The development of near-patient testing in the sexual health field in recent years provides a much needed opportunity to improve the control of sexually transmitted infections (STIs). However, in many fields, this opportunity to improve sexual health is not being fully realised.

Sexual health has deteriorated markedly over the past decade. Diagnoses of the most common STIs have risen markedly,¹ with these increases almost certainly caused at least partly by changes in behaviour and by worsening service access.

An increasing body of social and behavioural research suggest that more people are having sex with more partners at an earlier age. It is a trend that needs to be better reflected in the UK’s sexual health service response.²

With such changes in the behaviour and increase in diagnoses of STI, it is not surprising that services have struggled to manage. Less than half of all people seeking treatment in genito urinary medicine (GUM) clinics of the National Health Service (NHS) are seen within 48 h, with 25% of people having to wait more than 2 weeks.³

Furthermore, worsening service access may, in itself, be helping to fuel increasing levels of STIs. In broad terms, a vicious circle may be emerging in which worsening sexual health causes longer waits for GUM services, and these prolonged waiting times in turn facilitate further increases in transmission and diagnosis of STI.

This state of affairs is particularly worrying because of the UK’s hitherto strong track record in the sexual health field. There is a strong heritage of high-quality public health surveillance and GUM service delivery, as well as a strong track record of response to HIV in the 1980s and 1990s.

DEVELOPING A FRESH RESPONSE

Such is the scale of growth, and the scale of behaviour change that new ways of responding to these pressures are …