STIs Rising In the United Kingdom

Clinics are trying to cope with an increase in sexually transmitted diseases or STIs rising, a health expert has warned.  Identification of syphilis in Wales rose by 53% from 2016 to 2017, while instances of gonorrhoea went up 21%, based on Public Health Wales’ statistics.  The sexual health numbers change quarterly.

British Association of Sexual Health and HIV President, Dr. Olwen Williams blamed dating apps and said Welsh services needed more cash.  The Welsh Government said it will finance many sexual health projects.

Dr Williams said: “We’re seeing a genuine rise in STIs, if we were just seeing an increase in testing then our figures would look slightly different, but it feels that way.”  “Certainly in my career I’ve never seen so much gonorrhoea or syphilis in my area, ever.”

Dr. Williams, who works for Betsi Cadwaladr University Health Board in north Wales, said a change in relationship culture over the last few years. Like the use of relationship apps, has experienced a knock-on impact on solutions: “What we can say about sexual mixing and sexual networking is that things have changed considerably.

“The frequency of app hook-ups and dating apps used as a sort of medium to access sexual activity seems to have increased significantly.”

Usually, if someone has caught an STI, clinicians attempt to notify past spouses so that they can get tested and treated too.

However, the anonymous nature of many dating apps means clinicians are now not able to guide couples and reduce the spread of STIs, according to Dr. Williams.

Syphilis

Syphilis could be more usually linked with past times. However, it’s been rising for the last decade in England, with more cases in a year than in any year since 1949.

The disease was, in effect, eradicated in Britain in the mid-’80s just to re-emerge around 1999.

BBC Reality Check wanted to understand why this early disease is rearing its head in England in the 21st Century.

Syphilis is a disease that can be treated with antibiotics. Its symptoms include:

  • Sores around the mouth and genitals
  • A rash on the palms and feet
  • tiredness
  • headaches and joint pain
  • a high temperature

Left untreated over many years, it may spread into the brain, and be fatal.

Syphilis remains relatively rare, which makes up less than 2 percent of all STIs tested in England in 2017.

The fact that we are coping with a small overall number of cases makes the percent increase appear more tragic – 1,000 additional cases in 2017 compared to a 20% increase. The same amount of instances of other chlamydia would represent less than a 1 percent increase.

But however, there’s been a steady increase with the number of recognized cases more than doubling in a decade – 7,137 past years up from 2,874 in 2008.

The increase in syphilis was nearly all among bisexual, gay,  and men who have sex with men, as per government agency Public Health England, accounting for 78 percent of all cases diagnosed annually.

Public Health England told, “it plans to increase numbers and frequency of tests in populations at higher risk of infection, to promote early detection and treatment”.

‘Chemsex’ Trend

British Association for Sexual Health and HIV representative, Dr. Patrick French, tells that STIs rising is often associated with variations in sexual behaviour in a community.

He says this new increase in cases of syphilis has been pushed in part by behaviour changes especially amongst men who have sex with men.

Dr French says “Apps like Grindr have made casual sex more available and have been linked to a rise in people having group sex, which seems to be a risk factor for contracting syphilis.”

And there’s a growing “chemsex” trend – in which people today take drugs such as crystal meth during intercourse, possibly reducing their inhibitions and making them less likely to use protection.

Gonorrhoea

  • The disease is spread by unprotected vaginal, anal and oral sex
  • Symptoms may include a thick yellow or green secretion from reproductive organs, bleeding between periods, and pain when urinating.
  • However, rectal and vaginal infections often have no signs
  • An untreated infection may result in infertility, pelvic inflammatory disease and may be passed to a child during pregnancy.

From 2011 to 2016, people attending sexual Health clinics in Wales doubled, from 86,000 to 176,000, based on Public Health Wales report.

Regardless of the increasing demand for services, Dr. Williams stated there had been no substantial investment in sexual health services in the Welsh Government.

“Our biggest issue is around our staffing because we really do struggle to do outreach, to actually do partner notification… and if we’re not doing that then all we’ll do is see an increase in STIs in Wales,” she added.

“I think services will struggle if we don’t get investment.”

  • Dating apps blamed for syphilis increase
  • Calls for free self-testing STI kits

Dr. Williams also suggests the introduction of Internet test Kits which may be ordered online and returned through the post – a recommendation endorsed by Public Health Wales’ current Sexual Health Review.

“If you go to England and Scotland, people can go on the internet and get a free test for chlamydia and gonorrhoea and a free HIV test, which is obviously very convenient and can be done in the comfort of your own home, whereas in Wales, at the moment, the majority of people have to come in to clinics to get tested,” she said.

The Welsh Government said it had lately “commissioned an independent review of sexual health services in Wales”. And was now “implementing the review’s recommendations in full.”

A spokesman said it had approved funding for many projects. Including a “pilot online STI testing agency that will offer advice, risk assessment, provision of sexual health testing kits and referral to treatment where appropriate.”

More Testing

Syphilis and Gonorrhea are both highly infectious and, unlike some STIs, can be incurred by oral sex.

For the top of changes to sensual behaviour, more individuals are visiting STI clinics. Indicating more cases of syphilis are being found. So that’s very likely to explain part of the increase.

Men who have sex with men should definitely be tested. It is possible there are more individuals with undiagnosed infections in the rest of the population.

Sexual health clinic appearances increased by greater than 10 percent from 2013 to 2016. Around 30% amongst men who have sex with men.

However, the increase in diseases has outstripped the growth in testing, suggesting there has been a genuine increase in STIs.

Funds cuts to sexual health services have also been pointed to as a potential cause.

Head of policy at HIV charity the Terrence Higgins Trust, Debbie Laycock, said: “Continued deep cuts to sexual health services across England are definitely playing a part in this rise.

“The number of people accessing sexual health services has continued to rise, demand is on the increase. We’re hearing day-to-day more and more people are saying they’re being turned away from sexual health. Clinics so they can’t even get in the door – and that’s even people who have symptoms.”

When it becomes difficult to get an appointment, this is especially likely to deter individuals who do not have symptoms. But just need a routine test. Those regular tests help pick up illnesses at an early stage and prevent them from being spread to others.

  • Syphilis and Gonorrhea up by one-fifth
  • ‘We need to discuss syphilis.’
  • ‘Remarkable’ drop in new HIV cases

There is some push and pull going on here – more testing leads to more diagnoses which could push the figures. But at the same time contributes to early detection and prevents infections being spread which pushes down them as well.

A BBC investigation found some sexual-health clinics confronted closure or reduced hours as nearly half the councils in England (which fund the practices) plan to decrease spending.

But this rise in diseases has been happening for many years – and the specific spike in certain infections over others. Indicates that again cuts alone may not be the complete answer. That is where those lifestyle factors are involved.

Budget cuts aside, where funds are concentrated in the health service makes a change to STI rates. Both in less and more economically straitened times.

From the old 2000s, the national Chlamydia screening programme has been associated with an increase in cases being diagnosed. The drop in testing recently has also coincided with a decline in infections diagnosed.

The HPV vaccination programme has been associated with a reduction in cases of genital warts, especially among young girls.

And new diagnoses of HIV have dropped considerably in the last two years because of better testing. Quicker treatment preventing its spread, also as a few people obtaining pre-exposure prophylaxis drugs.

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