​For a Whole Bunch of Reasons, 2016 Looks Set to Be the Year of the STI

How can STI rates be up even though fewer people are having sex?

by Martin Robbins
07 January 2016, 6:00am

A 1939 poster warning of the dangers of syphilis.

A 1939 poster warning of the dangers of syphilis. (Image via)

The genitals of Britain are all festering time bombs, at least according to the tabloids. This week they reported an "explosion" of STIs, caused by dramatic cuts to sexual health services and the rise of hook-up apps. But how much of that is true, and how much is scaremongering by a conservative press that just doesn't want you getting your bits damp?

STI diagnoses in England are hovering near half a million, down very slightly on previous years but still near an all-time peak. However, that overall number is only a small part of the story. Some areas are worse than others; in Hackney you can find chlamydia in over 4 percent of the population, which is a hell of a lot, while Lambeth leads the country in gonorrhoea. A framed certificate and bronze statue of a grotty crotch are winging their way to those respective town halls.

There has been some success in treating some infections; the HPV vaccine has really helped the nation's genital wart situation, for example. But that has been dwarfed by rises in the rate of infection for other STIs. Gonorrhoea cases rose 19 percent in a single year, while syphilis went up by a spectacular 33 percent. That should be a big worry for men who have sex with men, who account for about 80 percent of syphilis and 50 percent of gonorrhoea diagnoses.

Naturally, people are looking for someone to blame, and dating apps have come under increased scrutiny. Several doctors have blamed services like Grindr and Tinder for the rise in STIs, and the British Association for Sexual Health and HIV even suggested they could be "potentially dangerous" to users' health. They believe that people who date online churn through sexual partners faster, exposing them to more infections, but nobody seems to have put any data forward to back this up.

In fact, more robust research seems to suggest that young people are actually having less sex. A big UCL study in 2014 found that women and men between the ages of 16 and 44 were having sex an average of 4.8 to 4.9 times per month. Ten years ago, just before Facebook appeared on the scene, they'd both be doing it more than six times a month. Across the Atlantic, a huge study of over 33,000 Americans found that Baby Boomers slept with more partners than millennials and came out with the amazing statistic that half of all 20-somethings hadn't bedded anyone in the last year. Less "Netflix and chill" and more just, well, Netflix.

(Photo by Flickr user Jes, via)

So if kids aren't to blame, what explains the rise? For some diseases there's a simple explanation. If you look at a chart of chlamydia infections in England since the early 2000s, it looks like there's been a massive increase – in 2005 there were about 200 cases per 100,000 people, but by 2008 there were over 350. In 2005, the NHS launched a successful National Chlamydia Screening program. With more people being tested for it, more cases were found, and that's why the graph shows a big rise.

For other conditions it seems far from clear – the reasons may be different from disease to disease, and the situation in Hackney might be driven by different factors than the situation in, say, Cheshire. But one thing we do know is that the more people get tested, the fewer people will be infected – which is why doctors told the Guardian this week that the government's £40 million cut to sexual health services will result in an "explosion" of new infections.

We already know what happens when you reduce STI funding because we've seen it elsewhere – cuts to clinics in New York contributed to a 60 percent rise in gonorrhoea diagnoses in the five years to 2014. That's 60 percent more money that needs to be spent treating gonorrhoea, which is almost certainly going to cost more than the amount saved by the cuts.

That's not the worst part, though. All those untreated diseases out there are evolving, and evolving fast. New strains of gonorrhoea have appeared that can resist the antibiotic drugs we use to treat it. An outbreak of "super-gonorrhoea" appeared in Leeds last year, and at least two frontline antibiotics used to treat it are no longer effective.

You might think gonorrhoea isn't much more than a nuisance, but that's mostly because we can treat it. Without those treatments, it can do serious, life-long damage, sterilising men and women and causing pregnancies to develop outside the womb. More drugs are in development, but if we're burning through treatments as fast as we can invent them, that's not a great situation.

So that's our future: a post-industrial wasteland filled with rampaging drug-resistant sexually transmitted diseases. The only hope is that by the time things get really bad our grandkids will be too busy pissing about with emojis on their iPhone 42s to bother with any of that grubby sex malarkey.

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