Sexually transmitted infections (STIs): migrant health guide
Source: gov.uk (2025-03-10)

Advice and guidance on the health needs of migrant patients for healthcare practitioners.

Main messages

A sexual history is an important part of an overall health assessment.

Although sexually transmitted infections (STIs) can be asymptomatic, they can have serious health consequences.

Offer a full sexual health screen to all sexually active people with a recent history of condomless sex with new or casual partners.

Investigate all people with symptoms of an STI promptly; give a full sexual health screen, and manage appropriately.

Where more specialist STI services are required, refer patients to the local GUM clinic.

Screen all sexually active women under the age of 25 for chlamydia (https://www.gov.uk/government/publications/ncsp-programme-overview/ncsp-programme-overview) annually, and/or whenever they change sexual partners, irrespective of symptoms or country of origin.

Address sexual health promotion with all sexually active people, providing:
- advice about safer sex and contraception for both men and women
- information about cervical screening for women (https://www.gov.uk/guidance/womens-health-migrant-health-guide)
Include sexual health promotion as part of a pre-travel health consultation for all sexually active travellers.

Prevention and control of STIs helps reduce the spread of HIV (https://www.gov.uk/guidance/hiv-migrant-health-guide).

Ensure that individuals are brought up-to-date with the UK immunisation schedule (https://www.gov.uk/government/publications/the-complete-routine-immunisation-schedule) recommendations, including offering girls and boys up to 25 years-old immunisation against human papillomavirus (HPV) (https://www.nhs.uk/conditions/vaccinations/hpv-human-papillomavirus-vaccine/).

Under the National Health Service (Charges to Overseas Visitors) Regulations 2015 (http://www.legislation.gov.uk/uksi/2015/238/introduction/made) the following are exempt from charge:
- diagnosis and treatment for STIs
- testing for HIV and associated pre-and post-test counselling
- HIV treatment (https://www.gov.uk/government/publications/hiv-treatment-for-overseas-visitors-in-england-from-1-october-2012)
Background

STIs are infections that are spread primarily through person-to-person sexual contact. There are more than 30 different sexually transmissible bacteria, viruses and parasites. Many STIs can also be transmitted from mother to child during pregnancy and childbirth.

According to the World Health Organization (https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis)), throughout the world:
- more than 1 million people acquire an STI every day
- there are 374 million new cases of curable STIs (syphilis, gonorrhoea, chlamydia and trichomoniasis) that occur annually
STIs can have serious health consequences beyond the immediate impact of the infection itself.

Prevention and control of STIs help reduce the spread of HIV (https://www.gov.uk/guidance/hiv-migrant-health-guide).

The range of STIs that occur commonly varies between different countries. Non-UK born patients may present in the UK with STIs that are less commonly seen here.

Acquisition of STIs may occur prior to arrival in the UK, but may also occur after arrival. Sexual health promotion is important to address with all sexually active people, and should include both safer sex and contraceptive advice. See the ‘Health promotion for sexual and reproductive health and HIV strategic action plan, 2016 to 2019’ (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/488090/SRHandHIVStrategicPlan_211215.pdf) (PDF, 694KB) and guidance based on applying All Our Health (https://www.gov.uk/government/publications/sexual-and-reproductive-health-and-hiv-applying-all-our-health).

Bacteria

The most common sexually transmitted bacteria are:
- Neisseria gonorrhoeae (https://www.gov.uk/government/collections/gonorrhoea-neisseria-gonorrhoeae-guidance-data-and-analysis): which causes gonorrhoea or gonococcal infection
- Chlamydia trachomatis (https://www.gov.uk/government/collections/chlamydia-surveillance-data-screening-and-management): which causes chlamydial infections, including lymphogranuloma venereum
- Treponema pallidum: which causes syphilis (https://www.gov.uk/government/collections/syphilis-surveillance-data-and-management)
Viruses

Sexually transmitted viruses include:
- human immunodeficiency virus (HIV) (https://www.gov.uk/guidance/hiv-migrant-health-guide): causes AIDS
- herpes simplex virus (https://www.gov.uk/guidance/genital-herpes) types 1 and 2: cause genital herpes
- human papillomavirus (https://www.gov.uk/government/collections/genital-warts-and-human-papillomavirus-hpv-guidance-data-and-analysis): causes genital warts and certain subtypes lead to cervical cancer in women
- hepatitis B virus (https://www.gov.uk/guidance/hepatitis-b-migrant-health-guide): causes hepatitis and chronic cases may lead to cancer of the liver
- human T-cell lymphotropic virus (https://www.gov.uk/guidance/human-t-cell-lymphotropic-virus-htlv-types-1-and-2) types 1 and 2 (HTLV-1 and HTLV-2): approximately 5 to 10% of people with HTLV-1 will develop a recognised associated clinical condition such as adult T-cell leukaemia/lymphoma or HTLV-1 associated myelopathy (also known as tropical spastic paraparesis)
Parasites

The most common sexually transmitted parasite is Trichomonas vaginalis, which causes vaginal trichomoniasis (https://www.nhs.uk/conditions/trichomoniasis/).

Diagnosis and treatment for STIs is exempt from charge under the National Health Service (Charges to Overseas Visitors) Regulations 2015 (http://www.legislation.gov.uk/uksi/2015/238/introduction/made).

Testing for HIV, associated pre-and post- test counselling and treatment are also exempt under these regulations.

Symptoms

The main symptoms associated with STIs (https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/) are:
- urethral discharge
- genital ulcers, blisters or sores
- vaginal discharge or bleeding
- lower abdominal pain
- neonatal eye infections (conjunctivitis of the newborn)
- rash
- itching
- pain when urinating
Sexually transmitted infections can often be present without symptoms. For example, up to 50% of women and 10% of men don’t experience any symptoms of gonorrhoea. Most people do not experience symptoms of chlamydia. Even asymptomatic infections can however lead to the development of serious complications (https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis)).

Complications include chronic infection, and serious delayed consequences such as:
- infertility
- ectopic pregnancy
- cervical cancer in women
- pelvic inflammatory disease (PID) in women
- congenital infections (for example, syphilis)
- adverse pregnancy outcomes
- the untimely death of infants and adults
Testing and treatment

In the UK, STIs are typically diagnosed and treated through sexual health services, which are able to offer comprehensive screening and treatment for a wide range of diseases, partner notification, and sexual health promotion services.

An increasing number of services offering STI diagnosis and care are being commissioned in other community-based settings, including general practice and contraceptive services. This includes services offering access to chlamydia testing through the National Chlamydia Screening Programme (NCSP) (https://www.gov.uk/government/collections/national-chlamydia-screening-programme-ncsp).

All services offering STI management are expected to follow Standards for the management of sexually transmitted infections (STIs) (https://www.bashh.org/about-bashh/publications/standards-for-the-management-of-stis/) developed by the British Association for Sexual Health and HIV (BASHH). Further guidance on surveillance, data, screening and management (https://www.gov.uk/government/collections/sexually-transmitted-infections-stis-surveillance-data-screening-and-management#management) is also available

However, where more specialist STI services are required, referral to the local sexual health service is the preferred option.

Primary care practitioners should be aware that:
- a sexual history is an important part of an overall health assessment
- sexually active people who are from countries with an HIV rate of 1% or less (https://www.unaids.org/en/resources/documents/2024/HIV_estimates_with_uncertainty_bounds_1990-present) should be offered sexual health screening as appropriate for their sexual history
- all sexually active people with a recent history of condomless sex with new or casual partners should be offered a full sexual health screen
- people from countries where HTLV-1/-2 is endemic should be considered for HTLV testing (https://www.gov.uk/guidance/human-t-cell-lymphotropic-virus-htlv-types-1-and-2#diagnosis)
- all sexually active people under the age of 25 should be screened for chlamydia (https://www.gov.uk/government/publications/ncsp-programme-overview/ncsp-programme-overview) on an annual basis and/or whenever they change sexual partners, irrespective of country of origin
- symptomatic patients should be promptly investigated, treated and managed
Find your local sexual health service (https://www.nhs.uk/service-search/sexual-health/find-a-sexual-health-clinic) by postcode.

Guidelines on testing and management of a range of sexually transmitted infections, and other sexual health issues, are available from BASHH (https://www.bashh.org/guidelines).

Prevention and control

Prevention and control of STIs rely on:
- safer sexual practices such as condom use
- prompt diagnosis and treatment of disease
- partner notification
- vaccination (for people meeting relevant eligibility criteria for vaccination; for example, for HPV, HepA, HepB or mpox)
Sexual health promotion is important to address with all sexually active people and primary care practitioners have an important role to play in conveying appropriate sexual health messages to different people at risk of STIs.

Investigate and treat symptomatic patients promptly. Partner notification (https://www.nice.org.uk/guidance/qs178/chapter/Quality-statement-6-Partner-notification) is a routine part of sexual health service practice to limit further spread of disease.

For further information on STIs, see Sexually transmitted infections (STIs): surveillance, data, screening and management (https://www.gov.uk/government/collections/sexually-transmitted-infections-stis-surveillance-data-screening-and-management), which includes statistics on new diagnosis of STIs in England by world region of birth (https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables).

Resources

The National Chlamydia Screening Programme has produced a patient information leaflet (https://www.gov.uk/government/publications/ncsp-patient-information-leaflets).

Human papillomavirus (HPV) vaccination: A guide to immunisation for teenagers and young people (https://eur01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fassets.publishing.service.gov.uk%2Fmedia%2F66953aa349b9c0597fdafd31%2FUKHSA_12962_young_people_immunisation_2024.pdf&data=05%7C02%7CHamish.Mohammed%40ukhsa.gov.uk%7C63522e81ead047ab611d08dd1dce677d%7Cee4e14994a354b2ead475f3cf9de8666%7C0%7C0%7C638699494508385931%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=mNT04OyIRpC1PzPUoHFVH1SLltduxsHFHvw4WVIdIKY%3D&reserved=0).

The Green Book (https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book) has the latest information on vaccines and vaccination procedures, for vaccine preventable infectious diseases in the UK.

The National Travel Health Network and Centre (NaTHNaC) has produced advice on:sexually transmitted infections and travel (https://travelhealthpro.org.uk/factsheet/15/sexually-transmitted-infections).

The Zanzu website (https://www.zanzu.de/en) provides simple information on contraception, sexually transmitted infections, pregnancy, relationships and sexuality in Albanian, Arabic, Bulgarian, Dutch, English, French, German, Persian, Polish, Romanian, Russian, Spanish, Turkish and Ukrainian.

Country-level data on contraception use is available from the World Health Organization (https://www.who.int/).