weeks or struggling to get an appointment at all. “If it’s hard to get tested or treated, lots of people are going to have untreated STIs for longer,” says Dr Nutland. As sexual health services become more badly funded and resource-starved, health inequalities –  in terms of age, ethnicity and country of origin – are increasing.

“Over recent years, sexual health services have been expected to take on more and more with far less and we have warned for some time that services are at breaking point,” Deborah Gold, the CEO of National AIDS Trust, tells Dazed. “The alarming increases in STIs across the country are a symptom of failure to properly resource action in this crucial area of public health. Continued chronic under-resourcing of sexual health services will prevent the Government from meeting its commitment to end new HIV transmissions in England by 2030, or from making progress to end deepening inequalities in HIV outcomes and sexual health more broadly.”

But while these new figures paint a bleak picture, it’s not all bad news. “If you look for something, you see more of it,” Dr Nutland tells Dazed. “One of the successes we can be proud of over the last ten years is that we’ve made it easier to test for lots of different things, and part of the increase we’re seeing is because we have increased the ability to diagnose.” 

“If it’s hard to get tested or treated, lots of people are going to have untreated STIs for longer” – Dr Will Nutland

There are a number of obvious solutions to the sexual health crisis, says Dr Nutland. The first is obvious: the government needs to invest more money in services. Beyond that, ramping up online testing (which already exists in London, where it has proven enormously successful) would make it easier for people to access testing, as well as saving money for local governments and the NHS. Having a central booking system in London, instead of forcing people to jump between clinics on the chance of getting an appointment, would make the process much easier to navigate.

Advances in medicine also have a role to play. DoxyPEP – which involves taking a dose of antibiotics after having sex – is a tool which significantly reduces the risk of acquiring a number of STIs, including gonorrhoea, chlamydia and syphilis. It’s cheap, safe, and effective for up to 72 hours after a potential exposure. “If you’re going to saunas, backrooms, sex parties or having a kinky weekend away, you might want to consider taking DoxyPep,” says Dr Nutland, although he stresses that gay and bisexual men are not the only people who would stand to benefit. “There are other groups who may have a higher instance of certain STIs, including some younger black communities in London, who have a higher instance of than the rest of the population. It would be worth thinking about how doxypep could be introduced into those networks as well,” he says.

There are new developments on the horizon, including the Bexsero vaccine, which is currently used to protect people from meningococcal (a bacteria which causes meningitis). A growing body of evidence suggests that it is also effective against gonorrhoea, and the government is currently considering a proposal to include it as part of standard sexual health provision. A vaccine for syphilis is also currently under development. 

When it comes to sexual health, there are things we can all do to look after ourselves (testing is always a good idea, however frustrating the process might be.) But we know that appealing to individual responsibility can only take us so far. For a variety of understandable and sympathetic reasons, lots of people feel so anxious about going for an STI check-up that it’s a challenge for them to even pick up the phone, nevermind those who are actively seeking healthcare and encountering barriers – the process needs to be as easy, accessible and frictionless as possible, which can only come with more money and resources.