Rates of sexually transmitted infections (STIs) are soaring in Ireland, raising questions about why this is happening and what those who are sexually active can do to protect themselves.
From the beginning of this year to October 7, the Health Protection Surveillance Center (HPSC) recorded a total of 10,546 cases of chlamydia. An increase of 40% over last year.
Gonorrhea cases increased from 2,769 in 2022 to 5,309 in 2023, an increase of 91%. Herpes cases increased by 6% and HIV cases by 11%.
The numbers represent people who took the test. They exclude people who may have symptoms but are afraid of getting tested, as well as those who have not yet shown symptoms of infection.
Dr Nick Flynn, of Union Quay Medical Center in Cork, which provides a comprehensive STI screening service, said this lack of awareness was not unusual.
“Many STIs can be asymptomatic or show only mild symptoms, making it possible for people to be infected without knowing it.
“Chlamydia is a common asymptomatic sexually transmitted infection that, if left untreated, can cause long-term damage to the body’s reproductive system.”
Dr Aisling Lowy is a consultant in sexual health and HIV care at St James’s Hospital in Dublin.
She believes that many sexually active people have unknowingly been exposed to or carried common sexually transmitted infections such as gonorrhea, herpes or human papillomavirus (HPV).
“Take HPV, for example,” she said. “Many of us are infected but only a small number of cases result in abnormal cervical smears, cervical cancer or genital warts.
Because we can carry these STIs without showing symptoms, sexually active people are advised to take proactive steps to stop their spread.
Regular STI testing is an important aspect of this, especially for those most at risk.
Professor Fiona Lyons is clinical lead for the HSE’s Sexual Health and Crisis Pregnancy Programme.
By analyzing HPSC data, she identified two groups most affected by STIs.
One category is young people aged 15 to 24, and the other category is gay, bisexual and other men who have sex with men.
“It’s important for the public, especially young people and men who have sex with men, to understand how to prevent STIs and when, how and where to get tested,” she said.
Lowy said there are two main reasons why people should get tested regularly.
“We want to minimize the risk of spreading the infection to others and prevent the serious health consequences that untreated STIs can have,” she said.
“We know that some STIs can cause pelvic inflammatory disease, which can lead to fertility problems, while others, such as syphilis, can affect the development of a pregnant woman’s fetus.
“But most STIs are now treatable or manageable, so it’s best to diagnose them as early as possible.”
Lyons and the team at the Sexual Health and Crisis Pregnancy Program have launched free home STI testing to make services more accessible.
“We want to increase access to STI testing and know that these tests are simple enough for most people to do themselves at home,” Lyons said.
“Following pilot testing in Cork and Kerry in 2021, we rolled out nationally in October 2022 and can now report a successful first year.”
In 2022, SH24.ie ordered a total of 96,996 free home testing kits, 56% of which were ordered by people who had never been tested for an STI before.
Professor Sam McConkey, consultant in infectious diseases at Dublin’s Beaumont Hospital, believes home testing kits may have influenced the current spike in sexually transmitted infection rates.
“Rapid home testing is a more accessible way for people to get tested,” he said. “They don’t have to go to the doctor or go to a clinic. They can just order the kit and it will arrive in the mail.
“They collect some samples, send the kit back for processing, and get the results back within 72 hours of the sample arriving at the lab. This is a huge advance in health care and could explain the increase in sexually transmitted infections.
Social changes may also influence rising rates of sexually transmitted infections. Flynn has observed a change in attitudes toward STI testing.
“The stigma that existed in the past no longer exists and we are seeing more and more people attending sexual health checks regularly,” he said.
“Some people participate once a year, others every six months, some every three months, depending on their perceived risk of their behaviour.”
Lowe suggested other possible explanations.
“Dating apps and hookup culture have increased the likelihood of sexual activity, especially casual sex,” she said. “Exposure to pornography means young people engage in more sexual activity, which often leads to riskier oral and anal sex.
“Increased cocaine use lowers people’s inhibitions, leading to more risk-taking behavior.”
Lowy said the introduction of pre-exposure prophylaxis (PrEP), which can stop the spread of HIV if taken before unprotected sex, could lead to a decline in condom use among men who have sex with men.
“Overall, condom use has also decreased.”
Sex education is still lacking, she said. “I’m still shocked every day by how little people know.”
So, what steps can we take to prioritize sexual health? First, we need to know when to test.
“If you have symptoms suggestive of an STI, your partner has an STI, you are in a non-monogamous relationship, you have multiple sex partners, you have a new sex partner, you are pregnant, or you… Testing recommended “We are using PrEP to prevent HIV,” Flynn said.
Second, how often should you test?
“It depends on your level of risk,” McConkey said. “For example, if you change sexual partners frequently, it is recommended that you have a check-up every three months. This way, if you contract an infection, it can be treated before any complications develop.
Third, people should realize they have choices when it comes to testing.
“The HSE’s free home testing kit includes answering some questions to determine which tests you need,” Lyons said. “You will then receive the test and instructions on how to take it.
“This may include taking a swab from the throat, anus, penis or vagina and a small blood sample.
If you’re experiencing symptoms such as changes in vaginal discharge, discharge from the tip of your penis or painful urination, Lowy recommends making an appointment to see your GP or sexual health clinic.
“The nurse or doctor there will ask about your symptoms and sexual history,” she said. “They will then carry out a quick and simple test, which usually involves a vaginal swab for women, a urine sample for men and throat and anal swabs. “Blood samples will also be taken. “
Flynn hopes to reassure people, noting that most STIs are treatable or at least controllable.
“Antibiotics often treat chlamydia, gonorrhea and syphilis, while antiviral drugs treat viral infections such as herpes and HIV,” he said.
McConkey is eager for people to know that vaccines can prevent certain sexually transmitted infections.
“There are now hepatitis B vaccines and HPV vaccines available for school boys and girls,” he said.
“If all young people were vaccinated against hepatitis B and HPV, it would stop the spread of related sexually transmitted infections.”
Experts say prevention is the first line of defense.
“The best way to protect yourself is abstinence, but that’s no fun,” Lowe said. “So the best thing to do is use a condom when having oral, anal or vaginal sex.”
McConkey added that condoms should be used responsibly.
“When used correctly, they can stop the spread of most sexually transmitted infections,” he said. “But they need to be used with caution because people can forget to use them, or they can also fall off during sex.”
For those who want to have sex with someone new, Lyons recommends doing it safely: “Using condoms can help prevent STIs and unwanted pregnancy.
“They are available free of charge at STI clinics, student health services, tertiary settings, sexual health NGOs and community venues. Before you stop using condoms, consider getting an STI test to ensure you are both protected .”
McConkey summed up the public health message about STIs by saying, “We’re not trying to scare people. We want people to understand their bodies and enjoy their sexual expression in a positive and healthy way.”
“That requires knowledge and information, and that’s what we’re trying to provide.”
Thirty-year-old Amy* had always wanted to undergo an intense test for sexually transmitted infections, but the cost of doing so was too high.
“I’ve always wanted to get tested, but I was worried,” she said. “Not knowing what it involved added to my anxiety, so I thought about the potential outcomes and was afraid of being judged.”
When she finally got checked in at the clinic, she was pleasantly surprised by how quick and easy the experience was.
“Everyone was warm and friendly, which helped ease my nerves,” she said. “The procedure was explained to me.
“My questions were answered and I was assured that all my details would be kept confidential.
“The whole process lasted about 15 minutes and by the end, I felt relieved and empowered that I had overcome my initial hesitation and taken control of my health.”
The process started by asking some questions to determine what tests Amy needed, then taking a blood sample to check for HIV, syphilis and hepatitis C.
Amy is determined to get checked regularly in the future.
“I think this is an important aspect of maintaining overall health and I am committed to prioritizing my health,” she said.
She only saw the benefits of doing so. “In my experience, testing can give you peace of mind and reduce anxiety and uncertainty about your health status.”
She urged others who may be afraid of getting tested to make an appointment. “You may not know what you’re dealing with, but it’s not as scary as you think,” she said.
“When you get tested for an STI, you’re probably going to get nothing but understanding and sympathy.”
For more information visit sexwellbeing.ie