in england , surveillance for stis is conducted through mandatory reporting in sexual health clinics ( shcs ) ( genitourinary medicine [ gum ] and integrated gum / sexual and reproductive health clinics ) by using the gum clinic activity dataset version 2 ( gumcadv2 ) ( 3 ) . shcs provide free and open access services and , since 2012 , all ( 216 in 2014 ) have submitted data to public health england . although stis are not notifiable diseases in the united kingdom , gumcadv2 is a comprehensive , patient - level dataset of all attendances and laboratory - confirmed stis at shcs . information about the sexual orientation of each attendee is collected through gumcadv2 ( completion > 90% since 2011 ) ; this information was also collected by the preceding system , the kc60 aggregate return ( 3 ) . we reviewed the most recent gumcadv2 data , extracted on april 28 , 2015 , to assess trends in laboratory - confirmed gonorrhea , infectious ( primary / secondary / early latent ) syphilis , chlamydia , genital herpes ( first episode ) , and genital warts ( first episode ) . only 1 diagnosis of each sti was counted within a 6-week period ; this restriction also applies to instances of infection at multiple anatomic sites ( 3 ) . these data represent the number of diagnoses reported , not the number of persons in whom the infections were diagnosed . descriptive analyses by demographic characteristics and tests for linear trend were performed ; p values < 5% were considered significant . since 2013 , syphilis diagnoses among msm increased by 46% ( from 2,375 to 3,477 ) ; this increase is the largest year - on - year increase in syphilis diagnoses among msm since 2005 ( figure 1 ; table 1 ) . relative to 2013 , in 2014 the number of syphilis diagnoses among heterosexual men and men of unknown sexual orientation decreased by 0.2% ( from 578 to 577 ) , with a larger decrease in women ( 7.1% , from 283 to 263 ) ( table 1 ) . * genitourinary medicine ( gum ) and integrated gum / sexual and reproductive health clinics . in 2014 unknown sexual orientation figures for women who have sex with women are not reported here because in 2014 , homosexuality was reported for < 0.5% of women . msm , men who have sex with men ; non - msm men , heterosexual men and men of unknown sexual orientation ; sti , sexually transmitted infection . from 2013 to 2014 , diagnoses of gonorrhea among msm increased 32% ( from 13,629 to 18,029 ) ( figure 1 ; table 1 ) . although this increase was relatively large , it is consistent with the increasing trend from 2005 ( 3,817 diagnoses ; p = 0.015 ) . compared with the increased diagnoses in msm since 2013 , in 2014 the increases in gonorrhea diagnoses among heterosexual men and men of unknown sexual orientation ( 5.2% , from 8,122 to 8,546 ) and women ( 9.3% , from 7,664 to 8,379 ) were smaller ( table 1 ) . relative to 2013 , in 2014 , diagnoses further increased for chlamydia ( 25.8% ) , genital herpes ( 10.1% ) , and genital warts ( 9.5% ) among msm , consistent with the increasing trend since 2005 ( figure 1 ; table 1 ) . diagnoses of chlamydia decreased among heterosexual men and men of unknown sexual orientation ( 0.4% , from 44,512 to 44,339 ) and increased among women ( 4.9% , from 48,642 to 51,045 ) . genital herpes diagnoses decreased by 4.8% ( from 10,938 to 10,415 ) and 0.9% ( from 20,069 to 19,883 ) and genital warts by 5.2% ( from 37,872 to 35,893 ) and 4.8% ( from 32,834 to 31,251 ) among heterosexual men and men of unknown sexual orientation and among women , respectively . although the number of sexual health screen ( tests for chlamydia , gonorrhea , hiv , and syphilis ) among msm increased 29% from 2013 to 2014 , the rates ( diagnoses/1,000 screenings ) of syphilis and gonorrhea increased 13.8% ( from 20.9 to 23.8 ) and 2.9% ( from 120.2 to 123.6 ) , respectively . the rate ( diagnosis/1,000 screenings ) of chlamydia decreased 2.2% ( from 80.4 to 78.6 ) ( figure 2 ) , and the proportion of diagnoses of extragenital chlamydia and gonorrhea also decreased ( figure 2 ) . rate of diagnoses ( per 1,000 sexual health screens ) of chlamydia , gonorrhea , and syphilis ( primary , secondary , and early latent ) and proportion of extragenital chlamydia and gonorrhea diagnoses among men who have sex with men who attended sexual health clinics , england , 20092014 . surveillance codes for extragenital infections were introduced mid-2011 and are only available for chlamydia and gonorrhea diagnoses . in 2014 , the median age for msm in whom these stis were diagnosed ranged from 28 years ( genital warts ) to 36 years ( syphilis ) ( table 2 ) . more than three quarters of msm in whom stis were diagnosed were white , 60.3%71.4% were born in the united kingdom , and 12.6%18.4% were born in other european countries ( table 2 ) . msm in whom bacterial stis were diagnosed were more likely to be hiv positive and live in london than were msm in whom genital warts and herpes were diagnosed ( table 2 ) . * genitourinary medicine ( gum ) and integrated gum / sexual and reproductive health clinics . we report the continuing increase of diagnoses of all stis among msm , particularly for syphilis , for which the largest number of cases was recorded since 1994 . similar levels of syphilis diagnoses among men ( reporting for msm began in 1994 ) were last reported in the late 1970s and were followed by a precipitous decline after the emergence of hiv in the united kingdom in the 1980s ( 5 ) . in 2014 , most msm in whom stis were diagnosed lived in london , and an average of 16% were born in europe outside the united kingdom . given such a mobile population , the potential for spread of these infections to msm in other major cities is clear ( 6 ) . diagnoses of stis among hiv - positive msm since 2009 have steadily increased ; the sti rate is 24 times that among msm who are hiv negative or of unknown hiv status ( 7 ) . sex without condom use , associated with increasing hiv seroadaptive behaviors ( i.e. , seeking out partners according to their hiv serostatus for unprotected sex ) and use of geospatial social networking applications , may facilitate sti transmission in concentrated sexual networks ( 8,9 ) . given the risk for emergence of strains of neisseria gonorrhoeae that are resistant to first - line antimicrobial drugs ( 1 ) , the increase in gonorrhea diagnoses , especially among msm , is concerning . in response to gonorrhea testing guidance published in 2010 ( 10 ) , use of highly sensitive nucleic acid amplification tests for screening of extragenital sites in msm has occurred more frequently ( 11 ) ; this change may account for part of the increase in gonorrhea diagnoses in the earlier part of the decade . however , the most recent update contained no changes in syphilis testing guidelines ( 12 ) , so recent increases are unlikely to result from changes in testing practice . further , although more msm were tested for stis in 2014 compared with 2013 , the rate of chlamydia and gonorrhea diagnoses remained relatively stable , while that of syphilis increased . given the comprehensive coverage of national sti surveillance and that shcs in england are open access and free , most syphilis and gonorrhea cases are probably captured in gumcadv2 ( 13 ) . a key limitation of gumcadv2 is that it does not collect any behavioral data ; however , an enhancement to collect data on behavior , including recreational drug use and unprotected anal intercourse , is being piloted ( https://www.gov.uk/guidance/genitourinary-medicine-clinic-activity-dataset-gumcadv3-pilot ) . a focus on biomedical interventions , such as preexposure prophylaxis , for the control of hiv among msm may have unintended consequences for transmission of other stis , which highlights a need to ensure that robust sti prevention and control measures are in place ( 14 ) . these measures should include promoting condom use ; increased screening ( in the united kingdom , quarterly hiv / sti testing of msm who engage in condomless sex with new partners is recommended ) ; ensuring that services are easily accessible ; and promoting other risk reduction strategies to improve the health and well - being of msm ( 15 ) .
surveillance data from sexual health clinics indicate recent increases in sexually transmitted infections , particularly among men who have sex with men . 
 the largest annual increase in syphilis diagnoses in a decade was reported in 2014 . 
 less condom use may be the primary reason for these increases .