Let’s talk about sexually transmitted infections

Irish people have become increasingly open about discussing their sex lives and contraception in recent decades. The average number of sexual partners people have during their life has also risen.

However, one area remains largely taboo – sexually transmitted infections (STIs). People are still reluctant to admit if they have ever had an STI or to ask their partner if they have ever been tested or diagnosed.

Medical professionals agree that Irish people need to be more aware of their sexual health, to get tested for STIs regularly if they are sexually active and to prevent infections by using condoms. Many STIs have few or no symptoms and, if left untreated, can cause long-term health problems as well as remaining infectious.

However, despite a steady rise in the number of STIs diagnosed annually during the past 20 years, a survey by insurer Aviva Health in 2013 found that 70 per cent of people surveyed had never had an STI test. More than half said they weren’t concerned about their sexual health.

A separate study by researchers in the Royal College of Surgeons in Ireland, National University of Ireland Galway and the HSE found that the most important barrier reported by young people to seeking or accepting an STI test was the stigma associated with STIs.

The fear of stigma was greater among young women, especially those from rural backgrounds and in urban working class settings, who feared the consequences of being publicly exposed through asking for a STI test.

Online tests

While the GP, hospital outpatient clinics or private sexual health centres are usually the main options for those wishing to have themselves tested for STIs in Ireland, online testing services are now available here. These services are becoming popular due to their easy accessibility and discretion.

LloydsOnlineDoctor, which provides a range of medical services through its website, says more than 1,500 people in Ireland have used its online home testing STI patient programme since it was launched here 18 months ago.

The online service tests for chlamydia, gonorrhoea and HIV and is provided in partnership with the Irish Family Planning Association (IFPA).

The technology for detecting STIs has improved significantly in recent years, making testing easier, faster and more accurate. Many tests now use a swab or urine test, which is ideal for online and home testing.

The LloydsOnlineDoctor website requires people interested in taking an STI test to fill out a questionnaire to assess whether the online service is right for them.

The website advises any individual experiencing severe pain from a suspected STI infection to visit a GP or IFPA clinic without delay.

Suitable applicants receive a test kit through the post, after which they send their completed sample directly to a laboratory for assessment. They are then notified of their results via a confidential online record. If someone tests positive for chlamydia or gonorrhoea, they are posted a prescription for the relevant treatment.

If someone tests positive for HIV they are contacted directly by one of the service’s doctors and advised to get a second test to be absolutely sure.

LloydsOnlineDoctor says its tests are as accurate as any test from a clinic (with respect to false negatives), and results are completely confidential.

Technology

Stephen Bourke, general manager of LloydsOnlineDoctor Ireland, tells

The Irish Times

that online medical services provide patients “with an affordable, discreet and convenient way to get tested for STIs”.

“Many of the people who use our tests can’t or won’t go to a clinic to be tested and so this service complements the more comprehensive testing carried out by the IFPA,” he says.

Niall Behan, chief executive of the IFPA, says the online service gives people across the country and those who cannot attend an IFPA clinic an accessible option for STI testing.

Bourke adds that online STI testing was cheaper than attending a private sexual health clinic, costing between €50-€70 for standard to enhanced testing through LloydsOnlineDoctor.

Data

Data from LloydsOnlineDoctor shows that in its first full year of operation in Ireland, some 961 people used the STI-testing service.

Out of those, 60 people (over 6 per cent) tested positive, of whom 60 per cent were women, and 40 per cent men.

In 2014 more females than males used the service, with 57 per cent of tests taken by women, compared with 43 per cent for men.

Over half – 54 per cent – of men who ordered tests opted for the enhanced HIV test, compared with just 42 per cent of women.

Nearly 44 per cent of all tests were taken by people in their 20s, closely followed by those in their 30s. A total of 97 people in their 40s and 16 people in their 50s took tests last year.

The majority of tests taken were in Dublin (43 per cent), followed by 13 per cent in Cork, and 4 per cent in Galway and Limerick respectively.

Of a sample of men tested, 68 per cent were heterosexual, 23 per cent were homosexual, and 7 per cent were bisexual, while 2 per cent did not indicate their sexuality. Of a sample of women tested, 98 per cent were heterosexual, 1 per cent were lesbian, while 1 per cent did not indicate their sexuality.

March recorded the highest level of patients tested in 2014, with 140 tests taken, while September recorded the lowest level of tests taken at 51.

A separate company, DrEd.com, which has just launched online sexual health services in Ireland, says January is its busiest month for online STI testing, based on UK data.

Concern

Some doctors working in the area of sexual health have expressed concerns that online STI testing means the patient misses out on face-to-face medical consultations where safe sexual practices can be discussed as well as treatment options and a prescription can be dispensed immediately if the person tests positive. Furthermore, if diagnosed with an STI, the person may not be aware that they may need to contact previous sexual partners to notify them that they may also have an STI and need screening and treatment.

Chlamydia

Commenting on the advent of online STI testing, Alison Begas, chief executive of the

Dublin Well Woman Centre

, said she welcomed any way to make STI screening more accessible and increase awareness of the risks of STIs, especially silent ones such as chlamydia.

The number of people tested for chlamydia in the Dublin Well Woman Centre's three clinics peaked in the past year, according to figures released to The Irish Times.

In 2014, the Well Woman’s three clinics carried out a total of 5,042 tests for chlamydia, their highest ever number, and recorded their second highest annual number of diagnoses of chlamydia at 253.

If diagnosed early, chlamydia can be treated successfully with a course of antibiotics. However, if left undiagnosed, the infection can lead to chronic pelvic pain, ectopic pregnancy and infertility in women, and to orchitis (testicular inflammation) in men.

According to Stephen Bourke, earlier diagnosis means more effective treatment and significant savings for the taxpayer.

“The time is right for the Government to implement a national sexual health programme, complete with national screening,” he said.

The NHS in England provides a national chlamydia screening programme for under-25s, according to Bourke.

Bourke confirmed that LloydsOnlineDoctor has been on contact with the HSE in an effort to explore setting up a national chlamydia screening programme in Ireland, to be delivered via an online/home testing model.

No age barrier: STIs in the over-50s

While the burden of STIs in Ireland is greatest in the 18-34 year age group, the incidence of STIs in the over-50s has risen significantly in the past 15 years.

People in this age bracket may now be widowed, divorced or separated and entering new sexual relationships, having previously had one or few sexual partners, according to Dr Shirley McQuade, medical director of the Dublin Well Woman Centre.

The use of Viagra has prolonged and revitalised the sex lives of older people, says Stephen Bourke, general manager, LloydsOnlineDoctor Ireland, while McQuade notes that more older women were now being treated for vaginal dryness and other age-related health issues that can affect sexual enjoyment.

While post-menopausal women no longer have to worry about contraception to prevent pregnancy, they often do not realise they are at risk of contracting STIs and need to take appropriate precautions, she explains.

Both the Well Woman clinics and LloydsOnlineDoctor have tested people in Ireland aged in their 50s and 60s for STIs in the past year.

In the UK, LloydsOnlineDoctor has tested people "well into their 80s", according to Bourke.

He note that in recent years in the UK and US there have been STI outbreaks in nursing homes and retirement villages, proving that older people continue having sex well into retirement and are at risk of contracting STIs.

Case study: ‘I probably took risks I shouldn’t have’

'Mark', a professional in his late 30s working in Dublin, was tested for STIs a number of times during his 20s. He chose to use a GP who specialises in sexual health issues.

He was diagnosed with chlamydia in his early 20s but his other tests were clear.

The last time Mark was tested was at the start of his current long-term relationship at the request of his partner.

"I found the GP very good but it is not a pleasant thing, to be diagnosed with an STI. I would certainly have used an online testing service if they were around when I was single.

“Looking back, I probably took risks I shouldn’t have, and my main worry was getting someone pregnant as opposed to catching something,” he says.

“When you are out drinking and having a good time and meet someone, STIs are the last thing on your mind.”

STIs in Ireland: The numbers

Reported STI cases in Ireland rose from 3,361 in 1995 to 12,719 in 2012.

Reported STI cases peaked at 13,442 in 2011.

During 2013, a total of 12,753 cases of STIs were reported in Ireland.

Preliminary figures for 2014 show there were at least 10,182 reported cases of STIs.

The most frequently reported STIs in Ireland are chlamydia, at over half of all reported STI cases, followed by anogenital warts, gonorrhoea and herpes.

The burden of STIs is greatest among those aged less than 25 years.

There was a 32.9 per cent increase in the number of cases of gonorrhoea between 2011 and 2012. There were reductions in the number of anogenital warts cases and syphilis cases notified.

Data collected and published by the Health Protection Surveillance Centre (HPSC)