One of the curious aspects of human behaviour has been to observe how easy it is to create panic in the population. For the past two years Bird Flu has been in the headlines and has driven many patients to us in search of treatment, yet not a single person in the UK has ever been infected with Bird Flu.
This contrasts with the ostrich “head in the sand” approach that most people take to sexually transmitted diseases or infections (STD’s, STI’s). While epidemics of chlamydia, herpes, genital warts, gonorrhoea, syphilis, nsu and ureaplasma are rife, no-one seems to know about this or discuss prevention or treatment. Indeed many clinics do not test for ureaplasma although we have seen it cause may symptoms such as discharge and infertility.
There is such a range of STD’s and STI’s that anyone having unprotected sex with one new partner per annum is guaranteed to catch an infection even though they may not be considered promiscuous.
More worrying is the beginning of a heterosexual spread of HIV which is also now observed in the UK.
People starting new relationships often attend sexual health clinics with their partners for screening prior to having unprotected sex. Using condoms is strongly advised if you do not know the sexual health status of your partner, however two factors have increased the risk of spreading STD’s in the UK.
Firstly there has been an increase in the number of men seeing sex workers and having unprotected oral sex which can transmit infections. Secondly, the rise in alcohol consumption has fuelled the incidence of unplanned spontaneous casual sex which is usually unprotected.
There has also been a rise in opportunistic STD's infections. Molluscum contagiosum used to be a mild warty viral disease affecting children, but has now become an STD which although not serious, can take many months to disappear. Candida haemophilus and streptococci are not, strictly speaking, sexually transmitted, but there is an increase in these infections in those exposed to new partners especially if no condom was used.
If someone believes they may be infected it is vital for them to be tested rapidly, in order to reduce spread to new partners. It is also important to treat infections at first suspicion and to organise contact tracing so that partners may be treated too. There is no point in treating someone with chlamydia only for them to be re-infected by the person who gave it to them in the first place.
There are several types of HIV test which may be offered. The HIV1 and 2 antibody test can be performed using instant technology 28 days after contact. These results are available in 60 seconds and are highly accurate. Further accuracy may be obtained by adding the measurement of p24 antigen in the DUO test which also tests for HIV 1 and 2 antibodies. Results from the DUO test are available in 2-3 hours by telephone.
HIV1 antigen can be tested 10-14 days after contact using a PCR proviral DNA test, but the results often take a few days to come through.
Sexual health testing often creates fear – many men still believe the urban myth that an umbrella type device is inserted into the urethra. In fact testing for Chlamydia, gonorrhoea and NSU may be carried out on urine samples in men and women-normally patients are asked not to pass urine for 2 hours prior to testing.
Confidentiality is another issue that creates anxiety and the proposed NHS computer system has made many people aware that they do not want STD testing and the results on their personal medical records. Specialist sexual health clinics such as samedaydoctor will accept patients under pseudonyms and their records are not shared with any central database.
Facing these challenges a new beginning is needed to publicise the risks of sexually transmitted infections, and to promote better sexual health awareness. This should include better and faster access to confidential STD testing and earlier treatment of existing diseases. A widespread prevention programme that encourages the use of condoms is essential if we are going to turn the tide on the epidemic of sexually transmitted diseases.