The Fabulous Pharmacist: STIs are like any other infection — it's vital we reduce the shame

Our guest columnist Laura Dowling shines a spotlight on sexually transmitted infections and explains why people need to test themselves regularly

Laura Dowling. Picture: Moya Nolan

With sexually transmitted infections on the rise in Ireland, it’s time to get real about testing, especially when new easy, free and discreet services are available.

Figures from the Health Protection Surveillance Centre show that chlamydia, gonorrhoea, and genital herpes were the most prevalent infections in 2023.

In total, 22,730 sexually transmitted infections were recorded, a rise of 29% (5,135) from the previous year’s figures. Chlamydia cases increased by 24% year on year. Gonorrhea cases jumped 67% on 2022 figures, while 1,615 cases of genital herpes were notified to the HPSC.

Some 70% of STIs remain asymptomatic (show no symptoms), so not only might you not think you have an STI, but you might be unknowingly transmitting it.

Screening

SH:24 is a free online sexual health service in partnership with the HSE and the NHS in Britain. It offers testing for the four most common sexually transmitted infections (STIs): Chlamydia, gonorrhoea, HIV, syphilis and hep B and C. Quick and confidential, it provides test kits, information and advice 24 hours a day.

Order an STI kit online and it will be delivered to your door by post. Blood is collected by fingerprick, using the lancet provided and, depending on gender and sexual orientation, urine samples and swabs of the vagina, rectum and throat are self-taken to test for chlamydia and gonorrhoea. Then, you return the samples by Freepost, and SH:24 will text you the results. It’s generally very fast, but the best part is that it removes any potential embarrassment or shame we shouldn’t be feeling.

We need to change the mindset that picking up an infection from having sex is somehow shameful. This way, people will seek help sooner, and there will be less chance of transmitting these infections to others.

Untreated infection

Chlamydia is often asymptomatic, but if left untreated, it can cause pelvic inflammatory disease (PID) and sometimes infertility in women. Repeated infection is also a risk factor for infertility (but the percentage of people affected is not clear). It is critical people get treated if they have an infection.

Protection

The message I’d like you to take away from my column today is to test, test, test.

Of course, using condoms is very important, but unfortunately, people do not use them as often as they should. Regardless of condom use for penetrative sex, couples also need to use them for oral sex. Remember, you can get infections in your mouth, throat or eyes. It’s not just in the genitals.

Treatment is usually straightforward: a shot or a course of antibiotics.

People should always test between partners, as many STIs don’t have obvious symptoms. The guidance on high-risk individuals is to test every three months.

Be mindful that there is a window between exposure to the infection and the time you can tell the test is a true negative. It’s two weeks for chlamydia and gonorrhoea, six weeks for HIV, and 12 weeks for syphilis. You can, of course, test earlier than this if you have any concerns or symptoms. Anyone thought to be ‘at risk’ would be advised to test again at six and 12 weeks if they get a negative test.

HIV

According to the HPSC 2023 figures, other infections to see jumps in Ireland include lymphogranuloma venereum (up 30.77% year on year) and syphilis (up 8.08% year on year), while HIV notifications have risen by 9%, from 814 to 888. (HIV notifications in the report represent the first time each individual has a positive HIV test in Ireland.)

There’s often a misconception that only gbMSM (gay and bisexual men who have sex with men) get HIV, but it’s also on the increase in the heterosexual community.

PrEP is a medication for people who don’t have HIV but who are at risk of getting it. It can reduce the risk of getting HIV from sex by about 99%.

PEP is a short course of medicine for those who have possibly been exposed to HIV and is only for emergencies. PEP must be started within 72 hours after a possible exposure to HIV

HPV

HPV, or human papillomavirus, is a group of more than 100 viruses. It’s responsible for one in 20 cancers worldwide.

Most people will be infected with a form of HPV in their lifetime. The infection is transmitted sexually, including orally and digitally.

The majority of HPV infections do not need treatment because our bodies clear the virus. But in some people, the presence of HPV drives cancer of the cervix, anus and head and as well as causing genital warts.

Cervical screening now tests for HPV and if the test is positive, the cells are checked.

Many women can feel shame when diagnosed as HPV-positive and feel quite anxious about it. (Men feel anxious too, of course.)

We now have a vaccine that targets the oncogenic subtypes of HPV (nine types in all) with the added benefit of reducing the incidence of genital warts.

HPV is not included in the SH:24 test.

End the shame

An STI is like any other infection, only that it’s in your genitals or your throat. It is vital that we try to reduce the shame surrounding these infections.

We live in a world where there is so much exposure to sex. Yet, there is still a huge stigma associated with having an STI. But times have changed, and we have lots of knowledge and education.

If you are experiencing pain, bleeding, discharge, foul-smelling discharge from the penis or vagina, or are feeling uncomfortable, it’s best to get checked out. And if you’ve engaged in unprotected sex, it’s worthwhile getting tested, especially now it’s free, quick and discreet.