More capacity needed for public health, claim researchers

September 07, 2005

UK researchers are calling for a major increase in the capacity of clinics to tackle the current sexually transmitted infection (STI) epidemic, claiming that current levels are inadequate to meet the government's own health targets.

Recorded numbers of new sexually transmitted infections have doubled in the last five years. Figures from the Health Protection Agency show that last year only 41% of people attending GUM clinics were seen within the recommended 48 hours, and 26% were not seen within 2 weeks.

The researchers from Imperial College London and University College London believe that current capacity is inadequate to deal with this threat to public health, and that a significant increase is required to tackle the growing problem.

Their findings are based on research published in the Journal of Infectious Diseases, modelling how the current inadequate provision of sexual health services affects future demand, and how increasing capacity can reduce that future demand by reducing rates of spreading.

Dr Peter White, from Imperial College London, and lead researcher said, "Current levels of capacity have failed to keep up with increasing demand, resulting in yet more infections as many people are unable to get treated promptly - or even at all, in some cases.

"Our work has shown that a significant increase in capacity is needed to tackle the current epidemic. This would be an investment, with the pay-off that it would reduce the number of infections that occur in the future, and would reduce rates of complications like infertility, which are costly to treat," he said.

Current inadequate capacity creates a 'vicious circle', where failure to treat infections promptly - or at all, in some cases - allows infection to spread further, creating more infections and more unmet demand for treatment, maintaining the inadequacy of services. In contrast, increasing capacity to meet treatment needs creates a 'virtuous circle' because it reduces rates of spreading, and so reduces future demand for treatment. It is essential that the capacity increase is large enough to break the 'vicious circle' and enter the 'virtuous circle', otherwise high rates of spreading will continue indefinitely.

Professor Geoff Garnett, from Imperial College London and senior author adds, "The current capacity of sexual health clinics is inadequate to meet the targets set by the government. Although the target is to have everyone seen within 48 hours of seeking care, many patients wait for two weeks or more. This delay can lead to increased infections, and a further increase in demand on already overstretched services."

Prof George Kinghorn, Clinical Director for Communicable Diseases for Sheffield Teaching Hospitals NHS Foundation Trust, and Honorary Professor of Genitourinary Medicine for the University of Sheffield, commented, "Investment now in GUM services is imperative. The more the delay, the more expensive it will become to restore control of STIs in the UK."

Dr Angela Robinson, President of the British Association for Sexual Health and HIV said: "With waits of up to 8 weeks for a routine screen for STI in some parts of the country and some people being turned away who may never get seen, STIs will continue to rise until capacity is increased sufficiently in specialist services with the experience to deal with cases efficiently and speedily."

Prof Kinghorn added, "If the investment made by the government in its "Choosing Health" allocations to Primary Care Trusts is invested now in GUM services, then there is a real opportunity to break out of the vicious circle. However, if PCTs divert this resource to other healthcare priorities then STIs and HIV will continue to increase."

Imperial College London

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