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Lets talk about sex

We can buy sex toys on the high street and slip away for 'dirty weekends' where chocolate-dipped strawberries await us in the hotel room. The techno-age has introduced the word 'sexting' into the common vernacular, while the era of sexual liberation has given us phrases such as 'booty call' and 'friend with benefits'.

And yet open and frank conversation about sexually transmitted infections (STIs) for some is strictly verboten, even with our closest friends. I've never met anyone who's contracted an STI, a curious fact which says more about the embarrassment factor that goes hand-in-hand with STIs, than the seemingly puritanical people I keep company with.

Consider the lack of STI-led storylines in sitcom Sex and the City, despite the sexual adventuring of its lead women. Ask yourself how many times conversation has turned to STIs during your history of one-night stands.

In researching this feature, I visited the Department of the Genito-Urinary Medicine and Infectious Disease (GUIDE) Clinic, a sexual health centre at St James's Hospital. A couple passed through the doors alongside me as I was leaving. Talk about not talking to anyone about it; this couple could barely talk to each other. The few muffled words they did exchange were preceded by a cursory look over their shoulders to see if I was within their hearing distance.

A colleague, meanwhile, couldn't discuss the feature on the phone, preferring to use email to conceal his obvious embarrassment. STIs are the last taboo.

There is a stigma attached to STIs in Ireland, which has led to us shying away from regular check-ups, and being red-faced in the instance of testing positive.

"The first myth is that it is something awful, horrible, anti-social and something someone should feel ashamed of," says STI specialist, Dr Derek Freedman. "Really, it's a sports injury.

"People play tennis and get tennis elbow; people ski and twist their knees. You have sex, you might catch an infection.

"And I see that people suffer much more from the stigma, or what they perceive as a stigma, than from the actual infection itself.

"We recommend that someone who has an infection talks about it with friends. They shouldn't be afraid. If someone talks about warts, someone else should say, 'Yes, I had them two years ago and I got rid of them'."

Stigmas are often borne of ignorance, of course, and there is a collective vagueness about STIs in Ireland.

Often, there's an assumption that most STIs are systemic; that others are untreatable. Other infections are stigmatised simply because they sound awful.

Take genital warts. What many don't realise is that genital warts are a manifestation of particular strains of HPV (human papillomavirus); a virus that, according to Freedman, more than 90% of people will be in contact with by the age of 40.

"We'd be more worried about the 10% who have never caught it," he says. "Why? Because they may be socially dysfunctional and have not formed relationships in their lives."

HPV is also the virus that leads to cervical cancer, a cancer that is often stigmatised because of its flawed associations with casual sex.

The lack of education surrounding HPV is staggering. The fact is, you can have one partner in your entire lifetime and still contract a strain of HPV.

It shows the ignorance of those who claim the Gardasil vaccine promotes promiscuity, the subtext being 'that only bad girls get cervical cancer'.

Another myth that needs to be debunked is the misconception that all STIs present symptoms. In fact, the most common STIs in Ireland are the most inconspicuous. You can be infected with HPV, chlamydia and gonorrhoea, and show no symptoms.

"With STIs, the big stumbling block is the appreciation that you can have an infection and show no signs or symptoms of it," explains Freedman.

"It is then a question of going to someone who can do a full screen. The treatment of all these conditions is very simple. Once treated, they can have no ill effects -- even the STIs that people dread are so easily managed."

Interestingly, while there has been a rise of STIs in Ireland in the past decade, there has been a slight reduction in the last couple of years.

"You've got to look at this in the background of an economic recession," explains Freedman. "You're going to get fewer parties, fewer golf trips, fewer stag parties, fewer promotional trips ...

"So, while there is still a consistent amount of infection out there, there's a lot more infection among friends, neighbours and acquaintances."

What is worrying, though, is the very recent rise in HIV/Aids among Irish people. "What is actually a little frightening today is we're seeing more HIV/Aids than ever before," Freedman says. "Even this year, I've seen three cases, in both heterosexual people and homosexual people, and all of them Irish.

"There are a lot of people being careless about their sexual practices. People are dropping their guards for HIV.

"Today, what's regarded as the most important thing with HIV is that people get regularly tested, particularly after any risk, because it's in the first three to six months that you've got a higher viral load and it is most transmissible. There's emphasis in New York and San Francisco on early diagnosis, early recognition."

Today, the challenge is revising people's understandings of STIs and educating them on the importance of regular STI testing. According to Shirley McQuade, the medical director at the Well Woman Centre, it is thanks to the relatively recent national chlamydia campaign that young women are actively seeking chlamydia tests.

"There are a lot of posters and literature in colleges and on the backs of doors in nightclubs," she says. "If people do come in, the one infection they are particularly worried about is chlamydia, because there certainly is a lot of information about it."

Even so, there are still those who shirk STI screening until they show symptoms. The reasons are multi-fold: embarrassment, shame, finances ...

According to McQuade, even geography can play a part. "There is probably a bit of a divide between big urban centres and rural areas, where access to services is much more difficult.

"If you know your GP, it can be quite difficult because often they are a family friend. It's kind of difficult to go along to them and ask to be tested."

Our sexual health strategy is fundamentally flawed. We place prudishness in front of long-term health risks. We seek out a cure when we show symptoms, rather than reduce our chances of infection through prevention. We completely disregard the STIs that present no symptoms at all.

The message is to get tested whenever you have unprotected sex with someone who isn't a long-term partner. "Most people should get tested after they have taken a risk and people should be tested before they commence a relationship where they are going to go unprotected," says Freedman.

Even condoms do not completely eliminate risk, so single, sexually active people -- even those who consistently use condoms -- need to pencil in regular sexual health check-ups, too.

"Most people wouldn't think they're in a high-risk group," agrees McQuade. "As with everything: the mentality is that it'll happen to someone else; it'll never happen to me." HQ

FURTHER INFORMATION: The GUIDE Clinic specialises in the care of people with sexually transmitted infections (also called STI, or STDs), HIV and general infectious diseases (ID). The service is confidential and free of charge.

GUIDE Clinic, St James's Hospital, James's Street, Dublin. Tel (01) 416 23 15/6; www.guide2guide.ie

Common STI's

>> CHLAMYDIA Known as the “silent killer”, as it often presents no symptoms. Chlamydia is a bacterial infection that can be successfully treated with antibiotics. Early treatment is essential, as it can cause pelvic inflammatory disease and infertility in women.

>> GONORRHEA Gonorrhea is another bacterial infection, slightly less common than chlamydia. It can be cleared with a course of antibiotics. It may present no symptoms, in particular with women, but some may experience pain when passing urine or the need to pass urine more often. Left untreated, it can cause infertility and if the infection is still active during childbirth, the child can experience severe eye problems.

>> GENITAL WARTS Grey, painless, flesh-coloured growths that appear on the penis, vagina or anus. They are part of the HPV (human papillomavirus) family and can be contracted from someone who appears to have no symptoms at all. They can be treated with prescribed lotions or creams and removed by cryosurgery (freezing) or laser surgery.

>> PUBIC LICE Black specks on the pubic hair that cause a severe itch in the genital area. The lice can be killed by lotion, available from the chemist. However, it’s also important to have a full STI screening.

>> SYPHILIS A bacterial infection that can be treated successfully with antibiotics. Early diagnosis is important; if left untreated it can lead to eventual damage of the vital organs. Initial symptoms usually appear after three weeks and may present themselves as painless ulcers (similar to a cold sore) on the genitals, mouth or anus, along with an enlargement of the local lymph nodes.

>> HEPATITIS The Hepatitis B and C viruses are spread through sexual contact or by exchange of bodily fluids with an infected person. Hepatitis A is classed as an STI because it can be passed on sexually, particularly during activities such as anilingus (rimming). Hepatitis affects the liver and blood. Common symptoms include flu-like illness, fever, jaundice, nausea and tiredness. You can protect yourself from Hepatitis B with a vaccination, which is advised if you are in one of the main-risk groups.

STI FAQ

Vital tips on testing at home and at recognised clinics

DOES AT-HOME STI TESTING WORK?

“Home-testing is useless and very dangerous,” says Dr Freedman. “The chlamydia test these companies are using is about half as sensitive as the ones we use. Attend a recognised clinic. There are 26 STIs. You need to be tested for all.”

SHOULD YOU ASSUME THAT THE CLINIC HAS TESTED FOR EVERYTHING?

Not all clinics and doctors offer the full range of STI tests. Ask exactly what they are testing for beforehand. It’s better to attend a clinic that specialises in STIs.

WILL THE CLINIC INFORM MY RECENT PARTNERS IF I TEST POSITIVE FOR AN STI?

Private clinics not connected to hospitals rely on their patients to tell partners. Hospitals work on contact tracing. It is up to the patient to disclose the contact details of their recent partner/s and the hospital notifies the person/people that they’ve been in contact with someone with an STI.

HOW OFTEN SHOULD A SINGLE, SEXUALLY ACTIVE PERSON HAVE AN STI TEST?

Whenever you are involved in anything that constitutes a risk. If you feel any anxiety, the only way you can alleviate it is by having a full screen.

CAN STIS BE SPREAD THROUGH ORAL SEX?

Yes. Many STIs can be spread through oral sex, in particular bacterial infections such as GONORRHEA and chlamydia, and viral infections such as warts. It’s very rare for HIV to be spread this way.