More than 80% of women and nearly 90% of men who reported having unsafe sex in the past year did not consult sexual health services, findings from the third National Sexual Attitudes and Lifestyles (Natsal 3) study have shown.

Using computer assisted interviews, participants were asked if they had ever attended sexual health services, and if so when, and where they would go for diagnosis and/or treatment if they thought they had a sexually transmitted infection (STI).

Participants were considered to have had unsafe sex in the past year if they reported: not using a condom at first, vaginal or anal, sex with a new partner in the past year and/or two or more sexual partners in the past year and no condom use in that time.

There were 5,707 men and 8,218 women who were sexually experienced; 22% of men and 23% of women aged 16-74 years reported ever having attended a sexual health service; 12% reported attending in the past five years and 5% in the past year. Attendance was highest among young people, 19% of men and 26% of women aged 16-19 compared with < 1.5% of those aged 45 and over.

Among those who were sexually active (4,819 men and 6,668 women aged 16-74 years), 4.9% of men and 6.0% of women reported attending sexual health services in the past year. After adjusting for age, those who attended sexual health services in the past year were more likely to have reported STI risk behaviour.

Overall, 15% of sexually active men and women aged 16-74 had had unsafe sex in the past year. Reported unsafe sex behaviour included:

• Not using a condom at first sex with a new partner in the past year - 59% of men and 63% of women

• Not using condoms with two or more sexual partners in the past year - 10% of men and 6% of women

• Both of the above - 31% of men and 30% of women.

Of those who reported unsafe sex in the past year, 89% of men and 82% of women reported not having attended a sexual health service in that period. They were more likely to be older, and cohabiting with a partner in the case of women.

Among 16 to 44 year olds who reported unsafe sex in the past year, around half, 50% of men and 54% of women, would seek diagnosis and/or treatment from a GP if they thought they might have an STI. There was a difference in preferences according to past sexual health services attendance. Of those who had never attended sexual health services, 65% of men and 77% of women would seek treatment from a GP; while those with previous attendance, 75% of men and 77% of women, would return to sexual health services to seek treatment.

This study provides valuable information about the potential unmet need for STI testing and treatment, particularly as much of the research on sexual health service use has been based on attenders. The authors point out that some people reporting potential sexual risk behaviours expressed a preference for GP care.

This is a message for primary care teams to be prepared for more STI testing. While this might improve access to STI testing, it must be accompanied by robust treatment and referral pathways, including partner notification.

‘Given that non-attenders reporting risk behaviours expressed preference for GP care, this may be an avenue for improving access to STI testing. However, this must be alongside improved referral from GP to more specialist services for patients with more complex needs to ensure they receive a more comprehensive package of care, including partner notification,’ they caution.

Dr Richard Ma

Tanton C, Geary RS, Clifton S et al. Sexual health clinic attendance and non-attendance in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) Sex Transm Infect 2018;94:267-75