Summer lovin': Danger of getting an STI during festival season

But, fuelled by alcohol, or drugs, it can be all too easy to throw caution — and crucial sexual protection — to the wind.

Be warned: The risk of contracting a sexually transmitted infection (STI) in this country has rarely, if ever, been higher.

In the first five months of this year, the health service registered an increase of 70% in syphilis, 40% in gonorrhoea and 21% in chlamydia.

In May, the HSE’s Health Protection Surveillance Centre said it had recorded 1,116 new cases of gonorrhoea in 2019, nearly 40% more than in the first 20 weeks of 2018, while 291 cases of the potentially fatal disease of syphilis compares with 171 in the same period in 2018, a rise of 70%.

Longer-term analysis, which compared the latest situation with 2013/2014, charted an even more worrying surge in the incidence of STIs, with the number of syphilis cases alone up by nearly 90% in just five years.

These results, from research by the Health Protection Surveillance Centre, showed the five most prevalent STIs, syphilis, gonorrhoea, herpes, chlamydia and HIV, have significantly increased in terms of annual detection rates since 2013/2014.

The level of gonorrhoea has soared from 1,282 cases in 2013 to 2,407 last year, an explosive 88% increase. In 2013, Ireland recorded 339 cases of HIV but that rose to 530 last year, an increase of 56%, while cases of chlamydia have also increased sharply from 6,246 in 2013 to 7,942 last year.

Meanwhile, genital herpes rates also rose over the same five-year period, from 1,127 to 1,594. Concern is also focused on syphilis, an infection that should be eliminated, where there has been an increase of 88%.

While the message about the importance of consent has been highlighted in recent years, part of the reason for the sharp rise in the incidence of STIs is that people are less cautious about having protected sex, says Prof Mary Horgan, consultant physician in infectious diseases and internal medicine at Cork University Hospital.

There’s a need for a stronger health-promotion message about the need to have protected sex, she says, adding there is a mindset that people adopt while travelling abroad on holiday, when they “leave normal common sense at home”.

This concern is underlined by the International Association for Medical Assistance to Travellers (IAMAT), which says about 50% of people who engage in new sexual relationships abroad inconsistently use condoms and, as a result, “a large number of STIs occur in returning travellers”.

IAMAT urges travellers to take precautions and to be aware of the fact that certain STIs may be more common at your travel destination. It also says travel insurance generally will not cover treatment.

Alcohol and drug use make people less cautious and more likely to engage in risky behaviour, says Prof Horgan, who has some unsettling information for those who adopt a casual approach to sex.

“We’ve seen big increases in syphilis and gonorrhoea. We’re also seeing increased resistance to antibiotics, and we might reach a situation where we may be unable to treat gonorrhoea. People need to be mindful of that risk. Gonorrhoea is smarter than us and can evolve much quicker.”

Thanks to the roll out of the HPV vaccine to teenage girls in recent years — it is to be extended to schoolboys from September — doctors are expecting a dramatic reduction in the level of genital warts, as well as in cervical cancer, she says.

“In Australia, where HPV came out a decade or so ago, they are seeing a dramatic decrease in the incidence of genital warts. The HPV vaccine is very important, it saves lives.”

Last year, the HSE launched a safe sex campaign to coincide with the hugely popular Electric Picnic festival, following another significant increase in the diagnosis of sexually transmitted infections in young people.

Among other initiatives, it involved the provision of free condoms at festivals.

In this context, the recorded increases in STIs this year, may come as a disappointment, but another factor may be at play, says Danny Quealey, clinical nurse manager at the genito-urinary medicine/STI clinic at Cork’s South Infirmary Victoria University Hospital.

“There is a belief that STIs are something that happens to somebody else — there is this myth that it will never happen to me,” he says.

One of the biggest contributors to the spread of STIs is alcohol consumption. And once people have had a few drinks, they’re less likely to buy a condom, he says. “In fact, they’re more likely to spend money on a pint than a condom.”

Statistics published in 2018 show that young people aged 15-24 account for 49% of chlamydia cases, 39% of herpes and 32% of gonorrhoea cases. Also, he says people don’t always realise oral sex counts as unprotected sex and that chlamydia, gonorrhoea and genital warts can be contracted through semen or vaginal fluid.

Condoms are often offered freely at festivals, and there is a push for people to engage in protected sex, but the reality is that people will drink at festivals and they will take risks.

The clinic at SIVUH deals with 3,000 calls a month and sees about 8,000 people a year, the majority of whom are in their 20s.

It provides a free HPV vaccination programme to men aged between 16 and 45 who have sex with men. Also, near the end of the year — in line with the national rollout — the clinic will launch its pre-exposure prophylaxis programme (PrEP), a HIV prevention programme which is being implemented by the Government.

Dublin-based specialist in sexual health and sexually transmitted infections, Dr Derek Freedman, says sexual behaviour is changing with the times.

“Most cases of STIs come where people are not in steady relationships, although we see significant numbers who go ‘offside’, and are then consumed with guilt and anxiety. Today, people are marrying and settling later, and there are a lot of separations, so the number of ‘singletons’ is much greater. And they wish to lead a full, normal life.”

There is a “lack of fear about STIs” and there is not sufficient information about the subject in the media,” he says.

“It’s not in the public consciousness as it was 20 or 30 years ago, when HIV first came on the scene,” he says.

Now that HIV can be treated effectively and easily, people have lost their fear of it, he points out, adding that this is particularly true in the groups most affected, men who have sex with men and younger people.

“There is a concentration of infection in those who have lost a fear of HIV. If they are on effective treatment, which suppresses the virus to an undetectable viral load, then the virus is not transmissible, and they will not transmit HIV — they can go wild, be more sexually active, take risks, and catch the other infections.”

Such risk takers, who do not perceive their risk and fail to come for testing and treatment, are a cause of concern, he says.

At a societal level, sex is no longer regarded as something special, he says, and as a result has become a “consumer item” for some.

“People expect to go out on a weekend to a club and to find someone to have sex with,” he says.

Apps such as Tinder and Grindr can make it easy to find sex.

While these apps can be useful to help people in making contact, they are a double-edged sword. They need to be regulated in terms of providing safe sex messages and offering reminders about the risk of infection.

Dr Freedman believes STI clinics should be more accessible, rather than attached to hospitals. He points to cities such as London, New York and San Francisco, where clinics have been set up in areas where there is a lot of infection.

“People can be diagnosed and initiate immediate treatment. In Dublin, for example, an STI clinic is needed in Temple Bar, he says. “You need the clinics where the action is.”

Risk of STIs

• Be aware of the risk of STIs and protect yourself.
• Oral sex counts as unprotected sex and can result in the transmission of an STI.
• The more sexual partners you have, the higher the risk.
• Don’t wait for symptoms because there may not be any. If you have any concern, get tested. It’s free.
• Know who you are with, get their mobile phone number, and use protection. 

Useful contacts:

www.sexualwellbeing.ie

Cork: SIVH Clinic, www.mysexualhealth.ie, 021-496 6844

Sexual health clinics for 17-24 year olds are available at the Youth Health Service at Penrose Quay, Cork, 076-108 4150

Dublin: St James Hospital, www.guideclinic.ie, 01-416 2315