STI cases soar as partners take risks

PEOPLE take more risks, have more partners, drink more — and, from an earlier age indulge in more sexual contact, often without protection.

So it comes as little surprise that sexually transmitted diseases are on the rise — and that, according to experts, casual attitudes to sex are making young people particularly vulnerable.

About 60% of all new STI cases occur in the 20 to 29 age group, while a quarter of early cases of syphilis were among people aged 25 to 29, according to figures from the Health Protection Surveillance Agency.

Even the period between June and September 2012 saw an increase in the incidence of conditions like chlamydia in the 20-29 age group (from 776 cases to 914) and in gonorrhoea (from 148 to 165).

A casual, even careless attitude to sex is often the reason for infection.

Attitudes to the risk of infection and to sex can vary hugely from one person to the next, according to Dr Derek Freedman, a specialist in sexually transmitted infection.

“Sometimes a person who has taken only one risk is frightened silly by it — but we often see people who have had sex with multiple contacts on a regular basis.

“They see it ‘as part of life’, and they don’t seek help until they have symptoms — by which time they may have spread the infection within themselves and to others.”

Sexually transmitted infection, he warns, “is the gift which keeps on giving”.

The period between 2010 and 2011 alone saw an increase of more than 12% in STIs as a whole, with a jump of more than a third in gonorrhoea cases and a steady increase in genital herpes. Chlamydia is the most common sexually transmitted disease, accounting for nearly 50% of cases.

There are several reasons for this which can be categorised under changes in social trends and attitudes, according to Dr Freedman.

Altered social patterns have seen many young people postpone marriage until later in life, which means that young people now tend to have far more sexual partners than their parents or grandparents.

Add to that the growing number of separations among married couples. “People generally are spending more of their lives as ‘singletons’ than before,” he said.

People are also starting to have sexual intercourse earlier, both in terms of age — Freedman says he’s treated patients as young as 14 — and in terms of at what stage a relationship becomes sexual.

Sometimes, those who are living the life of a singleton get ‘hungry’ for sex, he says, and will have what he calls “a casual event” or casual sexual intercourse, often when their inhibitions are reduced by alcohol or drugs.

Things have changed in the last few years, agrees Professor Mary Horgan consultant in infectious diseases at the STI clinics at Cork’s South Infirmary Victoria Hospital, which sees about 8,300 people annually and receives about 3,000 calls per month.

“The scene out there is very different now. People take more risks, have more partners and drink more and from an earlier age, indulging in more risky behaviour without protection.

“I think people think it won’t happen to them, and they’re not well educated in the physical and psychological effects — and don’t use protection.

“On the ground we’re very busy — people are coming to be screened because they’re starting a new relationship, or have symptoms or are concerned after a one-night stand,” she says, adding that about 50% of the clinics patients are between the ages of 18 and 25.

“The two big infections we consistently see are genital warts and chlamydia in males and females, predominantly in young people.”

The attitude, says Horgan, is that “everyone’s doing it and I’m no different”, but, she says, people often don’t realise the risk they’re taking.

“Although the staff are very reassuring and friendly and it’s a nice place, this is something people only want to do once.”

There’s been an increase in the attendance of people in second relationships, she says.

“They may have separated or divorced and gone on to a new relationship or plan on one and want to get screened before they go into it — in between relationships they have may have been having unprotected sex.”

That’s partly because people in their 40s and 50s may not have received the same level of information about STIs and STI prevention as today’s young people — and so they can contract an infection between relationships.

Sexually transmitted disease is not unknown in the elderly sector of the community either, says Freedman. He points to the United States where a large increase in the incidence of sexually transmitted disease has been reported among the geriatric community in retirement homes where there is a lot of social activity.

It’s believed that the increased use of drugs by older men seeking to reverse erectile dysfunction may be having an unexpected side effect.

Horgan doesn’t believe this is a major issue in Ireland — while some older people have reported STIs, she says, generally they’d be in the minority. “This is a group which would still be conservative and frown on casual sex — they would tend not to have a whole lot of different partners.”

The overall rise in STI diagnoses can also be attributed to improved screening and more modern, sophisticated and sensitive testing for sexually transmitted disease means more cases are identified.

“We now have more sensitive testing systems so our detection rate for gonorrhoea, chlamydia and herpes has dramatically increased,” says Freedom.

On top of that, he says, it’s now acknowledged that sex can be a “multi-site” activity, involving both anal and oral, as well as genital sex. “We’re discovering more infection by testing these sites,” he says, warning that anyone who is being screened for sexually transmitted infections should tell their doctor if they are having oral or anal sex.

Hand in hand with all of this is a worrying reduction in the levels of fear and inhibition about sexually transmitted infections, says Freedman — “often among people who we think should know better.

“We are seeing an outbreak of syphilis, gonorrhoea and lymphogranuloma venereum in men who have sex with men. Unprotected sex is too common, and gives the risk of HIV acquisition,” he warns.

Anyone who feels they may be at risk should be screened, says Freedman.

“The most common infections in this country are genital warts, urethritis, gonorrhoea, chlamydia and herpes. These infections are extremely silent. Just because you have no signs or symptoms or complaint does not mean that you do not have an infection. The only way you can detect an infection is by having the full set of screening tests from all sites involved, with microscopy of the secretions.”

Women and men are equally vulnerable, he warns. While chlamydia was more frequently reported among women (53.8%) than men (43.1%) in 2011, men account for far more cases of syphilis, gonorrhoea, and ano-genital warts than women.

While women attend clinics for family planning reasons and for cervical smears, and so are more likely to have a test for chlamydia, often they may not have the tests required to rule out other infections, he says.

“However women are more health conscious and more likely to attend for advice, whereas men are known to be not as likely to look after themselves so well.”

What we need to do is prioritise the idea of ‘quality sex’, says Freedman. “That is, sex with somebody you know, somebody with whom you get on well with, somebody whose mobile number you have and somebody you have breakfast with the next morning. Make something of it, don’t make sex a fast food outlet.

* For more information visit www.hpsc.ie