You might feel embarrassed, but there’s no need – the staff at these clinics are used to testing for all kinds of infections. You may be offered a Quick Check if you are coming to see us for a routine check up and don’t have any symptoms or signs of infection. Otherwise, symptoms may include pain when you urinate, unusual discharge and, in women, bleeding between periods or after sex. You can go to a sexual health clinic whether you’re male or female, whatever your age, regardless of whether or not you have STI symptoms. If you’re under 16, the service is still confidential and the clinic won’t tell your parents. You don’t have to give your real name if you don’t want to. If you do, it will be kept confidential.
Your GP won’t be told about your visit without your permission. That is why as the article pointed out, research is ongoing. Note that records of infection in those aged under 10 years are not reported. If you’re not sure about anything, ask them to explain. Tests for herpes aren’t usually done unless you have sores on your genitals or anus. In this case, a swab will be taken from a sore. This will be uncomfortable for a moment.
With some tests, you can get the results – and treatment, if you need it – on the same day. The ratio of female to male diagnoses in 2011 was 2.2:1, which has been a consistent finding over the past ten years. There were similar numbers of type 1 and 2 infections reported (Figure 1). In men, 59% of infections (for which typing data were available) were type 2 compared to 42% in women, in whom type 1 infections predominate. Some infections, such as HIV, have no cure, but there are treatments available. Outwith the island NHS boards, the lowest rates of genital herpes infections were recorded among men in Borders NHS Board and among women in Lanarkshire NHS Board (Table 3, Figure 2). In 2011, 64% of infections were diagnosed among persons aged under 30, following the pattern over the last decade (Table 4).
The clinic can give you some condoms so you can practice safer sex. In 2011, 18,961 diagnoses of genital chlamydial infection were reported to HPS, which compares with 19,054, 18,277, and 18,561 reported in 2008, 2009 and 2010, respectively (Table 5). The improved data capture of laboratory test results via ECOSS means that the data in recent years have been subject to more extensive validation particularly with regard to removing repeat samples taken for the same episode, data suggest that of 18,961 positive diagnoses received via ECOSS during 2011, 552 individuals had more than one episode, with a fraction of these having more than two episodes. During the past five years (2007-2011), the number of diagnoses has stabilised at between around 18,000 to 19,000, with a mean of 18,539 annual diagnoses – representing a mean of 11,510 in women and 6,824 in men during this time. As is the case with genital herpes infection, the majority of diagnoses (63%) were made in women (Table 6). I guess that it could,”eliminate allergic symptoms”. Outwith the island NHS boards, the lowest rates for males and females were observed in NHS Dumfries & Galloway and NHS Highland, respectively: in the latter NHS board these data were thought to reflect an underrepresentation of diagnoses as Highland residents living in areas which were part of the former Argyll & Clyde NHS Board may actually have been diagnosed in, and thus reported from, Greater Glasgow & Clyde.
In women aged under 25, the highest rates per 100,000 – all greater than 3000 per 100,000 population aged less than 25 – were observed in Tayside, Dumfries & Galloway, and Forth Valley NHS Board areas; for corresponding males, the highest rates were recorded in Tayside and Forth Valley NHS Boards (1799 and 1437 per 100,000 population, respectively) (Figure 3, Table 7). As with genital herpes, genital chlamydia is an infection which predominates in young people; in 2011, 73% of all diagnoses (63% and 78% of all male and female diagnoses, respectively) were made in persons aged under 25 (Table 8); the majority among women and men aged 20-24. Lymphogranuloma venereum (LGV) infection, caused by the L type serovar of Chlamydia trachomatis, re-emerged during 2003/2004 when outbreaks were reported in many European cities. LGV diagnoses have been made predominantly in MSM with high levels of concurrent STIs, in particular HIV, and are associated with multiple anonymous partners and high risk sexual behaviour. Since its re-emergence, over 1900 cases have been reported in the UK.1 In Scotland, during 2011, six diagnoses were recorded, all of which were made in MSM, compared to four in 2009 and 10 in 2010. In addition, data on tests performed using commercially available chlamydia test kits (Clamelle®) indicate that 833 kits were sold in Scotland between November 2008 and December 2011, 5.7% of the UK total (14,495). Updated data are awaited on the positivity rate and gender breakdown.
Since 2006, an increasing number of laboratories have adopted the routine use of nucleic acid amplification tests (NAATs) for the diagnosis of gonorrhoea infection. These tests have a greater sensitivity than standard culture and isolation techniques for the detection of gonorrhoea infection, and it is expected that most laboratories be using them in the near future. In 2011, 1547 diagnoses of gonorrhoea were reported to HPS, representing a 12% increase on the 2010 total of 1378. From the ten year trend data, as shown in Table 9, this is the highest number of episodes recorded. Note, however, that the totals during the past four years (2008-2011) are not comparable to previous years due to the increase in gonorrhoea testing and diagnosis which has resulted from the introduction of NAATs for routine testing in several laboratories. When compared to 2010 data, the gender totals observed during 2011 reflect a 5% increase in the number of diagnoses among women (from 446 to 468) and a 16% increase in those among men (from 930 to 1077) (Table 9). It should be noted that there is variability from year to year in the number of diagnoses in each NHS board; thus, for some NHS boards, clear trends as to whether the incidence is increasing or decreasing are not always evident (Table 10, Figure 4).
In 2011, however, the most notable changes were an increase in episodes in NHS Lothian and NHS Tayside and a decrease in NHS Greater Glasgow & Clyde. The data indicate that, for those cases for whom the referral source was known, 83% (890/1075) and 62% (291/467) of men and women, respectively, were diagnosed in the sexual health clinic setting. A trial at Vienna Medical School found that stimulating immunity and blood flow reduced healing time for sores by up to half. In contrast to genital herpes and genital chlamydial infections, the majority (70%) of gonorrhoea cases were among men (Table 9). In females, infection with gonorrhoea is associated predominantly with a young age group – 74% of female, compared to 46% of male, diagnoses occurred in those aged under 25 – a pattern similar to that of preceding years (Table 11). The increase in gonorrhoea among males, observed between the late 1990s to 2006, is considered to be due, largely, to transmission among men who have sex with men (MSM). While a decrease in diagnoses was recorded between 2007 and 2009, the subsequent increase observed in the past three years may also be due to a rise in infection in this group.
Rectal gonorrhoea is a key marker for unprotected anal intercourse. In 2011, 27% (288/1077) of men had a rectal swab positive for gonorrhoea, the highest proportion recorded over the past ten years (Table 12). Overall, the number of laboratory positive diagnoses for genital herpes simplex types 1/2 (as reported to HPS), genital chlamydia and gonorrhoea have increased between 2010 and 2011. Note that in the last three to four years, HPS has been refining the ECOSS data collection system to improve the quality and quantity of the laboratory diagnoses dataset, thus, it is not possible to make direct comparisons with previous years’ data. It should be noted that much of the increase in chlamydia diagnoses in the past ten years is due to a combination of issues including: increased opportunistic testing,2,3 the use of more sensitive diagnostic tests, increased awareness through health promotion campaigns, and latterly improvements in data collection. Publication of the Sexual Health and Blood Borne Virus Framework (2011-2015)4 has re-focused attention on the public health challenges for Scotland presented by sexual health, HIV and hepatitis B and C, building on the foundations of the sexual health strategy Respect and Responsibility,5 the HIV Action Plan in Scotland6 and the Hepatitis C Action Plan for Scotland.7 Outcomes are monitored against a set of indicators. While an indicator relating to chlamydia diagnoses will require further discussion, diagnoses of gonorrhoea infection, including levels of rectal infection in men, are being measured.
Information about sexual orientation is not available from laboratory reports to SBSTIRL and HPS, and it is impossible to know if infections in men are occurring among those who have sex with women or those who have sex with other men. Therefore, to ascertain information about heterosexual transmission, the analysis of STIs in women can be used to provide an insight. Trends in genital herpes and gonorrhoea among females, however, could be considered true reflections of any changes in high risk sexual behaviour among heterosexual populations. In this respect, there have been, in general, increases in the incidence of these infections over the last five years. For genital herpes, caution should be applied in interpreting the data as these do not necessarily reflect incident infection. With respect to gonorrhoea, in 2011, twice as many diagnoses were observed among females compared to pre-2006. I’ll assume that the MediBeam is the same device as the BioBeam refered to at the cited conference.
Nevertheless, the data continue to indicate that young people, in particular women, are acquiring STIs at an early age. While it is not possible to use the data to determine if the incidence of genital chlamydia infection has increased in recent years, there is no doubt that very large numbers of people are infected – particularly affected are those in the younger age groups. Evidence of re-infection among some individuals with chlamydial infection underlines the importance of ongoing health education around safe-sex. The discrepancy between the numbers of male and female chlamydial infections is almost certainly due to more women than men undergoing testing. In summary, the evidence suggests that the incidence of STIs among young heterosexuals through casual unprotected sexual intercourse remains a problem in Scotland. It is imperative that efforts to effect behavioural change amongst this group, through positive sexual health messages and awareness raising, continue, and the testing and treatment of those at risk of STIs is encouraged. Surveillance data indicate that the number of newly diagnosed HIV cases among MSM has remained stable between 2010 and 2011 (158 and 156 diagnoses, respectively), compared with a peak number of 207 cases in 2007.10 Although the estimated incidence of infection in those undergoing repeat HIV testing has remained unchanged since the late 1980s at 15 per 1000 person years,11 and analyses of data from the Medical Research Council’s triennial cross-sectional surveys of men in gay bars in Glasgow and Edinburgh, indicate that there has been no significant increase in risk-taking behaviour among gay men between 2002 and 2008,12 a high proportion of HIV infection in this group is acquired in Scotland and, thus, HIV transmission among this group remains a serious public health concern.
In summary, information from both infection data, particularly the increase in rectal gonorrhoea, and behavioural studies suggest that rates of unprotected sexual intercourse, and thus the risk of STI, among MSM, continue despite initiatives to raise awareness and levels of knowledge. Challenges for control and prevention of STIs in this group continue. Health Protection Agency. Epidemic of lymphogranuloma venereum (LGV) in men who have sex with men in UK intensifies. Health Protection Report 2011; 5(24). Available at http://www.hpa.org.uk/hpr/archives/2011/hpr2411.pdf. Scottish Intercollegiate Guidelines Network.
Management of genital Chlamydia trachomatis infection. No. 42. Edinburgh: SIGN, March 2000. Scottish Intercollegiate Guidelines Network. Management of genital Chlamydia trachomatis infection. No.
109. Edinburgh: SIGN, March 2009. Available at http://www.sign.ac.uk/guidelines/fulltext/109/index.html. Scottish Government. Sexual Health and Blood Borne Virus Framework (2011-2015). Edinburgh: Scottish Government, 2011. Available at http://www.scotland.gov.uk/Publications/2011/08/24085708/0.
Scottish Government. Respect and Responsibility: Strategy and Action Plan for Improving Sexual Health. Edinburgh: Scottish Government, 2005. Available at http://www.scotland.gov.uk/Publications/2005/01/20603/51182. Scottish Government. HIV Action Plan in Scotland (2009-2014). Edinburgh: Scottish Government, 2009.
Available at http://www.scotland.gov.uk/Publications/2009/11/24105426/0. Scottish Government. Hepatitis C Action Plan for Scotland (2008-2011). Edinburgh: Scottish Government, 2008. Available at http://www.scotland.gov.uk/Publications/2008/05/13103055/0. Scottish Microbiology Forum, British Association of Sexual Health and HIV, Health Protection Scotland. Guidance on the use of molecular testing for Neisseria gonorrhoeae in diagnostic laboratories 2011.
Molecular testing for gonorrhoea working group. Edinburgh, Scottish Bacterial Sexually Transmitted Infection Reference Laboratory, 2012. Health Protection Scotland. Syphilis in Scotland 2011: update. HPS Weekly Report 2011; 46(31): 265-268. Available at http://www.hps.scot.nhs.uk/ewr/redirect.aspx?id=52238. Health Protection Scotland.
ANSWER: HIV infection and AIDS: quarterly report to 31st December 2011. HPS Weekly Report 2011; 46(8): 62-67. Available at http://www.hps.scot.nhs.uk/ewr/redirect.aspx?id=50639. McDonald SA, Hutchinson SJ, Wallace LA, Cameron SO, Templeton K, McIntyre P, Molyneaux P, Weir A, Codere G, Goldberg DJ. Trends in the incidence of HIV in Scotland, 1988-2009. Sex Transm Infect 2012; 88(3): 194-199. Knussen C, Flowers P, McDaid LM, Hart GJ.
HIV-related sexual risk behaviour between 1996 and 2008, according to age, among men who have sex with men (Scotland). Sex Transm Infect 2011; 87(3): 257-259. HPS wishes to thank Janis Shade at the SBSTIRL for help with database maintenance and analysis, as well as the consultant microbiologists, consultant virologists and their staff who supply data to the SBSTIRL and to HPS.