LONDON LETTER:SOME OF Britain's best-known agony aunts came together for a photo-shoot in London this week dressed in bathrobes to promote the Terrence Higgins Trust's campaign to safeguard sexual health clinics from the cuts making their way through public services.
The need is undeniable. The UK has the highest number of teenage pregnancies in western Europe, despite the ready availability of contraceptives; along with one of the worst records for sexually transmitted diseases.
Dubbing themselves as the Sexual Health Coalition of Agony Aunts, the group, including the Sun’s Deirdre Saunders, declared: “During economic uncertainty, sexual health services are often seen as easy targets – they’re more likely to go first or lose more of their funding compared to others.
“Good sexual health is essential to physical and mental health as well as positive relationships, self-esteem and self-identity and personal responsibility. We’re here to remind decision-makers that sexual health services must be protected,” they said.
For years, health authorities have urged the public to be careful in choosing sexual partners, but mostly to no avail, as the number of cases of sexually transmitted diseases of all kinds continued to increase.
Today, there is some good news, but not much. For the first time in over a decade there has been a drop in the number of new infections in England, figures show – a small decline, but a decline deemed significant, nevertheless, by the Health Protection Agency.
However, even though the figure has decreased by 1 per cent in 2010, the number – 420,000 – is still extraordinary, including 189,612 cases of chlamydia – an infection that can lead to infertility in women years after youthful excess has been put to one side.
For the first time since statistics have been gathered, chlamydia rates did not increase last year, perhaps a reflection of greater awareness of the disease since 2.2 million tests for the infection were carried out in English surgeries – up by 196,500 on the 2009 figure.
Predictably, STDs are mostly a curse of youth: men aged between 20 and 24 and girls aged between 16 and 19 years are the most at risk, particularly if they live in London and, most especially, if they are homosexual or bisexual males; or black, of either sex.
For the Terrence Higgins Trust, which was set up in the 1990s to counter the wave of public ignorance about Aids, the latest figures from the Health Protection Agency are “small, but very significant”, said its chief executive, Sir Nick Partridge.
“We’re finally beginning to see a slowing down in the rates of infections, particularly among young people, showing that the time and money that has been put into sexual health, and in particular chlamydia screening, in recent years, is starting to pay off,” he said.
However, the picture is more complicated. The agency says that the rise in cases over the last decade is partly explained by increased and better testing, but, also, to an increase in unsafe sexual conduct among the young.
Chlamydia terrifies health authorities, since it has already created an unseen “infertility time bomb” that will cause major social consequences in the decades to come when women in their late 30s and early 40s find pregnancy impossible.
“Since 1999 the number of annual cases of chlamydia has more than doubled. In 2008, there were 123,018 new diagnoses of chlamydia in genito-urinary medicine clinics – a record number,” said the agency. It is particularly dangerous because its effects are often unseen.
“Chlamydia can have no symptoms and therefore many people do not come forward for testing, even though the infection can be easily diagnosed and effectively treated,” it said.
So great was the concern that the Department of Health in England in 2003 set up a national screening programme, which tested one in seven of young people aged between 15 and 24 between 2008 and 2009.
In a welcome move, syphilis fell 8 per cent to 2,624 in 2010. The fall follows a decade of substantial increases, year after year. In 2008, for example, the number of news cases presenting was eight times the number found in 1999.
However, gonorrhoea cases are up 3 per cent to 16,531. Most worryingly, such cases are becoming harder to cure. This week, the Health Protection Agency warned that it could no longer recommend cefixime – the option of first-resort for the last decade – to doctors as the first choice of treatment because laboratory tests show that it is becoming increasingly ineffective.
Instead, the agency is recommending a more powerful cocktail of ceftriaxone by injection, and oral azithromycin. The move has come following tests showed that up to one in five gonorrhoea samples taken from patients were no longer being dealt with by cefixime. Five years ago, the drug would not have failed in even one case.
Prof Cathy Ison, the agency’s expert in the field, told Medical News Today, that the usefulness of the new cocktail will not last indefinitely: “History tells us that resistance to this therapy will develop too. In the absence of any new alternative treatments for when this happens, we will face a situation where gonorrhoea cannot be cured,” she said.
