London is the syphilis capital of the UK. According to new figures from Public Health England (PHE), more people contract the STI in the capital than anywhere else in the country, with 2,811 cases reported last year alone – a huge increase of 163 percent since 2010. To break that figure down a little more: the highest rates of infection were reported south of the river, with 447 cases in Lambeth and 290 in Southwark; and more than 90 percent were among men who have sex with men (MSM).
Not unlike scurvy or fax machines, syphilis very much sounds like a thing of the past – "When you think of syphilis," says sexual health and relationship expert Annabelle Knight, "you think of Victorian England." But it's not; it is, in fact, very much a thing of the present, and if you don't get it treated, long-term complications can include hair loss, fatigue and even serious damage to the heart, brain and eyes.
Still, browse the internet and you'll find plenty of people shocked at their diagnosis. "I don't understand how this could've happened, and I'd really rather it be anything else but this," said one Reddit user."Four days ago, I was screened for blood donation. It turned out that I was positive for syphilis. I was mind-fucked with the results! How the hell would I get syphilis without remarkable sexual history?" asked another.
Another question: why is it that cases of syphilis are soaring in London and not elsewhere?
Knight suggests it could just be down to the sheer amount of people living in the city. The capital's population hit a record 8.6 million high last year, and it makes sense that more people equals more diagnoses. But a 163 percent rise in the space of six years doesn't really chime; there are a lot of people in London, but not 163 percent more than there were in 2010.
So let's look at the details. Southwark and Lambeth – home to the highest incidences of syphilis in London – are among the most impoverished boroughs in the capital. "You can't argue with the facts," says Knight. "[The figures] show that poorer areas are more widely affected."
Reduced access to quality healthcare surely plays a part in this; take the Margaret Pyke Centre – one of the UK's best sexual health services – which closed down in May. Dr Verity Sullivan of the British Association for Sexual Health and HIV (BASHH) points out that it's the "government's responsibility to invest in sexual health clinics to ensure those at higher risk are attending for sexual health screens, that people are being tested and treated for syphilis, and that partner notification is happening".
Second big thing: the report also found that 90 percent of cases reported in 2015 were among MSM. Rates of syphilis are booming, Knight tells me, in part because of the chemsex scene, which is much bigger in London than any other city in the UK: "I don't want to be tarring an entire community with the same brush," says Knight. "But there's a trend for sex under the influence. I appreciate the idea of taking sexual experiences to a different level, but it also lowers your inhibitions and lowers your ability to make rational decisions, like using protection."
This issue is compounded by the fact that gay men are statistically less likely to seek help from health and social services. Professor Kevin Fenton, Director of Health and Wellbeing at Public Health England, explains: "Despite vast improvements in social acceptance over the years, lesbian, gay, bisexual and trans people continue to face discrimination. As a result, this community faces barriers in accessing health services, and remain disproportionately burdened with ill health."
Knight is concerned that lessons still haven't been learnt, in part because of the lack of sex education in schools. "It isn't mandatory – it's entirely up to the education body of schools that teach," she says. "It's uncomfortable to talk about, cringy for teachers, students don't want to know... in order to slow down or reverse this, the only way we're going to do that is by educating ourselves. Sweeping it under the rug isn't going to help. I look at this way: If you're going to rewire a plug, you go online; if you're going to have sex, make sure you know about it."
It's knowledge, Knight says, that's the only way to "arm yourself".
"After all, you don't want your tombstone to read, 'Died from fucking.'"
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