The rate at which sexually transmitted infections are rising in the UK is worrying. Diagnoses of sexually transmitted infections in the UK had fallen significantly in the mid to late 1980s. This was during the period following the much-publicised onset of the HIV and AIDS epidemic. The levels of sexually transmitted infections remained low until just after the mid-1990s. However, data col- lected from genitourinary medicine (GUM) clinics from 1996–2001 showed substantial increases in new diagnoses of infections.
Almost all sexually transmitted infections have shown dramatic increases with over one million people attending GUM clinics each year (DoH 2000). The commonest infections include chlamydia, non-specific urethritis and wart virus infections. The concern is for those people who do not seek treatment or are unaware that they are infected. While the increase in new diagnoses gives health professionals clear cause for concern, we should remember that this data only includes those who have accessed services. As many sexually transmitted infections have no symptoms, the extent of the problem is likely to be much greater.
Chlamydia
A common example of an infection where many people are un- aware they are infected is chlamydia, where levels of infection in
Sexual Health 97 the UK have more than doubled over the past 10 years, particu- larly in teenagers. In 2004, genital chlamydial infection remained the most common sexually transmitted infection diagnosed in GUM clinics in the UK. Chlamydia is a bacterial infection that can be treated and cured orally with antibiotics; however, it has no symptoms in at least 70% of women and 50% of men (HPA 2005).
Three-quarters of chlamydia diagnoses in women were in young women, and 56% of diagnoses in men were in young men (HPA 2005). The infection rate has been estimated at around 11% in women but worryingly, this infection is often asymp- tomatic and may not be diagnosed until fertility problems are apparent. If chlamydia is untreated, the consequences may be serious and include pelvic inflammatory disease, which can progress to ectopic pregnancy and infertility. Complications among men with untreated infection include urethritis, epi- didymitis and Reiter’s syndrome (chlamydia-associated arthritis) (National Chlamydia Screening Programme 2005). Simms and Stephenson found evidence of chlamydia in around 40% of women who underwent laparoscopy for pelvic inflammatory disease much of which had not previously been suspected (Simms and Stephenson 2000).
HIV and AIDS
The number of people with HIV is also worrying. In 2004 there were an estimated 58 300 people living with HIV in the UK, of which an estimated 34% were unaware they had become infected.
Although most midwives are familiar with dealing with women with HIV, it is worth revisiting how the infection is transmitted.
The human immunodeficiency virus (HIV) which causes acquired immunodeficiency syndrome (AIDS) is transmitted through body fluids, in particular blood, semen, vaginal secretions and breast- milk. One can become infected with HIV through:
•
Unprotected sexual intercourse with an infected partner•
Sharing needles when injecting or other use of contaminated injection or other skin piercing equipment•
Blood and blood products, for example, infected transfusions and organ tissue transplants•
Transmission from infected mother to child in the womb or at birth and breastfeeding.HIV weakens the human body’s immune system, making it difficult to fight infection. Treatments exist which can prevent the
98 Essential Midwifery Practice: Public Health
onset of AIDS and although there are side effects, a person can lead a healthy active life with a long life expectancy if they respond well to treatment. However, they can still transmit the infection to others. Treatments do exist which can prevent the onset of AIDS and allow periods of illness to be followed by periods of remission.
However, there is still no cure for AIDS. Research is currently under way into vaccines, but none is yet available (National AIDS Trust 2006).
In the UK, there has also been a year on year increase in the num- ber of people who have become infected through heterosexual partners, suggesting that messages on HIV and sexually trans- mitted infections are being ignored (HPA 2005). According to figures published by the Health Protection Agency (2005) in 2004 approximately one in every 548 pregnant women in the UK was HIV-infected. Most cases were identified in women who themselves were born in high prevalence regions, particularly sub-Saharan Africa and Central America and the Caribbean. However, the prevalence of HIV among women born in the UK continues to rise slowly. As the AIDS epidemic continues, the total global popu- lation living with HIV and AIDS has grown to a staggering 40 million and the number of people who have lost their lives to the disease totals an estimated 30 million (HPA 2005).
If a pregnant woman has HIV but either does not disclose this or is unaware of her infection status, the risk of mother-to-child trans- mission of HIV is around 25%. However, if the woman receives anti-retroviral therapy during pregnancy, has a caesarean section and does not breastfeed, the risk of transmission falls to around 1% (National Study of HIV in Pregnancy and Childhood 2005).
The National Study of HIV in Pregnancy and Childhood is a sur- vey run by the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Paediatrics and Child Health (RCPCH) to give intelligence surveillance on the rates of HIV infections in pregnancy and children. This data helps to inform government policy and practice around supporting women and their families who are HIV-positive.
Other sexually transmitted infections
Although over the past five years there has been an 11% decrease in the number of new cases of gonorrhoea reported, 42% of the cases in women were under the age of 20 (HPA 2005). However, despite this downturn, young people in the UK are disproportion- ately affected by gonorrhoea and also chlamydia (as discussed
Sexual Health 99 earlier) and genital warts. Rates of diagnoses continued to increase among young people in 2004, with the highest rates of gonorrhoea diseases seen among young men aged 20–24 (HPA 2005).
The trend is remarkably different for syphilis, which rose by 37% between 2003 and 2004 in the UK. However, 88% of all dia- gnoses were in men, of which more than half were in homosexual men. The rates were also higher in slightly older men with the highest rates found among men aged 25–34 and 35–44 (HPA 2005).
The most commonly diagnosed viral sexually transmitted infec- tion is that of genital warts. Over the last few years, new diagnoses of genital warts rose by 4.2% (HPA 2005). Again the highest rates were seen in younger age groups, men aged 20–24 and – worry- ingly – young women aged 16–19. The prevalence of genital warts is likely to be vastly underestimated, as figures are only available for people who attend for treatment. Similar trends are apparent for genital herpes.