Clinics have been swamped by visits

Sexual health is one of the issues covered in the document.

What does the government plan to do?

• There will be a new national campaign targeted on those at greatest risk of catching a sexually transmitted infection or having an unplanned pregnancy.

• By 2008, everyone referred to a Genito Urinary Medicine clinic should have an appointment within 48 hours.

• Chlamydia screening will be rolled out across England by 2007.

What are the health risks?

The major STIs include HIV/Aids, gonorrhoea, syphilis, chlamydia, genital herpes and genital warts.

The consequences of infection range from death to minor discomfort.

THE MAJOR STIs HIV and Aids - caused by a retrovirus that attacks the immune system. At that severe stage of infection the person is often diagnosed as having Aids Chlamydia - generally symptom free bacterial infection that is a significant cause of infertility Gonorrhoea - caused by a bacterium. Can be symptom free or cause discharge from the penis/vagina Syphilis- caused by the bacteria-like spirochete Treponema pallidum. Symptoms can be vague. It can cause miscarriage in pregnant women Genital warts - found on or around the penis, anus or vagina, caused by certain types of the human papillomavirus Genital herpes - a common ulcerative STI caused by herpes simplex virus

Some are curable, but with others it is only possible to treat the symptoms and infection can return.

HIV is a serious infection. Without treatment most people are expected to die from their infection.

Syphilis can cause miscarriage, still birth or foetal abnormality, while chlamydia and gonorrhoea can leave a woman infertile.

The majority of people with genital herpes or warts experience mild and infrequent symptoms.

Genital warts are a serious health concern as certain strains of the virus causing this STI have been associated with cervical cancer.

How many people are affected?

At the end of 2002, UNAIDS estimated that 42 million people worldwide were living with HIV/AIDS.

In the UK, the estimated overall prevalence of HIV infection in adults increased over 12 months by 20%, so that by the end of 2002 there were an estimated 49,500 people living with HIV in the country.

At the end of 2001, chlamydia was the most diagnosed sexually transmitted infection in the UK.

Last year, 708,083 people in England, Wales and Northern Ireland were diagnosed with an STI.

Marked geographic variations in disease occurrence exist, with a concentration of the HIV and STI epidemics in Greater London.

Is it getting worse?

Between 2002 and 2003, new episodes of STIs seen in genitourinary medicine (GUM) clinics in England, Wales and Northern Ireland increased from 1,546,812 to 2,125,243.

Individually:

• Genital chlamydial infection increased by 9%
• Syphilis increased by 28%
• Gonorrhoea decreased by 3%
• Genital herpes simplex infection decreased by 2%
• Genital warts increased by 2%
• Diagnoses increased by 4%
• Workload increased by 63%

The statistics were provided by the Health Protection Agency.

What did campaigners want?

The British Medical Association, the Family Planning Association and the Terrence Higgins Trusts say ministers should add sexual health to the key performance goals against which Primary Care Trusts and GPs are inspected and financially incentivised.

They say more GUM facilities that are geographically accessible are urgently required, with longer opening hours, more trained staff and increased funding.

RECOMMENDATIONS Shake-up of GUM services Safe sex education Targets and incentives for GPs and Primary Care Trusts Over-the-counter testing kits

They would like to see a target of 48 hours maximum wait to be seen at these clinics for urgent cases.

The BMA is calling for investment in sexual health and provide services that young people feel comfortable using - including sex education in schools and access to community family planning clinics.

It also recommends that the British Broadcasting Standards Commission conducts a survey of popular television programmes aimed at teenagers which have a sexual content to ascertain how frequently the risks of STIs and family planning issues are raised.

General practitioners and other health professionals working in the field of sexual health should receive more training about the diagnosis and management of STIs, it says.

The Family Planning Association recommends better integration of sexual health services, including greater integration between contraceptive and abortion services at the funding and commissioning level.

The Terrence Higgins Trust believes HIV and STI testing kits should be available to buy 'over the counter' at community pharmacy services and other outlets.

The Independent Advisory Group for Sexual Health and HIV, which was set up to advise the government, recommends increasing availability of free condoms through the NHS and removing VAT on all over the counter contraceptives.

It would like HIV tests to be offered routinely to people attending GUM clinics and tailored sexual health services for ethnic minority groups.