Why we need to talk about STIs

Dating apps and a disregard for condoms have combined to send rates of STIs soaring. 
Lisa Harvey explores a dangerous shift in attitudes towards sexual health

‘It felt like my stomach was going to fall out when I was told I had chlamydia,’ says Amelia*. After a ten-year relationship, she’d been single for five months and was having casual sex with four men. ‘I’d met two on Tinder, one through a friend, and one at work. I was on the pill and we mostly used condoms, but there were times when we didn’t,’ she says. Then, the symptoms started. ‘My vagina felt different. I thought it was thrush or a UTI but I also felt fluey, so I booked an STI test.’

Amelia got the results a week later, shortly after meeting Rob. ‘Like the other guys I’d slept with, apart from one who’d since ghosted me, I told Rob I had chlamydia and had taken antibiotics but couldn’t have sex for a week,’ she explains. ‘He said not to worry, that he’d had it eight times. Apart from the initial “Shit, I’ve got an STI”, I wasn’t that regretful. I’m 29 and saw it as a rite of passage; something most people go through.’

That might sound alarming, but in terms of numbers, Amelia has a point: recent data from Public Health England reveals someone aged 15-24 is diagnosed with chlamydia or gonorrhoea every four minutes. Globally, the World Health Organization says more than 1 million STIs are acquired every day and in 2016, 127 million between 15 and 49 contracted chlamydia, 87 million got gonorrhea, 6.3 million were diagnosed with syphilis, while 156 million were infected with the parasitic disease trichomoniasis (aka, trich).

All four bacterial infections are currently curable but according to Superdrug’s resident sex expert Alix Fox, this is leading to ‘magic capsule cockiness’ among millennials. ‘Many have grown up with a “quick-fix” attitude to sexual heath and believe if they get an STI, the issue can be instantly sorted,’ says Fox. ‘It’s why people take their chances with condomless sex, then rely on medicine to treat the problem if they need to afterwards.’

Previously, sex education focused on condoms as a tool for pregnancy prevention. This, along with the fact there weren’t any major STI awareness campaigns nationwide between 2009 and 2017, has led to a generation either missing out on the message, or using the pill and thinking all bases are covered. ‘There’s also this horribly prevalent myth that STIs are simply something that only happens to other people,’ Fox adds.

However, many STIs are masters of disguise. ‘People assume there’ll be discharge, a rash or another red flag signalling a problem,’ says Fox. ‘But chlamydia, for instance, doesn’t show obvious symptoms in 70 per cent of women, and 50 per cent of men who are infected. You can look and feel OK for a long time while carrying an STI. But if they’re left to fester, undetected infections can lead to major health issues.’

But while Amelia may be fortunate to have access to effective antiviral treatments, it appears drug shortages and antibiotic resistance to STIs is a growing concern. ‘In the past year, we’ve seen three cases of a gonorrhoea “superbug” that isn’t treatable by standard antibiotics,’ says Dr Olwen Williams, president of the British Association for Sexual Health and HIV. ‘It’s not a simple matter of taking a tablet any more; for some, it’s a hospital admission − or worse. Syphilis is a major disease and we’re seeing a lot more diagnoses in young women. If contracted during pregnancy, there’s a high risk of miscarriage, stillbirth or serious infection for the baby.’

But there are other reasons for the rise in STIs. ‘More people are getting them through oral and anal sex, and there’s a link between STI rates and social deprivation, age at sexual intercourse and access to information and services,’ says Dr Williams. ‘Condom use has also significantly dropped. We know young people are less likely to use a condom during their first sexual contact with a new partner.’

Even if young women are aware that barrier protection (condoms and Femidoms) helps prevent STI transmission (in most cases), what else is stopping the urgency to use it? ‘There’s an element of awkwardness if you’re having casual sex,’ says Amelia. ‘You get carried away and if they don’t mention protection, I won’t either. Unless I know I’m not bothered about seeing him again, then I’m like: “condom!”’ Laura*, 33, who’s also recently had chlamydia, agrees that casual sex and dating apps play a part: ‘They’ve made hook-ups feel like you’re playing a game and you’re less likely to take condom-wearing seriously,’ she says.

‘The hook-up culture means we’re not necessarily as thorough about learning our partner’s sexual history. And, because sex can be so accessible, it’s easier to be sexually complacent,’ says Dr Anna Hushlak, co-founder of Ferly, the first ever digital sexual well-being studio. Mainstream porn, which doesn’t encourage condom usage, hasn’t helped either. ‘Last year, one study found a direct correlation between regular consumption of porn and a decreased frequency of condom usage,’ adds Dr Hushlak.

 

‘The hook-up culture means we’re not necessarily as thorough about learning our partner’s sexual history’

 

Surprisingly, there’s still a significant amount of stigma surrounding women carrying condoms, but these attitudes are being challenged by modern femtech innovations, including Hanx, Europe’s first female-focused condom brand. Its research found 73 per cent of women were embarrassed about buying condoms, and yet 85 per cent felt they should be buying them. ‘We’re spreading the message that it’s normal to carry condoms,’ says co-founder Dr Sarah Welsh. ‘It’s not promiscuity; it’s taking control of your health and body.’

And yet ‘shame’ is preventing many from booking an all-important STI check-up, which in itself is a significant factor increasing the spread of infections. ‘Whether people are embarrassed about being regularly tested or being more assertive about safe sex, the overall stigma and taboo is the reason why people tend to take a reactionary, as opposed to a preventative, approach to their sexual health,’ says Dr Hushlak.

Rachael, 26, has battled with embarrassment since contracting genital herpes five years ago from an ex. ‘I slept with someone when I wasn’t having a breakout, but I didn’t mention my herpes as I was scared he’d ghost me,’ she says. ‘After getting support through The Herpes Viruses Association, I have since told my current partner. But my best friend also has genital herpes and her boyfriend doesn’t know.’

Trends in unsafe sexual behaviour aside, the government has also cut budgets for sexual health services repeatedly since 2010. ‘I’ve had women who’ve struggled to make it to a sexual health clinic because of restrictive opening hours or long waiting times − and then symptoms have worsened,’ says Dr Kathryn Basford, from Zava UK. This online GP service has seen a 33 per cent increase in their STI home-testing kits in the past year.

So, how can we stop STI figures soaring? ‘We need to get the message across that condoms do more than protect against pregnancy,’ says Dr Hushlak. ‘Sexual health is as important to our well-being as exercising. Millennials need to understand that healthy sex is good sex − and that good sex is pleasurable.’

This year’s theme for Sexual Health Awareness Week (16-22 September) will hone in on offering access to services and more information, but the fundamental message is loud and clear: ‘We’ve always said prevention is better than cure,’ says Dr Williams. ‘STIs are a silent epidemic. People need to take protection seriously, get regularly tested and let all sexual partners know if they test positive. We need more open, honest conversations around sex in general. Ultimately, it’s about showing each other mutual respect.’

The STI low-down

Cases of chlamydia, genital warts, gonorrhoea and genital herpes are soaring**. Here, Dr Basford explains what happens if symptoms are left untreated

Chlamydia

‘This may lead to serious health problems, including pelvic inflammatory disease, which can cause infertility and increased risk of complications during pregnancy.’

Genital warts

‘Most warts disappear without treatment, but it can take a long time. They may also multiply and, although they rarely have a significant health impact, there’s 
a real risk of passing them on.’

Gonorrhoea

‘This can spread into the womb and fallopian tubes, leading to pelvic inflammatory disease and increasing the risk of infertility or miscarriage. For men and women, the bacteria that causes gonorrhoea can spread through the blood, causing joint pain, swelling and stiffness. Untreated, it also increases the risk of contracting sexually transmitted HIV.’

Genital herpes

‘There is no cure, but managing outbreaks is vital to prevent passing on the virus to sexual partners.’

*Names have been changed throughout. **According to Public Health England, 2018

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