Syphilis infections rose by a staggering 63% between 2001 and 2002, according to a report issued last month by the health protection agency. And, taking the previous five years into account, the rise was 960% in England, with men in the West Midlands showing an increase of 4,800%. The sexual health of the nation is in decline with potentially serious consequences for infertility in young women and rising costs for the National Health Service in treating the long-term effects of sexually transmitted infections (STIs).
STIs can ruin lives. When your regular partner realises they have been cheated, deceived and had their health put at risk, it can wreck the relationship. Worse, some infections can be caught and carried without instant signs or symptoms.
Dangerous infections such as syphilis, chlamydia and gonorrhoea are spreading rapidly - the situation is being described by the parliamentary select committee on sexual health as a crisis. But few resources have been made available to the specialist medical units and other services that are trying to stem the tide threatening society and the economies of first as well as third world countries. The WHO estimates that, excluding HIV and hepatitis, 1.5 million people catch an STI every day of the year.
In July 2001, the public health laboratory service released figures showing a significant rise in the prevalence of STIs, notably gonorrhoea and chlamydia, particularly among younger people. On the same day, the government launched the first national strategy for sexual health and HIV services, with a national budget of just £47.5m to support a range of initiatives.
In July 2003, Dr Kevin Fenton, consultant epidemiologist at the HIV and STI division at the health protection agency (HPA) communicable disease surveillance centre, said: "The data confirm that we are still seeing sustained increases in new diagnoses of STIs and increasing attendance to genito-urinary medicine (GUM) clinics. Some of these increases are the result of increased awareness of STIs and more people using GUM services, and improvements in screening for STIs. However, high-risk sexual behaviour undoubtedly remains a significant contributing factor."
Rising rates of infection are not the only problem. A recent research letter published in the Lancet reported that the antibiotic resistance of gonorrhoea increased from 3% to almost 10% between 2001 and 2002 - and other studies show that HIV is also developing multi-drug resistance. This is particularly worrying and, like other healthcare professionals, I believe we really do have a sexual health crisis in Britain. I also believe that it was predictable and that much of the response now is merely shutting the stable door after the horse has bolted.
I left my NHS post as the UK's first outreach clinical nurse specialist in contraception and sexual health in south London two years ago. I wanted to raise awareness and increase understanding of the dangers of unprotected sex with random partners through my website, SEXplained... Ltd. However, I also continue to hold regular family planning sessions, and speak with more than 15 years' experience of working with all age groups and backgrounds.
There has never been a time of such great awareness about sex and sexuality. So how has this alarming situation arisen? Today, we assume that everyone knows about HIV and other STIs. We believe that most people, through sex education, are sensible enough to use condoms - particularly when having sex with a new partner. We are lulled into the false belief that STIs can be identified easily and treated like the common cold. And we are sure we will know if we have caught something nasty.
This is far from reality. Most STIs are caught and spread without the infected person knowing because there are no obvious symptoms - irrespective of age group and background.
An alarming number of adults, as well as young people, have never heard of many common STIs. Today's parents were not taught about contraception and sexual health at school, and do not have the knowledge to teach their own or other children. It is a specialist area, requiring input and support from many quarters. It is not just about biology, contraceptive and safe-sex methods for preventing infections - it also involves feelings, negotiation, communication, relationships and self-esteem.
According to the National Survey of Sexual Attitudes and Lifestyles' 10-year survey on sexual behaviour patterns, more people are having more lifetime sexual partners, the age of first intercourse has dropped from 17 to 16, homosexuality has increased, more men are paying for sex of all sorts and more people are having anal sex. This growing high-risk behaviour in a society which has forgotten the fear of HIV/Aids is not compensated for by a small but welcome rise in the use of condoms. Additional reasons often quoted include the increased use of alcohol and recreational drugs by young people, the influence of television, film and music, casual holiday sex which carries serious risks since many of the UK's HIV cases have been imported from abroad, stereotypical behavioural expectations, peer pressure, ignorance. The list goes on.
Even the older generation is at risk - the children of the 1960s sexual revolution - as they leave the relative safety of long-term relationships and find themselves in the singles market again. Internet chatrooms have also made the risk of meeting and engaging in sex with unknown partners a high-risk strategy.
GUM clinics are becoming overwhelmed by increasing numbers of people looking for treatment. Facilities and resources are often inadequate, as family planning and other sexual-health facilities are not given high priority when funds or space are allocated. Healthcare professionals would like to spend more time with their patients to explain the diagnosis, treatment and repercussions. They seldom have the time. So they offer a leaflet and hope the patient will read it.
Government committees and health advisers talk of crisis and the need for urgent action, but funds are not forthcoming. The problem gets forgotten until the next doomsday report. Along with contraception and sexual health services, condom budgets are a soft target and are slashed to save money. A simple condom costs the NHS about 8p, and prevents a wide range of STIs as well as unplanned pregnancies. Yet according to the national strategy for sexual health: "The average lifetime treatment cost for an HIV-positive individual is calculated to be between £135,000 and £181,000, and the monetary value of preventing a single onward transmission is estimated to be somewhere between £500,000 and £1m in terms of individual health benefits and treatment costs."
We could defuse this time bomb. We desperately need more funding for education, better and more appropriate ways of reaching out to young people, better detection of infection and earlier treatment. But specialists and other healthcare professionals are not optimistic.
Sexual health is a sensitive and intensely personal subject. Most young people are too embarrassed to seek advice. It takes obvious ill-health - and often a last resort - to consult a healthcare professional or, indeed, a family doctor.
· Helen Knox is a clinical nurse specialist in contraceptive and sexual health, founder of SEXplained... Ltd, WillyWorries.com and FemGen.com
