The routine vaccination programme for gonorrhoea prevention is targeted towards gay, bisexual, and other men who have sex with men (GBMSM), as this group is disproportionately affected by gonorrhoea infection, accounting for nearly half of all diagnoses in England.

The Government recognises that gonorrhoea and its complications can also disproportionately affect minority groups, including women from ethnic minority communities, particularly in urban and more deprived areas, where longstanding inequalities in sexually transmitted infection rates persist.

Vaccination is offered nationally through sexual health services (SHSs), which are skilled in identifying individuals who should be vaccinated, trusted by eligible cohorts, and understand the local populations they serve. SHSs can perform individual risk assessments to identify those at equivalent risk of gonorrhoea infection to GBMSM and offer vaccination where appropriate. Many services also undertake innovative and effective outreach programmes to reach those less able to access mainstream services.

The Joint Committee on Vaccination and Immunisation continues to keep all vaccination programmes under review as further evidence and epidemiological data emerge. Anyone concerned about their own risk should consult their local sexual health clinic for tailored advice and testing.

In November 2023, the Joint Committee on Vaccination and Immunisation (JCVI) issued advice on standing up a targeted, routine vaccination programme for protection against gonorrhoea.

Officials across the Department, the UK Health Security Agency and NHS England have been developing options based on the JCVI advice, assessing all the relevant factors to ensure that the United Kingdom’s high standards for world-leading vaccination programmes are maintained, and the best value for money for taxpayers is delivered. A decision on a vaccination programme for the prevention of gonorrhoea is expected shortly, following the outcome of this process.

NHS England will work with partners across national, regional, and local levels to ensure that plans for any new vaccination programme will meet local need, ensure equity of access and support a high level of uptake of the vaccination offer by those who are eligible.

In November 2023, the Joint Committee on Vaccination and Immunisation (JCVI) issued advice on standing up a targeted, routine vaccination programme for protection against gonorrhoea.

Officials across the Department, the UK Health Security Agency and NHS England have been developing options based on the JCVI advice, assessing all the relevant factors to ensure that the United Kingdom’s high standards for world-leading vaccination programmes are maintained, and the best value for money for taxpayers is delivered. A decision on a vaccination programme for the prevention of gonorrhoea is expected shortly, following the outcome of this process.

NHS England will work with partners across national, regional, and local levels to ensure that plans for any new vaccination programme will meet local need, ensure equity of access and support a high level of uptake of the vaccination offer by those who are eligible.

The data on the cost of treating gonorrhoea to the National Health Service is not held centrally. This is because most gonorrhoea infections are treated with antibiotics in sexual health services using funding from the Local Authority Public Health Grant. In 2023, there were 85,223 diagnoses of gonorrhoea in sexual health services in England.

For infections and complications requiring treatment in secondary care, the UK Health Security Agency estimates that the cost to the NHS of treating gonorrhoea in secondary care in 2022/23 was approximately £2,000 per in-patient admission. Data on the number of admissions is not held centrally.

The following table shows the number of gonorrhoea diagnoses in sexual health services in England between 1994 and 2023:

Source: UK Health Security Agency

The information requested is not held centrally.

On 10 November 2023, the Joint Committee on Vaccination and Immunisation (JCVI) issued advice on standing up a targeted, routine vaccination programme for the prevention of gonorrhoea.

Officials across the Department, the UK Health Security Agency, and NHS England are developing policy options based on the JCVI’s advice, taking into account a number of factors, including programme deliverability, interrelationship with other immunisation programmes, and National Health Service delivery options. A decision on the vaccination programme is expected shortly after the outcome of this process.

On 10 November 2023 the Joint Committee on Vaccination and Immunisation (JCVI) issued advice on creating targeted, routine vaccination programmes for the prevention of Mpox and gonorrhoea.

Officials across the Department, the UK Health Security Agency, and NHS England are developing policy options based on the JCVI’s advice. A decision on the vaccination programme for the prevention of gonorrhoea will be taken following the outcome of this process. The policy position on the Mpox vaccination programme is being updated to reflect the emerging international concerns, and a decision on this is expected shortly.

On 10 November 2023 the Joint Committee on Vaccination and Immunisation (JCVI) issued advice on creating targeted, routine vaccination programmes for the prevention of Mpox and gonorrhoea.

Officials across the Department, the UK Health Security Agency, and NHS England are developing policy options based on the JCVI’s advice. A decision on the vaccination programme for the prevention of gonorrhoea will be taken following the outcome of this process. The policy position on the Mpox vaccination programme is being updated to reflect the emerging international concerns, and a decision on this is expected shortly.

Both gonorrhoea and syphilis have returned to, and exceeded, the high levels reported in 2019, prior to the COVID-19 pandemic. Between 2021 and 2022, gonorrhoea increased in all age-groups, with the largest rise among young people aged 15 to 24 years old. Over the same period, infectious syphilis increased among gay, bisexual, or other men who have sex with men, and heterosexuals.

The UK Health Security Agency (UKHSA) conducts comprehensive surveillance of sexually transmitted infections and supports local authorities and sexual health services in using this data to inform sexual health service delivery. The UKHSA is undertaking work with partner organisations to identify the best use of existing and emerging preventative interventions, to address the increase in gonorrhoea and syphilis.

Sexually transmitted infection diagnosis data is published annually, as official statistics by the UK Health Security Agency (UKHSA), and is available at the GOV.UK website, in an online only format. There were 82,592 gonorrhoea diagnoses and 8,692 infectious syphilis diagnoses, including primary, secondary, and early latent, reported in sexual health services in England, in 2022. This is compared to 31,177 gonorrhoea diagnoses and 3,345 infectious syphilis diagnoses, primary, secondary, and early latent, in 2013.

Gonorrhoea is increasing in people of all ages, but the rise is highest among young people aged 15 to 24 years old. Infectious syphilis, including primary, secondary, and early latent, is increasing among gay, bisexual, or other men, who have sex with men and heterosexual people.

Dedicated sexual health services play a key public health role in diagnosis, early treatment and management of STIs and we are providing local authorities with more than £3.5 billion in 2023/24 (increasing to £3.6 billion in 2024/25) through our public health grant to support this activity.

We continue to support the delivery of local services, providing guidance and data through UKHSA and my department. In March 2023 the Department of Health and Social Care in collaboration with UKHSA, published the Integrated Sexual Health Service Specification to support local authorities in comprehensive commissioning of services and provide advice and guidance on managing STIs outbreaks.

UKHSA has also published a Syphilis Action Plan to address the increase in syphilis diagnosis in England, focusing on key interventions such as targeted testing, partner notification and awareness raising.

No assessment has been made of any resulting loss of working days, due to gonorrhoea and syphilis diagnoses.

Sexual health services play a key public health role in diagnosis, early treatment and management of sexually transmitted infections (STIs), including syphilis and gonorrhoea. We are providing more than £3.5 billion to local authorities through the Public Health Grant to fund public health services, including sexual health services, in this financial year. Individual local authorities are responsible for and well placed to make funding and commissioning decisions about the sexual health services that best meet the needs of their local populations, ensuring patients can be adequately diagnosed and treated to avoid further transmission and long-term health problems.

As part of the HIV Action Plan, we are investing over £3.5 million from 2021 to 2024 to deliver the National HIV Prevention Programme for England, including HIV Testing Week and other campaigns to improve information and testing for human immunodeficiency virus (HIV) and other STIs.

The UK Health Security Agency supports local areas to improve sexual health service delivery through data monitoring and reporting. It has also published a Syphilis Action Plan to address the increase in syphilis diagnosis in England, focusing on key interventions such as targeted testing, partner notification and awareness raising.

Currently there are no vaccines in the United Kingdom licensed for protection against gonorrhoea. The Joint Committee on Vaccination and Immunisation (JCVI) are aware of ongoing studies evaluating the potential protection against gonorrhoea from meningococcal B vaccination and plan to consider evidence on other vaccines which could be used to protect against gonorrhoea. Once the JCVI has concluded its review and provided advice, the Government will consider options for implementing a programme.

The effectiveness of treatment for gonorrhoea continues to be threatened by the development of resistance to the last-line treatment, ceftriaxone. The UK Health Security Agency’s (UKHSA) Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) includes a suite of testing and surveillance systems to detect and monitor antimicrobial resistance in Neisseria gonorrhoeae and potential treatment failures. GRASP reports annually on drug resistance in N. gonorrhoeae in England and Wales and has directly influenced changes in treatment guidelines on three occasions.

Additionally, all primary diagnostic laboratories test gonococcal isolates for susceptibility to ceftriaxone and refer suspected resistant isolates to the UKHSA national reference laboratory for confirmatory testing and follow-up in real-time. UKHSA has published guidance on managing cases of ceftriaxone-resistant gonorrhoea and performs a risk assessment for each case. If there is a risk of transmission within England, UKHSA instigates an Incident Response to contain spread.

This applies to all population groups, including vulnerable and elderly populations, as the approach to tackling antibiotic-resistant gonorrhoea is universal across England.

The effectiveness of treatment for gonorrhoea continues to be threatened by the development of resistance to the last-line treatment, ceftriaxone. The UK Health Security Agency’s (UKHSA) Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) includes a suite of testing and surveillance systems to detect and monitor antimicrobial resistance in Neisseria gonorrhoeae and potential treatment failures. GRASP reports annually on drug resistance in Neisseria gonorrhoeae in England and Wales and has directly influenced changes in treatment guidelines on three occasions.

Additionally, all primary diagnostic laboratories test gonococcal isolates for susceptibility to ceftriaxone and refer suspected resistant isolates to the UKHSA national reference laboratory for confirmatory testing and follow-up in real-time. UKHSA has published guidance on managing cases of ceftriaxone-resistant gonorrhoea and performs a risk assessment for each case. If there is a risk of transmission within England, UKHSA instigates an Incident Response to contain spread.

Local authorities are mandated to provide confidential, open access sexual health services. These services include testing and treatment for gonorrhoea. It is recommended that all those attending services with needs relating to sexually transmitted infections (STIs) are tested for gonorrhoea, syphilis, human immunodeficiency virus, and chlamydia, even if asymptomatic.

UK Health Security Agency undertakes surveillance of testing and diagnoses of STIs at commissioned sexual health services, including online testing to monitor testing and diagnoses, and provide information on local and national trends in gonorrhoea.

We have not made a specific assessment of a correlation between the Government’s public health funding and rates of syphilis and gonorrhoea in England.

Local government is responsible for commissioning sexual health services through the public health grant, and the Government allocated more than £3 billion for the public health grant in 2022/23. We will announce the 2023/24 public health grant allocations to local authorities in due course.

The forthcoming sexual and reproductive health strategy for England will set out plans to improve sexual and reproductive health outcomes and wellbeing, including tackling sexually transmitted infections (STIs). The strategy will focus on reducing the harms associated with STIs, reducing the incidence and adverse outcomes such as stillbirths or infertility and tackling stigma, morbidity and mortality. As part of the strategy’s development, we are considering various goals including those proposed by the World Health Organization, related to the control of STIs.

We are developing a new Sexual and Reproductive Health Strategy for England, which will be published later this year. The Strategy will set out our plans to improve sexual and reproductive health outcomes and wellbeing, including tackling sexually transmitted infections (STIs). As part of the Strategy’s development process, we are currently considering the control of STIs. The reproduction or ‘R’ numbers for various STIs will not be included in the Strategy, as the R number for a typical STI differs from many other infections and cannot not easily measurable or generalised to the overall population. Factors include the population density of susceptible people, transmission probability per sexual partner and the number of sexual partners during a period of time, as well as the time spent in the infectious state.

The current reproduction number or ‘R’ of chlamydia, gonorrhoea and syphilis is not known, as R number estimates for sexually transmitted infections (STIs) require behavioural information which cannot be easily measured.

The calculation of R for a typical STI differs from many other infections, in that it does not depend only on the population density of susceptible people, but rather the transmission probability per sexual partner and the number of sexual partners during a period of time, as well as the time spent in the infectious state. The value of R differs between different sexual networks and groups at higher risk of STIs as well as over time and cannot be generalised to the overall population.