Ireland has always had a complicated relationship with sex.
Outside of the State, many people attend for screenings for sexually transmitted infections (STIs) annually, just like going for a checkup with a dentist or doctor.
However, Dr Aisling Loy, a consultant in sexual health in St James’s Hospital and Himerus Clinic in Dublin, believes there is a “hangover” of Catholic guilt that makes Irish people uncomfortable with the idea of regular testing.
“It’s seen as something shameful or dirty, or they’re embarrassed to be going to an STI clinic,” she says. “There is a perception that if you have an infection you’d know you had it or that you only screen if you thought you had an infection.
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“I was speaking to someone about this last week and she said she was so mortified that she was here in the clinic and she had had a baby. And I was like, ‘But why? You had a baby so people know you’ve had sex?’ Like why are people in a maternity hospital not ashamed and embarrassed because they’ve obviously had sex too? [Screening] is just admitting that you’ve had sex.”
Changing this view is important, according to Dr Loy, due to the increasing prevalence of some STIs in Ireland and around the world.
Although Ireland has committed to the World Health Organisation goals of reducing STIs and ending their epidemics as a public health concern by 2030, the Health Protection Surveillance Centre says we are not on track to achieve the targets.
There was an obvious issue in 2023, when there was a more than 30 per cent rise in infections. In 2024, however, things started to improve when it came to some of the most common types of infection.
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In the first 44 weeks of the year, chlamydia diagnoses were down 16 per cent on the same period in 2023, while gonorrhoea was down almost 14 per cent.
However, while some indicators were down in comparison to the previous year, others remain on an upward trajectory.
Syphilis cases have increased by more than 15 per cent, while cases of trichomoniasis, an uncommon STI, increased from 57 to 183 infections. The number of new HIV cases in Ireland increased last year, to 881 in most recent figures – up from 781 in the same period a year earlier.
Dr Loy says the rise in HIV cases is largely the result of people diagnosed with the disease moving to Ireland rather than an increased rate of HIV circulating in the community.
In 2021, the HSE partnered with a company called SH:24 to offer a pilot home STI testing service to people living in counties Cork, Kerry and Dublin. This had been extended nationwide by October 2022.
Figures from the HSE up to the end of last November show there were 117,155 home STI test kits ordered. Of these, 73 per cent have been returned to a lab and processed. The HSE says demand for the service is stable at between 10,000 and 12,000 orders per month. This, according to Dr Loy, is one a “multitude of things” feeding into the rise in STI diagnoses.
“I guess there’s more advertising with that,” she says. “People became more aware of how they should test but also they had better access to testing. Like any of these things, when you start testing you will have a spike because you’re driving out the infection.
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“Hopefully it’s like cracking an egg to make an omelette: you have to make a mess to start with and that’s finding all the infections, and then gradually over time, as you clear out infections, you will hopefully see a decrease in the population because you’re hopefully mopping up that infection that is there.”
The availability of pre-exposure prophylaxis (PreP) – a drug that prevents the transmission of HIV – has also had an impact, according to Dr Loy.
“You will have a lot of people deciding not to use condoms because the fear of HIV is gone. We know that condoms are the cornerstone to sexual health and sexual healthcare. If you throw away condoms then you will see an increase in infections,” she adds.
The popularity of dating apps makes sexual encounters more accessible for many, she says, while the anecdotal increased use of cocaine and alcohol all drive up the number of STIs, particularly among those under 30.
The rise, Dr Loy says, is not necessarily a bad thing. The more cases being detected that otherwise could have gone hidden, should mean a reduction in the number circulating in the community in the longer term. She says many of these infections can be asymptomatic and people may not realise they have an STI or are passing it on to someone else.
“It will take years to come down because you have to get rid of the underlying asymptomatic infection base, and as that happens over time there should be less and less infections, but it takes time for that to happen,” she adds.
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