As gonorrhoea and chlamydia levels soar in the UK, we need to tackle the stigma around sexually transmitted infections
As much as we would like to ignore it, there's no denying that having sex opens you up to the possibility of catching sexually transmitted infections (STIs).
According to the latest figures, cases of diseases, such as gonorrhoea, have risen three-fold in the last year. The UK's chief medical officer, Sir Chris Whitty told MPs there are about 199,000 cases of chlamydia a year, as well as about 82,000 cases of gonorrhoea, about 26,000 cases of genital warts, and 8,500 cases of syphilis.
Sir Chris said the normalisation of STIs was crucial in tackling the problem. “The first thing to do is to normalise them,” he said. He inferred that often, people think it won't happen to them “rather than just to say, ‘look, this is just a normal thing that happens a lot in lots of different places’."
He encouraged people to view sexual transmission in the same way we view “oral or respiratory transmission – such as Covid or measles.” Speaking at the Women’s and Equalities Committee, he insisted: “It is very important that we don't see this as in any way stigmatising,” before adding “Rhese are very common diseases, they spread around very easily, lots of people get them who have incredibly conventional, sexual and romantic lives.”
He also revealed that despite the figures already rising, there are likely a lot more cases that we don't know about. “Large numbers of people carry these infections without knowing about them’, so the figures are the ‘bottom end of the range,’” Sir Chris said.
As for why it's so important to prevent STIs, Sir Chris pinpointed gonorrhoea, in particular, as difficult to treat. “Gonorrhoea is, in the UK and internationally, one of the most highly drug-resistant organisms we have,” he said. “So we’re down to a very limited number of antibiotics now which can be used – previously we’d have had a much wider range. Fortunately, this hasn’t translated into drug resistance for most of the other antibiotic-treatable sexually transmitted infections, at least not to this level. But if we are really in deep trouble at the moment we do need some new antibiotics or some new way of approaching.”
It's estimated that 78% of men would take contraception, but they fear the potential side effects.
Research shows the age group most likely to be diagnosed with sexually transmitted infections is people who are 15-24 – and though the higher numbers may in part be due to increased testing, experts believe infections are certainly on the rise. This has been a steady pattern each year, with the exception of 2020, which saw STI rates dip as lockdown meant fewer people were having sex with new partners. Last year, Richard Angell, Chief Executive of Terrence Higgins Trust, revealed testing rates remain lower than pre-COVID, but the number of STIs being diagnosed is exceeding the high levels reported before the pandemic.
The latest figures concede that Chlamydia was by far the most commonly diagnosed STI overall, while syphilis cases reached the highest in any given year since 1948. And gonorrhoea numbers were the highest since annual records began in 1918.
With the average Brit having 18 different sexual partners in their lifetime, we should be talking openly.
How to defend against STIs?
The best defence against STIs is always condoms. If you're having sex casually or with a new partner, it's always advised to both get yourselves tested so you don't pass anything on – and if you've slept with someone new without a condom, get yourself to a sexual health clinic to protect yourself.
One of our sexual wellness writer's current faves when it comes to condoms:
Where can I get an STI test?
There are plenty of places you can get an STI test. You can visit your local GP or an NHS sexual health clinic for free. Some health clinics offer drop-in services so you don't need an appointment, but it's a good idea to call first to see if this is the case. You can find your nearest sexual health clinic here. Meanwhile, pharmacies like Superdrug sell STI test kits from £34.
How do I know if I've got an STI?
Remember, not all sexually transmitted infections cause symptoms, so it's always best to get tested if you've been with a new partner, to be sure. And just so you're clued up, here's what to look out for when it comes to STIs – so you'll know what to do if you catch more than feelings next time you have sex…
Chlamydia
What is it and how can you catch it?
Chlamydia is a bacterial infection and one of the most common STIs in the UK – it's transmitted during sex and sexual activity that involves the exchange of genital fluids (semen and vaginal discharge). You can catch chlamydia by getting genital fluids in your eye (yep), from sharing sex toys, rubbing genitals (no penetration or ejaculation needed - it's very contagious) as well as oral, anal and vaginal sex.
What are the symptoms?
Most people who have chlamydia don't notice any symptoms, but the ones who do usually experience a change in discharge, a pain when peeing, women sometimes get lower tummy pain or bleeding after sex, and men can get swollen or painful balls.
Although these symptoms may not sound particularly threatening, if the infection is left untreated it can spread to the rest of your body. In women, this can result in pelvic inflammatory disease and infertility as well as birth defects and premature labour if the infection goes untreated throughout a pregnancy.
What is the test?
A simple urine test or vaginal or anal swab will be able to determine if you are infected. You can get these tests at your GP, local sexual health clinic, or in the post sent to your home.
What is the treatment?
Chlamydia can be treated with a short course of antibiotics, either taking two to four tablets of one type in one go, or taking a week's course of another. It's imperative that your previous partners get treated, and that you don't have any type of sexual contact until seven days after you finish treatment.
Gonorrhoea
What is it and how can you catch it?
Gonorrhoea is a common sexually transmitted infection caused by a bacteria called neisseria gonorrhoeae. It's easily passed between people through vaginal, oral or anal sex as well as sharing sex toys.
What are the symptoms?
Half of infected women and 1 in 10 men don't experience any symptoms whatsoever, but they can include a thick green or yellow discharge, pain when peeing, and bleeding in between periods.
Left untreated, gonorrhoea can cause serious complications in other parts of the body including pelvic inflammatory disease, which can lead to ectopic pregnancy and infertility. During pregnancy, it can also cause miscarriage, premature labour and visual impairment in the baby.
Who is at risk?
Gonorrhoea is highly contagious, so anyone who has multiple sexual partners has an increased risk.
What is the test?
A simple urine test or vaginal or anal swab will be able to determine if you are infected. You can get these tests at your GP, local sexual health clinic, or in the post.
What is the treatment?
A simple course of antibiotics is usually used to treat it (given as an injection in the bum cheek) followed by a tablet. It's recommended that you attend a follow up appointment to check if you are clear as some strains of gonorrhoea have resistance to common antibiotics.
Syphilis
What is it and how can you catch it?
Syphilis is a bacterial infection that's caught when you have sex with someone who is infected.
What are the symptoms?
The initial symptoms vary and tend to be mild and disappear over time - but you remain infected until you receive treatment so it's important to get tested. The early symptoms that develop around three weeks after exposure can range from the appearance of small, painless sores on your vagina, penis, anus, mouth and fingers. You may also notice swollen glands in your neck or armpit. Later on, the infection develops to cause a blotchy rash, small wart-like growths, white patches in the mouth and flu-like symptoms. Although these usually only last a few weeks, the infection can still spread internally, eventually effecting the brain. Late stage syphilis that has spread to the brain can cause dementia symptoms, meningitis, strokes and more - so don't hesitate to get tested.
Who is at risk?
As with any infection, someone with an impaired immune system has an increased risk.
What is the test?
A standard blood test is used to determine if you are infected. You can book in for one at your GP or at your local sexual health clinic.
What is the treatment?
Early stage syphilis is treated with a short course of antibiotics (an injection of penicillin into your bum cheek). Later stages are treated with three injections, given at weekly intervals, or a 28 day course of tablets.
HIV
What is it and how can you catch it?
Human immunodeficiency virus, commonly referred to as HIV, is a virus that damages your immune system and weakens your ability to fight everyday infections and disease. Left untreated and unmanaged, the virus can lead to the development of acquired immune deficiency syndrome (AIDS), which refers to the life threatening infections that occur as a result of an immune system weakened by HIV.
HIV can be transmitted in a number of different ways, but involves the exchange of bodily fluids (semen, vaginal and anal fluids, blood and breast milk) from an infected person to a non-infected person (it cannot be transmitted through saliva, sweat or urine). This means that HIV can be transmitted through sex, anal sex and oral sex (although, the chances are much lower with oral sex), as well as during pregnancy, breast-feeding and other non-sexual ways.
Who is at risk?
Anyone who has unprotected sex is potentially at risk, so it's important to take proper precautions. If you do not know your sexual partner well, and are not sure whether they have had a recent sexual health check up, it is important to use a condom and an oral dam for oral sex.
HIV doesn't discriminate - anyone can catch it but research has shown that there are certain groups of people who have an elevated risk of catching it. People who have unprotected sex with multiple partners have a higher risk as well as men who have sex with men, simply because transmission of the virus is easier through anal sex. People who are users of intravenous drugs such as heroin are also at an elevated risk, as contaminated, shared needles can transmit the infection. Finally, people who were born in Africa have an elevated risk due to the higher prevalence in the general population.
What are the symptoms?
Most people experience a short flu-like illness 2-6 weeks after infection, which typically lasts 1-2 weeks. After this, HIV may not present any further symptoms for years, until the virus has caused more significant damage to your immune system. Therefore, if you believe you are at risk or fall into one of the high risk groups, you should have an HIV test, even if you feel well.
What is the test?
A test for HIV will involve giving a small sample of blood. This can either be done via a traditional blood test, where blood is drawn from a vein and a small sample is collected into a vial, which is then sent to the laboratory for analysis.
Many sexual health clinics now offer a finger prick test - a far less invasive test that involves a virtually pain-free prick to the tip of your finger. The nurse or doctor then squeezes a tiny amount of blood from your finger to test. The results to finger prick tests are often instant, it's known as a "rapid results" test, while full blood samples may take up to one week to come back from the lab. For those who aren't able to attend a clinic, there are also at-home finger prick tests, that you can order online and posted back for analysis.
The type or test you take and when you take the test will heavily depend on when you might have been exposed to the virus. If you have been exposed within the past three days or 72 hours, you should visit your local health centre or sexual health clinic immediately for post-exposure prophylaxis (PEP) to help prevent the virus developing. Signs of HIV don't show up on blood tests immediately; if you are having a blood test, the results will only be accurate four weeks after exposure, while results to a finger-prick test will only be accurate after three months. It's important to be honest when visiting your clinic so you receive the correct test.
What is the treatment?
While there is no complete cure to HIV, there are very effective treatments available that allow people with the virus to live a relatively normal, long and healthy life. The first treatment option is PEP, but this is only effective immediately after exposure - it must be started within 72 hours.
If you are positive for HIV, you will have regular blood tests to determine the amount of the virus in your blood, and the levels of the cells in your immune system. Depending on the results, you will receive antiretroviral drugs that stop the virus from replicating in your body, that you will have to take every day.
HPV
What is it and how can you catch it?
Human papilloma virus (HPV) is the name for a group of viruses that affect the moist membranes lining your body, like the anus, genitals, cervix, mouth and throat. While there are over 100 types of HPV, 40 of those types effect the genitals. Genital HPV is very common and very contagious and is spread through sexual intercourse and skin-on-skin contact of the genitals.
Who is at risk?
People who have lots of sexual partners have an increased risk of catching HPV, as are people with weakened immune systems. Areas of damaged skin are more prone to developing warts.
What are the symptoms?
Some types of HPV cause genital warts, which are painless growths or lumps, and other types of HPV cause abnormal changes to the cells in a woman's cervix, which can, in some cases, develop into cancer, which may cause bleeding after sex or in between periods as well as lower abdominal pain. HPV has also been known to cause cancer of the penis and anus.
What is the test?
There is currently no reliable test for HPV in men. Women can be tested by taking a small sample of cells from the cervix, which is what happens during a routine smear test as part of the national screening service.
What is the treatment?
Genital warts are treated using topical creams or by freezing them off. however, getting rid of the warts doesn't cure the virus, but your body can eliminate the virus over time.
There is vaccine to protect against the types of HPV that cause abnormal cervical cells, and it is offered to girls between the ages of 12-13 years old. There is also a national screening programme offered to women between 25-64 years old, providing free smear tests every three to five years. Regular tests help to detect any pre-cancerous abnormalities and have proved extremely effective at reducing the number of cases of cervical cancer.
Pubic lice
What is it and how can you catch it?
Also known as crabs, public lice are tiny little insects that live on coarse human hair, for example pubic hair but also underarm hair and even facial hair (ah). Weirdly, they don't infect the scalp and aren't found on head hair - they leave that to the head lice. Public lice are 2mm long, reddish grey in colour, have six legs and are very hard to see with the naked eye.
What are the symptoms?
Itching is the most common symptom of pubic lice and is usually worse at night when the lice are the most active. Interestingly, itching is caused by an allergic reaction to the saliva of the lice, rather than scuttling. You may also notice a black powder in your underwear, some redness and inflammation of the skin, and blue dots on the skin from bites.
Who is at risk?
The spread of lice isn't due to poor hygiene, but rather close bodily contact with an infected person, which is why sexual and non-penetrative , skin-on-skin contact (hugging included!) is the most common form of transmission. Unfortunately, condoms don't protect you from lice, so anyone who gets close and cuddly with another person is technically at risk. The best way to protect yourself is to ask your partner if they have had a sexual health check up recently, and get one yourself after each new sexual partner.
What is the test?
Diagnosis is usually made following a physical examination from a healthcare professional.
What is the treatment?
A simple topical insecticide cream will do the trick to rid you of your lice. The usual course is for 7 days, and potentially a second course after a week to kill any stragglers.
Trichomoniasis
What is it and how can you catch it?
Trichomoniasis is caused by a parasite called Trichomonas vaginalis that is transmitted through sex. It's super common but only causes symptoms in around 30% of cases, so the only surefire way of knowing you don't have it, is to have a sexual health check up.
What are the symptoms?
Men sometimes experience an itching sensation in their penises, as well as burning after ejaculation or peeing. They may also get a slight discharge from their penis. Women may experience itching and soreness of the genitals, uncomfortable urination and a yellow or white watery discharge with an unusually fishy smell.
Whether of not you have symptoms, trich makes it easier to catch and pass on other STDs. For example, the likeliness of catching HIV from a positive partner is increased if you have trich.
What is the test?
After an examination, women will need to provide a vaginal swab, while men will need to provide a urine sample.
What is the treatment?
A short course of an antibiotic called metronidazole is effective treatment, but your sexual partner will need to get treatment as well, and you'll have to wait 10 days before having sex again.
Hepatitis
What is it and how can you catch it?
There are different types of hepatitis, and the term is broadly used to describe disease of the liver. Hepatitis B is the type that can be transmitted through unprotected sex, as well as through blood and pregnancy. It's an infection that effects the liver, caused by a virus.
What are the symptoms?
Many people may fight off the virus without even noticing they had it, but any symptoms tend to present themselves around two months after exposure. As well as feeling generally unwell, you may experience nausea and being sick, tummy pain and yellowing of the skin and whites of your eyes. Normally, these symptoms pass within a few months but can last up to six.
Who is at risk?
Hepatitis is less common in the UK, so high risk individuals include those born in an area where the infection is common (including sub-Saharan Africa, east and south east Asia, Pacific Islands, the Middle East and the Indian subcontinent). People who have multiple sexual partners and don't use protection are also at an increased risk, as well as people who use injectable drugs and share needles.
What is the test?
A standard blood test is used to determine if you are infected. You can book in for one at your GP or at your local sexual health clinic.
What is the treatment?
Short term hepatitis B doesn't always require medical intervention, although sometimes people need treatment to manage symptoms. Longer-term, it's often treated with medications to supress the virus, and you'll need to have regular tests to check on the health of your liver. There's also an emergency vaccine that can be given up to 48 hours after exposure. If you're at risk, you can get a vaccine (although, this vaccine is a standard offering on the NHS, so you may have already had it!).
Herpes
What is it and how can you catch it?
Herpes simplex is a skin infection that can be broken down into two types - type 1 and type 2. Type 1 usually infects the mouth as a cold sore, and type 2 usually infects the genitals (although it's possible to get type 1 in both areas). Type 1 is spread by skin-on-skin contact, kissing and sharing objects that pass the lips (straws, lipsticks and toothbrushes - although this is highly unlikely as the virus cannot live for long away from the skin). Type 2 is passed by skin-on-skin contact during sex, sharing sex toys and transferring the infection on fingers.
What are the symptoms?
If you have become infected, you may initially notice flu-like symptoms and swollen glands. Then you may experience tingling or itching skin, followed by the appearance of blisters. The blisters usually contain a clear liquid and can be painful. Eventually they burst, scab and heal within a month.
Who is at risk?
Anyone who has multiple sexual partners, has a weakened immune system (for example through HIV, or receiving chemotherapy) has an increased risk.
What is the test?
It's hard to test for herpes unless you currently have blisters. If you do, the doctor will take a swab for testing, but it's possible to receive a diagnosis from discussing your sexual history and previous symptoms, so don't delay in getting checked out.
What is the treatment?
There is no cure for herpes, but there are medicines that can help to relieve symptoms as well as lifestyle changes that can help prevent reoccurrence. If you're having an outbreak, there are antiviral drugs that can help manage the symptoms and help the blisters heal. You are more likely to have an outbreak if you are run down, exposed to UV rays from the sun or sunbeds, or wear tight clothing in the area, so it's important to try and avoid those triggers through lifestyle changes and self care.
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