Sexual healing: Here's all you need to know about STI screening as infections in Ireland soar
Because we can carry these STIs without showing symptoms, it is recommended that sexually active people take proactive steps to stop them from spreading.
Rates of sexually transmitted infections (STIs) are soaring in Ireland, prompting questions about why this is happening and what those with an active sex life can do to protect themselves.
From the beginning of this year to October 7, the Health Protection Surveillance Centre (HPSC) recorded 10,546 cases of chlamydia. That’s an increase of 40% on last year’s rate.
Gonorrhoea cases are up 91% from 2,769 in 2022 to 5,309 in 2023. Herpes cases have risen by 6% and HIV cases by 11%.
These figures represent people who present for testing. They exclude those who may be symptomatic but fearful of getting tested and those who don’t yet have symptoms of infection.
This lack of awareness is not uncommon, says Dr Nick Flynn of the Union Quay Medical Centre in Cork, which offers a full STI screening service.
“Many STIs can be asymptomatic or only show mild symptoms, making it possible for people to be infected without realising it.
"Chlamydia is a common silent STI and, if left untreated, can cause long-term damage to the body’s reproductive system.”
Dr Aisling Loy is a consultant in sexual health and HIV care at St James’s Hospital in Dublin.
She believes many sexually active people will have been in contact with or carried common STIs such as gonorrhoea, herpes, or the human papillomavirus (HPV) without knowing it.
“Take HPV for example,” she says. “Many of us are infected but only in the minority of cases does it cause abnormal cervical smears, cervical cancer or genital warts.
Because we can carry these STIs without showing symptoms, it is recommended that sexually active people take proactive steps to stop them from spreading.
Regular STI testing is a vital aspect of this, particularly for those most at risk.
Prof Fiona Lyons is the clinical lead for the HSE’s Sexual Health and Crisis Pregnancy Programme.
From analysing the HPSC figures, she identifies two groups as being the most affected by STIs.
One is young people aged 15 to 24 and the other consists of gay, bisexual, and other men who have sex with men.
“It’s important for the general public, but particularly young people and men who have sex with men, to understand how to prevent STIs and when, how and where to test for them,” she says.
There are two main reasons why people should get tested regularly, according to Loy.
“We want to minimise the risk of passing the infection to others and we want to prevent the serious health consequences that can result from untreated STIs,” she says.
“We know that some STIs can cause pelvic inflammatory disease and in turn cause fertility issues while others, such as syphilis, can impact the developing foetus in a pregnant woman.
"But most STIs are curable or manageable now, so it’s best to get diagnosed early.”
Lyons and the team at the Sexual Health and Crisis Pregnancy Programme introduced free home STI testing to make the service more accessible.
“We wanted to improve access to STI testing and know that the tests were simple enough for most people to administer themselves at home,” says Lyons.
“After piloting the test in Cork and Kerry in 2021, we introduced it nationwide in October 2022 and can now report a successful first year.”
A total of 96,996 free home testing kits were ordered from SH24.ie in 2022, 56% of which were ordered by people who had never been tested for STIs before.
Prof Sam McConkey, an infectious diseases consultant at Beaumont Hospital in Dublin, believes the home testing kits may have impacted the current spike in STI rates.
“Rapid home testing is a far easier way for people to get tested,” he says. “They don’t have to see a doctor or go to a clinic. They simply order the kit, and it arrives through the post.
"They take some samples, send the kit back for processing and are contacted with their results within 72 hours of the samples arriving in the lab. This is a big step forward in healthcare and could explain the increase in STI figures.
Societal shifts may also be affecting the rise in STI rates. Flynn has observed a change in people’s attitudes to STI testing.
“The stigma that existed in the past isn’t there anymore and we’re seeing more people attend for regular sexual health checks,” he says.
“Some attend annually, others six-monthly, and some three-monthly depending on the risk they perceive in their own behaviour.”
Loy suggests other possible explanations.
“Dating apps and hookup culture have increased the availability of sex, especially casual sex,” she says. “Exposure to porn means more performative sex in young people, which often leads to riskier oral and anal sex.
"The increase in cocaine use decreases people’s inhibitions, which can lead to more risk-taking.”
The introduction of Pre-Exposure Prophylaxis (PrEP), which stops the transmission of HIV if taken in advance of unprotected sex, may have led to a decrease in condom use in men who have sex with men, says Loy.
“There’s also been a decrease in condom use in general.”
And there’s still a lack of sex education, she says. “I’m still shocked on a daily basis by how little people know.”
So, what steps can we take to prioritise our sexual health? Firstly, we need to know when to get tested.
“Testing is advisable if you have a symptom that suggests an STI, your partner has an STI, you’re in a non-monogamous relationship, you have multiple sexual partners, you have a new sexual partner, you’re pregnant or you’re using PrEP for HIV prevention,” says Flynn.
Secondly, how often should you be tested?
“It depends on your level of risk,” says McConkey. “If you regularly change sexual partners, for example, it’s recommended you get tested every three months. That way, if you catch something, it can be treated before there are any complications.
Thirdly, people should be aware that they have options when it comes to testing.
“The HSE’s free home testing kit involves answering some questions to determine what tests you need,” says Lyons. “You are then sent the tests as well as instructions on how to carry them out.
"This may include taking swabs from your throat, anus, penis or vagina as well as a small blood sample.
If you have symptoms such as a change in vaginal discharge, discharge from the tip of the penis or pain passing urine, Loy recommends making an appointment to see your GP or a sexual health clinic.
“The nurse or doctor there will ask about your symptoms and your sexual history,” she says. “They will then carry out quick and simple tests that usually involve a cotton bud swab of the vagina for women and a urine sample for men as well as a throat and anus swab for both. A blood sample will also be taken.”
Flynn wants to reassure people, pointing out that most STIs are treatable or at least manageable.
“Antibiotics can generally cure chlamydia, gonorrhoea, and syphilis while antiviral medications can manage viral infections like herpes and HIV,” he says.
McConkey is eager for people to understand that vaccines can prevent some STIs.
“There’s now a vaccine for hepatitis B and the HPV vaccine, which is available to schoolboys and girls,” he says.
“If all young people were vaccinated against hepatitis B and HPV, this would halt the spread of associated STIs.”
Prevention is the first line of defence, say experts.
“The best way to protect ourselves is abstinence but there’s not much fun in that,” says Loy. “So the next best thing is to use a condom when you’re having oral, anal, or vaginal sex.”
McConkey adds that condoms should be used responsibly.
“They prevent the transmission of most STIs as long as they are used correctly,” he says. “But they require careful use as people can get carried away and forget to use them or they can also come off during sex.”
For those about to embark on a sexual relationship with someone new, Lyons advises doing so safely: “Use condoms to help prevent STIs and unwanted pregnancy.
"They are available for free through STI clinics, student health services, third-level institutions, sexual health NGOs and community venues. And before you stop using condoms, consider having an STI check-up to make sure you’re both protected.”
McConkey sums up the public health message regarding STIs, saying: “We’re not trying to frighten people. We want people to understand their bodies and to enjoy their own sexual expression in a way that is positive and healthy.
"This requires knowledge and information and that’s what we’re trying to provide.”
Thirty-year-old Amy* always intended to get tested for STIs but was too nervous to do so.
“Getting tested had been on my mind for a while but I was apprehensive,” she says. “Not knowing what it involved added to my anxiety and so did thoughts of the potential outcomes and fear of judgement.”
When she finally got tested at a clinic, she was pleasantly surprised by how quick and easy the experience was.
“Everyone was welcoming and friendly, which helped to ease my nerves,” she says. “The procedure was explained to me.
"My questions were answered, and I was assured that all my details would be kept private and confidential.
“The whole thing took approximately 15 minutes and by the end, I felt a sense of relief and empowerment because I’d overcome my initial hesitation to take charge of my health.”
The process started with some questions to determine which tests Amy needed, after which a blood sample was taken to check for HIV, syphilis and hepatitis C.
Amy is determined to get tested regularly in the future.
“I see it as an important aspect of maintaining overall wellbeing and I’m committed to prioritising my health,” she says.
She only sees benefits in doing so. “In my experience, testing provides peace of mind and reduces anxiety and uncertainty about your health status.”
And she urges others who may be fearful of getting tested to book an appointment. “You may not know what you’re facing but it’s less intimidating than you think,” she says.
“You’re likely to be only met with understanding and compassion when you get an STI test.”
For more information, visit sexualwellbeing.ie
