Local NHS organisations in England have an "alarming lack of planning" on improving sexual health, charities say.
A quarter of trusts did not mention improving access to chlamydia screening
Campaigners say this is despite £250m being provided by the government.
A review by a number of sexual health groups of 44 primary care trusts (PCTs) said up to a half did not mention key sexual health targets in their plans.
PCTs said they were being forced to make difficult choices between investing in deserving services and balancing the books.
The UK has among the worst sexual health in Western Europe and the highest teenage pregnancy rates.
Leading sexual health charities Brook, the Family Planning Association and the Terrence Higgins Trust, the Medical Foundation for Aids and Sexual Health (MedFASH) and the National Aids Trust reviewed the Local Delivery Plans of 44 PCTs across England, looking at provision for improving sexual health services.
Only 30% examined mentioned targeted planned investment in sexual health.
The report also found only 52% of plans mentioned abortion services, more than 50% of trusts failed to mention HIV, while almost 50% did not mention planned work on reducing gonorrhoea.
Over 40% failed to mention tackling sexually transmitted infections (STIs) in general, while the same proportion did not look at contraception services.
And a quarter of PCTs did not mention increasing uptake of chlamydia screening among 15 to 24-year-olds.
New diagnoses of the STI increased by 223% between 1995 and 2004, with one in 10 sexually active young people estimated to be infected.
The charities called for the Department of Health and the NHS to make sexual health improvement a top priority.
Anne Weyman, chief executive of the Family Planning Association, said: "Sexual health remains too far down the list of local health priorities and is overshadowed by the pressure on PCTs to achieve financial balance."
James Johnson, chairman of the British Medical Association, said: "It is appalling that sexual health services are actually getting worse, despite clinicians' best efforts to deal with patient demand.
"This report shows that despite government pledges, targets and extra resources, PCTs in England appear to have plans to use funds allocated for sexual health to balance their books in other areas."
He added: "Primary care trusts need to get their act together and make plans to increase sexual health services in their areas."
Dr Nicholas Hicks, of the NHS Alliance, which represents PCTs, said: "Sexual health is a priority, and has been a Cinderella service for too long.
"But, across the country, it's well known that many parts of the health service are struggling to make finances balance - and the Department of Health is looking to the NHS to solve long-term financial problems but in a short space of time.
"That means parts of the NHS are having to make difficult decisions about reducing existing services or investing in new ones."
However a Department of Health spokesperson said: "The record amount of funding invested in sexual health clearly proves it is a key priority for government."