DOWN AND DIRTY

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Annual cases of STIS rocketed to 420,000 in Britain at last count – are you playing safe?

Envisage your daily schedule. More disciplined than a Himalayan monk’s. Your SAD alarm is programmed to wake you with ‘sunlight’ at the same time each morning, the reps you clock up in your lunchtime gym session are so perfectly timed, it would impress the Swiss, and your afternoon juice has just the rightsized dash of apple cider vinegar to keep you grinning rather than grimacing. Monica Geller would be proud. Until tonight, when, if you’re anything like 47% of respondents to a 2017 Yougov survey, you’ll enjoy a date with someone new, have heat-of-themoment sex, throw caution to the wind and forgo protection. By day, lives are run like a precision algorithm. By night, those same people are risking it all on sexual-health roulette. And the odds are looking very shaky.

If the last time you thought about your exposure to STIS was when an awkward teacher plonked a gnarly textbook on the desk in front of you, brandishing a banana, cucumber or other phallus-shaped one-ofyour-five-a-day, you’ll likely snap your eyes – and thighs – shut at the following figures. At last count in 2016, 420,000 STIS were diagnosed in England. Of those, 49% were chlamydia – with almost one test in 10 coming back positive for those under 24.

It’s a similar story in Wales, where the number of chlamydia cases was up 20% between 2012 and 2014. But there are contenders for its crown. Syphilis is now at its highest level since 1949 and gonorrhoea cases rose by 175% between 2008 and 2015, with over 36,000 diagnoses in 2016. In Scotland, rates increased by 28% between 2014 and 2015 – while incidences of genital herpes are the highest they’ve been for a decade. And – as an extra kicker – as infection rates rise, so the potency of some of these diseases strengthens.

FRESH THREATS

Gonorrhoea has gone next-gen, evolving to become so drill-sergeant tough that the drugs used to treat it in the past no longer work. In March, the first case of drug-resistant, or ‘super’, gonorrhoea was reported in the UK. ‘The fact that one person in the UK has acquired multiple drug-resistant strands of gonorrhoea doesn’t make this an outbreak – but it does present a real threat,’ explains Professor Claudia Estcourt from the British Association for Sexual Health and HIV (BASHH). ‘The bug itself has a very high ability to mutate, to change the proteins on its surface and to develop different mechanisms to evade particular antibiotics. Penicillin used to work, ciprofloxacin used to work – about five years ago, we changed from antibiotic tablets to an antibiotic injection – and later this year we’ll need to have new guidelines again.’

After chlamydia, gonorrhoea is the UK’S second most common bacterial STI – and a particular worry for women. Bacteria can infect the cervix, spread to your reproductive organs and cause pelvic inflammatory disease (PID) – responsible for ectopic pregnancy and infertility – in up to 20% of untreated cases. Contract it while pregnant and you risk miscarriage. Worst case, warns Professor Estcourt, gonorrhoea ends up untreatable. ‘We would then probably see infections carry through the bloodstream to infect joints and skin – something rarely seen in the UK.’ But it can happen.

Then there’s mycoplasma genitalium (otherwise known as mycoplasma or MG), a new STI on the scene that could also be especially harmful for women. ‘It can lead to PID, potentially escalating to infertility, long-term pelvic pain and ectopic pregnancy,’ confirms Professor Estcourt. A large-scale study found that one in 100 adults aged between 16 and 44 in the UK were infected with MG, with the majority showing no symptoms.

GETTING MESSY

So, what’s the root cause of this rise in STIS? Professor Estcourt points to one main culprit. ‘A reduction in the use of condoms,’ she argues. Indeed, 11% of sexually active 16 to 24-year-olds quizzed for Public Health England’s ‘Protect Against STIS’ campaign admitted they’d never used one. But this isn’t an issue powered solely by feckless, horny millennials. Of the 420,000 STIS diagnosed in 2016, 30,000 were among the over-45s. Our use of rubbers has fallen slack – but why? The first answer is obvious – condoms are a faff and rarely do men, or women, go wild for their texture, smell or the messy awks of disposing of one. The second issue, according to Lisa Hallgarten, policy manager at sexual health service Brook (brook.org.uk), is that many people feel a false sense of security based on their partner’s looks. ‘If someone’s appearance is clean and tidy, you assume they pose no risk.’ It’s easy to eye-roll at such naivety, but this sense of immunity is widespread. An alarming 72% of men and 62% of women have never had an STI test,

‘THE UK IS IN THE MIDST OF A SERIOUS STI AND CONTRACEPTION CRISIS’

according to Lloyds Pharmacy, while a 2018 study found that 60% of under-30s thought the contraceptive pill protected them from STIS. Read and repeat: only condoms do.

If P-in-v sex isn’t your vibe, the chances of picking up something nasty post-coitus is reduced – primarily because male ejaculate is like 5G wifi for spreading bacterial STIS. That said, women who sleep with women (WSW) are not completely without risk. ‘WSW may well have (or have had) sex with men, too. And if they’re carrying a viral STI, such as herpes, this can be transmitted by skin-to-skin contact,’ explains Professor Estcourt. ‘Plus, sharing sex toys has been associated with transmission of chlamydia through genital secretions.’ Her advice is to always wash sex toys with soapy water, don’t share them, and go for smears – and STI tests – just as regularly as WSM do.

Newspaper headlines are quick to blame dating apps for our STI spike – and it’s not just bluster. A study from Hong Kong University found users were three times more likely to be laissez-faire about using condoms than those who don’t swipe-tobone. But rubber reluctance can be just as much – if not more – of an issue with partners acquired the old-fashioned way. Helen, a 31-year-old recruiter, agrees that most men she’s met via apps have attempted to go bareback. ‘It’s comparatively easy to insist on protection in casual setups: emotionally, you’re less invested, so the decision is objective,’ she says. ‘But, when I dated a male friend, “we should use a condom” was met with a pride-dented,

“Oh, you think I have something?” It was painfully awkward, so I just went ahead without one. I was relieved to get the all-clear from an STI test shortly after.’

TESTING, TESTING

Now probably isn’t the best time to highlight the fact that we’re in the middle of a major sexual-health-funding shortfall. ‘The overall picture in the UK is of a serious STI and contraception crisis, and I believe the main cause of this is funding cuts,’ says Hallgarten. Problems began in 2013, when the commissioning of public-health services – including sexual health – moved from the NHS to cash-strapped local authorities.

The result has been a £531 million cut to public-health spending between 2015 and 2020, which has seen a quarter of local authorities reducing investment in sexualhealth services by 20% between 2013 and 2016. ‘Now, it’s a postcode lottery situation where the care you receive depends entirely on where you live and how the people in charge spend their reduced budgets,’ explains Hallgarten. The upshot? Specialist sexual-health clinics are closing, which is not good news. Their experts are likely to know the current best antibiotic to nuke an STI, whereas your GP may not. Those that do stay open are severely stretched.

In London, approximately half a dozen services have closed or been ‘reorganised’ in a way that significantly restricts your access to them. In October, Guy’s and St Thomas’ NHS Foundation Trust revealed that almost 11,500 people had been turned away in five months – unable to get STI advice, tests or contraception – due to three centre closures in the area. Cuts in one place clog up facilities elsewhere. Stretched resources mean that experts don’t currently have enough regional data to understand the scale of the problem elsewhere in the UK – but it’s unlikely to be rosy. Starting to rethink snubbing that rubber yet?

SCREENING UPDATE

For all the dubious progressions in sex tech (sex-robot brothels, say what?), e-testing could be the answer for overstretched clinics. Order an STI test kit online (there’s sh24.org.uk for London, or its sister site fettle.health for the rest of the UK), provide a sample (urine, finger-prick blood or a vaginal swab, depending on the test), pop it in the post and receive lab results by text message or phone call. In 2017, the London

School of Hygiene & Tropical Medicine compared the response rate of inviting people to either attend a free check-up at a clinic or order an E-STI test online and found that the latter had almost double the uptake. Professor Estcourt also evaluated a chlamydia e-sexual-health clinic – an entirely digitised service with online consultations and results via web link (if you’re positive, you simply collect antibiotics at a pharmacy) – and 91% of patients who had an STI were willing to receive the news in this manner.

You’re even able to let former partners know anonymously. SH:24 works with sxt.org.uk – a portal that finds your nearest sexual-health service – to inform exes that they might have chlamydia. You only have to share their number – no names – and this data is wiped every three days. Some Virgin Care clinics are also piloting anonymous digital partner notification to reduce STI spread. Tech reminders could also play a valuable role in nudging you to schedule seeing a specialist face-to-face – even if there is a long wait.

HAVE YOUR OWN BACK

So, stuck between mutant STIS you’ve never heard of and funding cuts you never knew existed, what’s the plan? Up your vigilance about your own sexual health, that’s what.

‘Yes, have a check-up if you notice any symptoms that you’re worried about,’ urges Professor Estcourt. ‘But also get tested as a matter of course when you change partner.

And use condoms unless you’re in a relationship with someone who’s been tested themselves.’ It might not be sexy, but it’s important to take what’s going on with your sexual health as seriously as you do your glute gains.

Unfortunately, taking more responsibility can prove challenging if, right now, you’re struggling with mental illness. As far back as 2008, studies began pointing to a correlation between women’s rate of depression and their diagnosis of STIS. ‘They’re linked, and I think that’s really important – but something that hasn’t been picked up on in the news,’ says Professor Estcourt. ‘People with depression, low mood or low self-esteem very often put themselves at greater risk in their sex lives.

It’s tied to low self-worth – if you’re lacking hope generally, you may think, what’s the point in using protection?’ she adds.

Of course, there’s every point. Your sexual health is too important to ignore. And you can’t assume that a new partner or publichealth services have you covered. The sense of responsibility you feel about what goes into your body shouldn’t stop when you get to the bits between your thighs. Class dismissed.