Elsevier

The Lancet

Volume 358, Issue 9296, 1 December 2001, Pages 1851-1854
The Lancet

Sex at the Millennium
Sexual behaviour in Britain: reported sexually transmitted infections and prevalent genital Chlamydia trachomatis infection

https://doi.org/10.1016/S0140-6736(01)06886-6Get rights and content

Summary

Background

Studies of the epidemiology of sexually transmitted infections (STI) are largely based on surveillance data. As part of a national survey of sexual attitudes and lifestyles (Natsal 2000) in Britain, we estimated the frequency of self-reported STIs, and the prevalence of urinary Chlamydia trachomatis infection.

Methods

We did a stratified probability sample survey of 11 161 men and women aged 16–44 years in Britain. Computer assisted self-interviews contained items on the nature and timing of previously diagnosed STIs. Half of all sexually experienced respondents aged 18–44 years were invited to provide a urine sample for ligase chain reaction testing for C trachomatis infection.

Findings

10·8% of men and 12·6% of women reported ever having an STI, 3·6% of men and 4·1% of women reported ever being diagnosed with genital warts, and 1·4% of men and 3·1% of women reported previous infection with C trachomatis. 76% of men and 57% of women ever diagnosed with an STI had been to a GUM clinic. C trachomatis was found in 2·2% (95% CI 1·5–3·2) of men and 1·5% (95% CI 1·11–2·14) of women with age-specific prevalence being highest among men aged 25–34 (3·1%) and women aged 16–24 years (3·0%). Non-married status, age, and reporting partner concurrency or two or more sexual partners in the past year were independently associated with infection with C trachomatis.

Interpretation

We show substantial heterogeneity in distribution of reported STIs, and the demographic and behavioural determinants of prevalent genital chlamydial infection. The results have potentially wide application for proposed chlamydia screening programmes which, given the demonstrated prevalence, must now proactively seek to involve men.

Introduction

The epidemiology of sexually transmitted infections (STIs) in populations results from the interaction between biological characteristics of the relevant organisms, the behaviours that transmit them, and the effectiveness of prevention and control interventions.1 In Britain, our understanding of STI epidemiology is largely based on surveillance data obtained from a national network of Genitourinary Medicine (GUM) clinics. Despite the declines in STI incidence in the 1980s, recent increases in the rates of STIs have led to growing concerns regarding deterioration in sexual health in Britain and the need to adopt a strategic, multidisciplinary approach to STI prevention.2 In this paper we examine the cumulative incidence of reported STIs and the prevalence of undiagnosed Chlamydia trachomatis infection in a national probability sample survey of sexual attitudes and lifestyles (Natsal 2000) undertaken in 1999–2001.

Section snippets

Methods

The second National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) is a stratified probability sample survey of 11 161 men and women aged 16–44 years, resident in Great Britain, interviewed between May, 1999, and February, 2001.3 The response rate was 65·4%. Among a range of questions about respondents' sexual lifestyles and attitudes were items about their history of diagnosed STIs (which, when, and where diagnosed). In addition, 5026 respondents at alternative sampled addresses, aged

Results

10·8% of men and 12·6% of women, who had ever had sexual intercourse (vaginal, oral, or anal) reported ever having been diagnosed with at least one of eight major STIs (table 1). Genital warts were the most commonly reported STI, and genital chlamydia the most common bacterial STI among both men and women (table 1). Other commonly diagnosed infections among women included pelvic inflammatory disease (PID), non-specific genital infection (NSGI), and genital herpes. Non-specific urethritis (NSU)

Discussion

Our probability sample survey explores the detailed epidemiology of reported STIs and prevalent undiagnosed C trachomatis infection. Our data indicate that more than one tenth of the population aged 16–44 years have been diagnosed with an STI and that GUM clinics are a popular site for their diagnosis and treatment, particularly among men. The lower prevalence of GUM attendance among women with diagnosed STIs in part reflects health care seeking behaviours and STI screening outside of GUM

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