Sexually transmitted infections (STIs) are on the rise in England. A recent report conducted by HIV prevention charity Terrence Higgins Trust and British Association for Sexual Health and HIV (BASHH) found that new STI diagnoses have risen by 5% from 2017 to 2018.

While some infections, like genital warts, have seen a decrease, others, like syphilis and gonorrhoea have skyrocketed by 165% and 249% respectively.

Why are we seeing such a rise in STIs? How do we deal with STIs as a community? And how does an infection impact the way we talk about and have sex?

The figures from THT and BASHH match the trends found in a smaller sample survey called ‘How risky is your sex life?’ by GMFA – the gay men’s health project. The survey, which has been taken by over 600 gay and bisexual men over the past three years, also looks into the emotional impact of STIs and delves into how and why they were diagnosed.

FACTS ARE FACTS

Let’s start with the facts and stats from the ‘How risky is your sex life?’ survey.

First we asked the respondents when was the last time they had an STI test:

Then we asked those who have tested if they have ever had an STI:

For those that said ‘yes’, we asked what they tested positive for: 

We also asked whether they had been tested for HIV in the last 12 months:

WHAT, WHO AND HOW

Gonorrhoea is on the rise and our survey indicates that chlamydia is still a major contender in STI prevalence, but what STIs were you diagnosed with and do you know how you got them?

Gregory, 31, told us: “I got symptoms for herpes in my ass. I’ve had a few flare-ups over the years. I got it after about a 20-second interchange in a sauna.”

“I had symptoms in the penis,” says Lachlan, 37. “I

informed my partners and the treatment was quick and easy. I have been informed by others in the past when they have been diagnosed with an STI too and I’ve always gone to get checked straight away.”

Adam, 38, had told us his story: “I had sore and itchy hands, and very itchy ankles. I originally though it was an allergic reaction but discovered it was scabies. My GP didn’t recognise it but I realised what it was after a few days. Treatment was very easy as I was able to buy a cream over the counter from a pharmacist.”

“I had symptoms for gonorrhoea,” says Dave, 44. “It was very painful. I got it from a one-night stand on holiday and I had no way to contact him. The treatment was quick and easy. I also picked up syphilis from a sauna visit. I was unable to trace a partner but refrained from sex until I was clear. The treatment was also easy and effective.”

TIMING IS EVERYTHING

STIs don’t tend to stick to a timetable and sometimes the symptoms can hit us at the most inopportune times. Some symptoms, such as pain while urinating and discharge, are harder to ignore than others.

James told us about his STI symptoms occurring at an inappropriate time: “I started to get symptoms when I arrived at Glastonbury. Mud, music and discharge. Gonorrhoea at Glasto. It was 2005, which was one of the wettest and worse festivals too. I arrived Thursday with no wellingtons, gono appeared on Friday, I had to leave on the Saturday as I was just so bad down there. I got a train back to London and watched the rest of Glasto on the television before I could get treatment on the Monday.”

“I found out I had an STI while I was in bed with my boyfriend,” explains Kurt, 27. “I woke up one morning with discharge from my penis. We were monogamous. At least I thought we were. It turns out he had been cheating on me and passed on a special gift.”

Matthew, 37, had a less than jolly festive season a few years ago. “I went back home for Christmas the day before Christmas Eve, and that evening it began to burn when I went to the toilet. I wasn’t returning home until after Boxing Day and most clinics would’ve been closed anyway. I was stuck with it. The Christmas gift that no one wants.”

MAKING YOUR DEBUT

Everyone remembers their first time. Unfortunately with STIs, that experience can burn in your memory as much as it did when you urinated.

“I remember not knowing what it was,” explains Lee, 31. “I was 19, not that sexually experienced really, and I didn’t know why it hurt when I pissed and why there was discharge. I was still living at home and I ended up going to my GP. They did some tests which took FOREVER to get the results back. Then I was referred to the sexual health department of my local hospital, which also took a long time. I was living with it for about a fortnight until I got treated. It definitely scarred my memory and made me very wary of sex for a long time.”

Tim, 29, told us his about his first time. “My first STI was gonorrhoea. I had so much discharge from my penis and it hurt to go to the toilet. I booked an appointment at a GUM clinic as soon as I could. By that point the discharge was so bad that I had to put a sock over my penis so it wouldn’t soak through my trousers.”

Not every inaugural STI is traumatic however.

“I didn’t have any symptoms with my first diagnosis,” explains Ryan, 24. “I went for a routine sexual health check-up and they told me I had chlamydia in the throat and ass. I got treated and I told the person I’d been sleeping with. The staff at the clinic were great and reassuring.”

Harry, 22, spoke to us about his first STI. ““I started PrEP in 2017 and I got my first STI. I started having bareback sex and going to fetish clubs and saunas. About three months after, l started getting stomach pains and feeling bloated. I asked my best friend to go with me to my local GUM clinic and the next day I received a text message telling me I was positive for gonorrhoea and Chlamydia in my penis and ass. I was scared as to what was going to happen to me as it was my first ever STI. My best friend told me not to worry and that they were super treatable. I got so scared I started to get tested for STIs and HIV every month, until the nurses told me it was ridiculous to get tested for HIV that often.”

Ian Howley, Chief Executive of LGBT HERO, the parent organisation of GMFA - the gay men’s health project said, “Although most of the men who talked with FS said they found the treatment to be “quick and easy”, many were still scared to catch an STI. This is a common reaction. The thing to remember is that there is no shame in picking up an STI, most STIs are simply another bacterial infection and we pass on these type of viruses to each other all the time. For example, the flu! However because these infections are related to sex and we have stigmatised the hell out of them people are scared to be diagnosed with some delaying testing because of that fear. We need to work on de-stigmatising STIs, increase the knowledge around just how easy it is to get treated and have better conversions around STIs.”

MORE THAN ONE

Some people, through no fault of their own, rack up the numbers when it comes to STIs. Infections are indiscriminate, so often there’s no stopping them whatever precautions you take.

Tommy, 37, informed us: “I have had syphilis, genital warts, gonorrhoea, scabies and pubic hair lice. Let’s take them one at a time. Pubic Hair Lice: I was dating a nice guy and everything was going OK but then it kinda ran its course and I was ready to end it. Just a few days before we were planning to meet I went to a clinic for a regular STI check-up. The doctor who assessed me informed me I had pubic hair lice. I was in denial and shock and only at a very small thing, I was young and didn’t know a lot. I said, “I can’t have lice”, and he said you can here is a nest of eggs - he pointed to a tiny patch of white shiny dust on my pubes. I thought OK I have lice. It was just tragic timing.

Scabies: The first boy I ever kissed in my life gave me scabies, which I brought home to my family house. Needless to say the whole place had to be cleaned and cleared. I had to douse myself in Lyclear, it got rid of them, but it was pretty embarrassing. Rotten luck to get something on the very first kiss.

Gonorrhoea: My boyfriend at the time gave me the clap and tried to blame me for it. I insisted I didn’t have it and had been faithful and he must‘ve gotten it from somewhere else. We fought a lot, we went to the clinic, they tested us, he had it, I didn’t. We should have broken up then as he was trying to pin his infection on me to cover his infidelity. I am and was far too easy going about it.

Syphilis: I met a gorgeous red haired young man. He had a rash on his chest, but as he was ginger I thought it was just his colouring. We made love a lot. We were dating for weeks. He developed a wart on his penis about four weeks into our fling. I developed a similar wart in my mouth about four weeks after our fling had ended. I got diagnosed with syphilis. I got treated with two shots of penicillin, one in each butt cheek. He didn’t handle it very well, he distanced himself from me and refused to believe he had syphilis. I didn’t mind so much that he had infected me, I mean I got treated pretty quickly, I just wanted him to take care of himself. He didn’t.

Genital warts: I got them on my dick, right on the head of the penis. They had to be burnt off with freezing cold paste from a stun gun apparatus. It was 20 years ago so my memory is scant, but I do remember asking the man treating me for a break, he had little sympathy and gave me about 30 seconds to breathe.”

Ian Howley of LGBT HERO said, “Tommy’s story is a prime example that it just takes one time for pick up an STI. Unfortunately, if you were to ask some gay and bisexual men on social media they’d have you believing that only people who attend orgies or enter darkrooms get STIs. And they are bad people for it. This level of stigmatising and ‘false news’ is not helpful in the battle to reverse the rise of STIs. You are not a better gay because you believe you never had an STI, and you are not a bad gay for being diagnosed with syphilis.

SYMPTOMS TO LOOK OUT FOR

How do you know if you have an STI? The simple answer to that is to get tested regularly. Every three to six months, depending on the type of sex you have. Some STIs may no show symptoms, which is why testing is so important, but here are a few to look out for:

Chlamydia: you might see a yellowy white discharge from your penis or irritation in your ass or throat. You may also have pain while urinating. However, some people don’t show any symptoms at all or dismiss a sore throat.

Gonorrhoea: symptoms can include a white or greenish discharge from your penis and a burning sensation when you urinate or cum. Rectal symptoms may include a yellowish discharge, fresh blood in your stools, mild diarrhoea, or itching and pain. Orally can result in a sore throat. Sometimes there are no symptoms.

Syphilis: this is a little more complicated. In stage one you might see a small painless sore or hardened lump one to ten weeks after infection, near the point where the bacteria entered your body. This could be your arse, penis or mouth. It’s possible for this to go unnoticed. Stage 2 can occur two to six months later with a rash on the body and a flu-like illness involving fever, headache and sore throat. Stage 3 usually has no symptoms and stage 4 occurs after a couple of years. It will stop being contagious but at this stage the infection can cause blindness, deafness, brain damage, heart attacks, paralysis, lung problems and strokes.

Shigella: you might no see any symptoms but some people get nausea, vomiting, diarrhoea, fever, and abdominal pain.

It’s important to go for regular sexual health screenings and inform any partners if you test positive, to stop the infection from spreading to others.

WHAT’S THE DIAGNOSIS, DOC?

Sexual health specialist Dr Sean Cassidy gives us a breakdown of tests and treatments for some of the major STIs.

Chlamydia 

Test: urine sample and swabs from throat and rectum.Treatment: one week course of oral antibiotics

There is a more severe form of chlamydia called LGV (lymphogranulum venereum); this usually affects the back passage. If your rectal chlamydia test is positive then usually the clinic will automatically send an LGV test, although this can take a couple of weeks to come back.

Treatment involves a longer course of the same antibiotic used to treat chlamydia; this is usually three weeks.

Gonorrhoea

Test: urine sample and swabs from throat and rectum. If you have symptoms and/or are a contact of gonorrhoea, then you may need to have additional swabs including a swab from your urethra (pee-pipe). This is a culture test which allows the clinic to determine the right antibiotics to treat gonorrhoea with, as some strains are becoming resistant to first-line treatments.

Treatment: usually a one-off dose of intramuscular antibiotic (i.e. injection in your bum); if you are allergic then you may be given a course of oral antibiotics instead. It is important you have a repeat test 2-3 weeks after treatment to ensure the infection has resolved, this is called a ‘test of cure’.

Syphilis

Test: blood test which looks for antibodies to syphilis; if you have ever had syphilis before this will remain positive lifelong. In these cases, a separate blood test is carried out (usually called RPR) which can indicate a new infection and determine response to treatment.

Treatment: usually a one-off dose of intramuscular antibiotic (i.e. injection in your bum); if you are allergic then you may be given a course of oral antibiotics for two weeks instead.

Scabies

Test: diagnosed clinically, i.e. based on appearance and pattern of symptoms. If there is doubt over the diagnosis then sometimes a scraping can be taken from the skin and looked at under a microscope.

Treatment: lotion which is applied to the entire body as a one-off treatment.

Herpes

Test: diagnosed via a swab test when symptoms are present.

Treatment: usually treated with a course of anti-viral medication during outbreaks; in people who have multiple outbreaks then sometimes suppressive therapy is given over longer time periods (e.g. six months to one year).

Hepatitis C

Test: blood test which can differentiate between current or past infection

Treatment: a course of anti-viral medication usually lasting around 8-12 weeks depending on which strain of hepatitis C you have.

Hepatitis B

Test: blood test which looks for current infection, previous infection or response to vaccination.

Treatment: infection acquired during adulthood usually resolves without treatment and confers lifelong immunity; in those people who develop chronic infection then this requires lifelong anti-viral treatment. Chronic hepatitis B infection can increase the risk of liver cancer and therefore it is necessary to have an ultrasound of the liver once a year to screen for this.

Shigella

Test: stool sample

Treatment: shigella is self-limiting so usually does not require treatment; sometimes a course of antibiotics is needed.

Hepatitis A

Test: blood test which can check for current infection or for antibodies (i.e. to check if you’ve been exposed to Hepatitis A before, whether through vaccination or previous infection)

Treatment: Hepatitis A is a self-limiting infection which doesn’t have a specific treatment. However, some people with the infection can be very unwell, requiring hospital admission and supportive management such as IV fluids.

REMEMBER: SEX IS FUN

Although all the STIs we have discussed may seem a little off-putting or scary, it’s not a bad thing to have an active fun sex life.

Having regular sex is a healthy part of life, however you want it and however you do it.

However, being educated and knowledgeable about different STIs, where to get tested and how to treat them is important in stopping the spread and rising rates of STIs. Get tested every three to six months. If you sex life is a little riskier, for example you enjoy bareback sex with multiple partners, then talk to your local GUM clinic about how often you should be testing and use websites such as www.gmfa.org.uk to find out ways to stay safer.

Finally, Ian Howley of LGBT HERO said: “If we truly want to reverse the rise of STIs in the community then we need to have a frank and honest conversation with ourselves to see how we can all work to get these numbers down. This might be you telling yourself to get tested more often, if you are engaging in condomless sex with multiple partners then try and reintroduce condoms back into your sex life for a while until we get the rate down or end some of these STIs.

“But remember, not all STIs are passed through fucking. Oral sex is a common way STIs are passed on. Even basic skin to skin contact during sex is enough for some STIs. The advice would be to use condoms for oral sex but we know, you know, everybody knows, that’s not going to happen so the best thing to do is know and look out for the symptoms of STIs and have regular check ups.”

Ian continues, “Most symptoms will start to show within a couple of weeks after infection has occurred. It takes roughly 10 days for an STI to show up in test and about four weeks for HIV.

“But the biggest advice we should all take from this is don’t be scared. Sex is supposed to be fun, if you pick up an STI it’s fine, we pass on viruses to each other every single day. The best thing to do is don’t ignore the symptoms, get tested, get treated, inform previous partners and let’s all work together to get these numbers down.”


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