Sexual health

Sexual health

Sexual health is defined as a state of physical, emotional, mental and social wellbeing in relation to sexuality; it is not just the absence of disease. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, which encompasses safe sexual experiences that are free of coercion, discrimination and violence. In England, the definition of sexual health also includes the provision of advice and services around contraception, termination of pregnancies, Sexually Transmitted Infections (STIs) and Human Immunodeficiency Virus (HIV).

The government’s Framework for Sexual Health Improvement in England highlights the importance of good sexual health and the ambition is to improve sexual health of the whole population, with key objectives outlined.

The Southampton Sexual Health Needs Assessment (available in the resources section below) has identified a number of opportunities to improve sexual health outcomes and reduce inequalities across the system.

Who is at risk and why?

The factors that affect sexual health (both positively and negatively) are multiple and complex. If a person is engaging in sexual activity the use of condoms improves the chances of avoiding unwanted pregnancy and contracting a sexually transmitted infection.

Different population groups have a differing range of factors affecting their sexual health. Higher levels of STIs and HIV are seen among young heterosexual people aged 15 to 24 years, people from Black ethnic groups and men who have sex with men (MSM).

The consequences of poor sexual health include:

• Unintended pregnancies and abortions
• Psychological consequences of sexual coercion and abuse
• Poor educational, social and economic opportunities for teenage mothers, young fathers and their children
• STIs and HIV
• Cervical and other genital cancers
• Hepatitis, chronic liver disease and liver cancer
• Pelvic inflammatory disease, which can cause ectopic pregnancies and infertility

More information is available in the sexual health dashboard and resources section below, covering a range of topics including sexually transmitted infections (STIs), HIV, reproductive health, and contraception.

Sexually Transmitted Infections and HIV

STIs and HIV are a consequence of poor sexual health, with efforts focused on reducing the incidence and prevalence as well as the onward transmission of STIs and HIV amongst the population, especially within high-risk groups. More information can be found in the resources section below.

Chlamydia – Is the most frequently diagnosed STI in England, with rates of infection substantially higher in young people aged 15 to 24. In 2024, 15.1% of females (aged 15-24) in Southampton were screened for chlamydia, with a detection rate of 1,399 cases per 100,000 females aged 15 to 24 (1,851 below goal). A high detection rate of chlamydia is not necessarily bad, as UKHSA recommend a detection rate of at least 3,250 cases per 100,000. Achieving this target would likely result in a continued reduction in the prevalence of chlamydia. Chlamydia is effectively treated with antibiotics.

Genital warts – Are caused by infection with specific subtypes of human papillomavirus (HPV), most commonly types 6 and 11. The HPV vaccine provides protection against these strains, significantly reducing the risk of developing genital warts. There is no cure for genital warts, and while symptoms can clear up on their own, further outbreaks may occur. In 2024, Southampton had a first episode genital warts diagnosis rate of 50.0 cases per 100,000 population, slightly higher, though not significantly, than the England average of 43.4 cases.

Genital herpes – Infections are frequently due to herpes simplex virus (HSV) type 2, although type 1 infection is also seen. Similar to genital warts, those diagnosed with herpes can experience outbreaks or recurrent episodes that require treatment. In 2024, Southampton had a genital herpes diagnosis rate of 44.1 cases per 100,000 population, an 11% increase from the previous year and lower, but not significantly to the England average of 48.3 cases.

Gonorrhoea – Is a STI caused by bacteria called Neisseria gonorrhoeae or gonococcus and can usually be treated with a course of antibiotics. Southampton had a gonorrhoea diagnosis rate of 86.7 cases per 100,000 population in 2024, a 34% decrease from 2023 and significantly lower, and better, than the England average of 124.5 cases.

Syphilis - Is a sexually transmitted infection caused by the bacterium Treponema pallidum. Antibiotics can resolve it in the early stages. Without treatment, it can lead to disability, neurological disorders, and even death. Syphilis cases have more than doubled in Southampton and across England over the last 10 years. In 2024, the rate for Southampton was 26.2 diagnoses per 100,000 (67 cases), an increase of over 100% since 2022 (32 cases). This was significantly higher than the England rate of 16.5 per 100,000. In 2014 the rates were 7.0 per 100,000 and 8.2 per 100,000 respectively. 

Shigella – Is a bacteria that causes Shigellosis (also known as bacillary dysentery). It can cause severe illness, requiring admission to hospital for treatment. Although anyone can pick up Shigella, gay, bisexual and other men who have sex with men (GBMSM) are at the highest risk. Infections through close sexual contact amongst GBMSM have been increasing over the past decade and circulating strains are becoming multi or extensively resistant to antibiotics. In 2024, Southampton had a crude rate of 13.0 per 100,000 adult male population, higher, but not significantly, than England’s crude rate of 10.0 and the 5^th worst amongst CIPFA comparators.

HIV – Is a virus that damages the cells in a person’s immune system and weakens their ability to fight everyday infections and diseases. In 2023, Southampton had a new HIV diagnosis rate of 30.1 cases per 100,000 population, a continued increase since 2020 and significantly higher than the England diagnosis rate of 10.4 cases. Early diagnosis of HIV is vital to effective treatment and reducing transmission, with later diagnoses associated with poorer health outcomes. Late HIV diagnoses remain high across the UK, with 43.1% of adults diagnosed in Southampton during 2021-23 classified as having a late diagnosis; similar to the England average of 43.5% and above the national goal of less than 25%. Whilst there is currently no cure for HIV, there are very effective drug treatments and antiretroviral therapy (ART) that enable most people living with HIV to live a long and healthy life. Undetectable = Untransmittable (U = U) relates to the fact that people living with HIV who are on treatment and have a fully supressed viral load (the amount of HIV virus in the blood is suppressed below the level of 200 copies/ml) have a zero risk of transmitting the virus to their sexual partners.

More information is in the sexual health dashboard below and in the resources section.

Teenage pregnancies

A large proportion of teenage pregnancies are unplanned and around half end in abortions. With the right access to reproductive health care and supportive services, teenage pregnancy is a preventable outcome for most young women. Although, for some young women having a child can represent a positive turning point in their lives, for many more teenagers bringing up a child is extremely difficult and often results in poor outcomes for both the parent and the child. In England, it is estimated 1 in 5 young women aged 16 to 18 who are not in education, training or employment are teenage mothers; young fathers are also more likely to have poor education and have a greater risk of being unemployed in adult life.

Teenage conceptions in Southampton among young women aged under 16 (aged 13-15) in 2022 is 3.0 per 1,000 (12 conceptions). If Southampton had 3 fewer conceptions, it would have the same rate as England of 2.2 per 1,000. Looking at 3 years pooled, there were 43 under 16s conceptions from 2020-2022, a rate of 3.7 per 1,000, with 48.8% leading to abortion. This is significantly higher than England’s conception rate of 2.1 per 1,000 and the 4th highest amongst CIPFA comparators. To match England’s rate, there would have needed to be just 25 conceptions among under 16s in Southampton, 18 fewer than actually occurred. Southampton’s percentage of conceptions leading to abortions is lower than England’s percentage (60.9%) and the 4th lowest amongst 16 CIPFA comparators.

For young women aged under 18, Southampton’s rate continues to fall faster than the England average. The conception rate for under 18s in Southampton was 16.2 per 1,000 in 2022, ranking 5^th lowest among CIPFA comparators, yet still higher than the England average of 13.9 per 1,000. In Southampton, 45.9% of conceptions led to abortions, which is lower than England’s figure of 58.2%. Just 9 fewer conceptions among under 18 residents would have brought Southampton in line with the England rate.

Ward analysis shows Bevois, Peartree and Redbridge have the highest number of teenage mothers between 2020-2024, with areas in Bevois and Redbridge being in the top 10% most deprived areas by England Deprivation deciles. Analysis shows a very strong link between deprivation and teenage mothers, with the number of teenage mothers 8.5 times higher for mothers living in the most deprived England deprivation quintile compared to the top two least deprived quintiles. More information can be found in the Health inequalities section.

Reproductive health

Reproductive health refers to a state of physical, mental and social wellbeing in all matters relating to the reproductive system. It addresses the reproductive processes, functions and system at all stages of life to ensure individuals have the capability to reproduce and the freedom to decide if, when and how often to do so (World Health Organisation- reproductive health).

Long Acting Reversible Contraceptives (LARC) are one of the most effective methods in reducing unwanted pregnancy, as they do not rely on a daily routine like other forms of contraceptive such as the pill. LARCs include contraceptive injections, implants, the intra-uterine system (IUS) or the intrauterine device (IUD). However, the contraceptive injection isn’t included within LARC indicators as this method has a higher failure rate. In Southampton, 44.4 per 1,000 females aged 15-44 years are using one of the LARC methods outlined above in 2023, a decrease from 54.7 per 1,000 in 2022 and similar to the England average of 43.5 females.

It is important that women requesting an abortion have early access to services and support, as the earlier in the pregnancy the abortion is performed, the lower the risk of complications there are. Data from the most recent period (2022) shows that within Southampton 86.6% of abortions were performed within 10 weeks gestation, which is similar to the England average of 87.9%.

More information can be found in the resources, available below.