So far, 2018 has brought with it a wave of horrifying STI-related news. The worst ever case of drug-resistant "super-gonorrhoea" was detected in March; syphilis and gonorrhoea are up 20 percent and 22 percent respectively since 2016, with cases of syphilis reaching the highest level since 1949 (LITERALLY POST-WAR BRITAIN); and chlamydia testing has fallen by 8 percent between 2016 and 2017, despite being the most commonly diagnosed STI in the UK.
Elsewhere in sexual health, HIV transmission rates have fallen – but rather than keep up what obviously seems to be working, government cuts took an axe to services, limiting access to essential checkups that helped to bring transmission rates down in the first place.
According to new data from Public Health England, the impact of STIs remains greatest in young heterosexuals aged 15 to 24, black ethnic minorities and MSM (men who have sex with men). I would like, now, to focus on the first demographic. Specifically – and this isn't something I say very often – I would like to focus on heterosexual men.
Here's a fun party game: turn to the straight cis guy next to you and ask him when the last time he had a full STI test was. My kingdom for a response that isn't guilty silence, "never" or a lie. In my personal experience of sleeping with men, what tends to happen is: they don’t bother. They operate under the assumption that everything is fine unless they can literally see that it is not, at which point it's way too late. I'm guessing it's a combination of growing up in a society that usually dumps the responsibility of safe sex on women, something psychological to do with their junk being on the outside and that stupid fucking rumour about the cocktail umbrella that circulates in high school. But none of those are excuses to shirk basic health admin. Not getting your dick assessed regularly is like riding your bike to work every day without ever checking the tyre pressure, or whatever. And do you know what happens when you don't do that sort of maintenance? Your bike falls apart.
I had a conversation with someone recently who told me one of their straight male friends revealed that he had never taken an STI test in his life. He is 29 years of age. A few days later, another friend relayed the exact same story. Last week, someone messaged me from a sexual health clinic, where she sat between the hours of 11AM and 4PM, and didn't see a single man pass through the doors. It is: a problem.
Claire Morgan is a Nurse Manager at Brook – an organisation that provides free and confidential sexual health services to under-25s in the UK. She tells me over email that women are more likely than men to regularly access sexual health services for contraception. "At this time, they would be offered opportunistic screening for sexually transmitted infections, whether they have symptoms or not," she explains. Conversely, "men will access condoms without an appointment with a clinician, and therefore they are not given this opportunity to take part in opportunistic screening or to talk about their sexual health and wellbeing with an expert".
This certainly explains why the footfall of straight men in sexual health services appears to be so low; NHS statistics from 2015-2016 revealed that a whopping 88 percent of individuals contacting services were women. But, Morgan continues, "It is important to note that many STIs do not have any symptoms at all, and therefore it is vital to get tested as soon as possible after having unprotected sex."
In all fairness, the stats for STI screenings don't reflect well on anybody. The same NHS report found that, among a group classified as having unsafe sex, 89 percent of men and 82 percent of women reported not having attended a sexual health clinic in the past year. Attendance does tend to be higher among young people, with 19 percent of men and 26 percent of women aged 16 to 19 attending in the past year, compared with 10 percent of those aged 25 to 29. So, basically, what happens is people figure out their primary method of birth control and then go forth and shag, never to return unless something looks upsetting.
After the fear of unwanted pregnancy subsides, we tend to take an arrogant "it won't happen to me" mentality towards STIs. This bridges all genders and sexualities, but straight guys are – as we have discussed – the worst offenders. Which is mind-boggling when you consider that all they have to do to get tested for common STIs like chlamydia and gonorrhoea is piss in a cup.
No swabbing; no chucking your feet up in stirrups while an overworked nurse pokes mechanically around in their 309th cervix of the week; no swirling a swab around up there yourself and hoping for the best. Literally all they have to do is piss. Women still have to wait an average of 7.5 years to get diagnosed with endometriosis, an actual debilitating disease, while modern science has advanced rapidly enough that a male STI test can now be done in the most convenient and least invasive manner possible. And do they do it? Reader, they do not.
Karin O'Sullivan, clinical lead for the sexual health charity FPA, confirms that "men are less likely to attend sexual health services in general". Going on to hypothesise why, she tells me that "some research has suggested this might be partly because men are more likely to take risks, or think health problems won't affect them". O'Sullivan also echoes Morgan’s sentiments about women being more likely to go to a doctor or clinic for contraception, "and so there's a chance to talk to them at that stage about STIs and testing".
If left untreated, both chlamydia and gonorrhoea can cause infertility in men and women. Chlamydia is symptomless for most people, while around 50 percent of women and 10 percent of men with gonorrhoea don't display symptoms. While this may be a win aesthetically-speaking, it's also very dangerous when attitudes to STIs focus on treatment rather than prevention. Unless you’re getting tested regularly off your own back, these infections can remain out of sight, out of mind for years.
"Sexual health services can be seen as being aimed at women, or gay men, when it's important that they're welcoming to everyone," O'Sullivan explains. "Over the years, I've seen an increase in the number of men coming to the sexual health clinics I work at in London, partly thanks to outreach programmes we've run where local schools are invited in for mock clinic sessions. It's really important that relationships and sex education covers this kind of practical information, making sure young people know how to access their local services."
Accessing local services can be difficult when £64 million of cuts between 2013 and 2017, and a 25 percent rise in patients last year, has left sexual health services struggling to cope. In 2017, Duncan Stephenson, director of external affairs for The Royal Society for Public Health, warned that "the government is rolling the dice with the public's sexual health".
One positive bit of news is the rise in e-STI testing. Online services like SH:24 and Free Test offer free home testing kits for chlamydia, gonorrhoea, HIV and syphilis, as well as sexual health information. Kits are posted out with instructions, you post the samples back for free, and 72 hours later you're like – *extremely Love Island contestant voice* – "I'VE GOT A TEEEEXT". Critics have called them a plaster for funding cuts, but there's a reason online STI kits have doubled testing uptake in young people: it's more convenient – and convenience is key when you’re a straight man who can't be arsed to moisturise or boil pasta correctly, let alone walk to a clinic.
Elsewhere, Public Health England launched their "Protect Against STIs" campaign in April to highlight the importance of being sex-smart and using condoms. Made In Chelsea’s Sam Thompson joined in after an "embarrassing" brush with chlamydia when travelling, and now he is very vocally pro-sheath. So there you are: if the VK brand ambassador who earnestly says "WHUDDUP" can shout about his chlamydia from the front pages of Metro, then everyone else should be able to grow up enough to piss in a cup.