Morbidity and Mortality Rates:
Morbidity rates for STIs
have been on the increase in the past number of years. In 2016 there was a 3%
increase in STI notifications compared to 2015(HPSC, 2016). Compared to Q1-Q2 in 2016, in Q1-Q2 2017
there was a 6% increase(HPSC, 2017)
The above table indicates
dramatic increases in Gonorrhoea, LGV notifications and significant increases
in Syphilis notifications.
Table 2: Notification Of STIs by year 1995-2012
Table 2 also indicates the
general increasing trend of STIs in the last number of years with the highest
total of STI notifications coming in 2011 (15442). Consistently, from 1995 to 2012,
Chlamydia was the most common STI out of those listed in Table 2. This trend is
also visible in Table 1(2016 and 2015).
Who is most affected by STIs?
Age: HPSC(2016) reported 86%
of all STIs notified in 2016 were among those aged less than 30 years. They
also found that 15-24 year olds accounted
for almost half of the Chlamydia cases, 43% of herpes simplex cases and 37% of gonorrhoea cases notified in 2016.
Sexual Orientation: Men
who have sex with men (MSM) accounted for 100% of LGV cases, 88% of early
infectious syphilis cases and 63% of gonorrhea cases in 2016 were in MSM (
where mode of transmission was known)
The table above indicates
that certain STIs affect one sex more than the other. Gonorrhoea, LGV, and Syphilis affected males more so than
females. Herpes Simplex and trichomoniasis affected females more frequently
than men. Chlamydia seems to affect both males and females relatively equally.
Most Common STIs
According to Table 2 the
most frequently reported STI (from the ten listed) in 2012 was Chlamydia,
however, this was not the case in 1995.
In 1995 the most commonly reported STI was Ano-Genital Warts.
Table 2 also indicates
that from 1995 to 2012 there were increases
in reported cases of almost all of the listed STIs with especially dramatic
increases in Gonorrhoea (91 to 1108), Herpes Simplex (198 to 1326), Chlamydia(245 to 6162) and finally Syphilis(
11 to 518).
Europe, the number of STI cases is increasing, with an estimated 17,000,000 new
cases per annum in Western Europe alone (Euroclinix, 2017)
World Health Organization (2016) reported that over 1,000,000 sexually
transmitted infections are acquired worldwide every day.
In the United
States of America, more than 2,000,000 cases of Chlamydia, gonorrhoea, and
syphilis were reported in 2016, the highest number ever (Centres for Disease
Control and Prevention/CDC,2017). The same report indicated that syphilis rates increased in the US by nearly
18% from 2015 to 2016.
Overall it is
clear that there’s a general increasing
trend of STI morbidity across the world.
Sexual risk-taking behavior
and substance abuse
contributor to the increase in STI rates globally the prevalence of sexual risk-taking behavior
amongst younger age groups. Substance abuse has been found to be associated
with sexual risk-taking by many studies.
indicate drug use is a major contributor
to increased sexual risk-taking behavior. A study carried out by Karen
McElrath,(2009) found that Sexual risk-taking
(eg. having multiple partners, engaging in sex without a condom) was prevalent
among respondents who did engage in sexual activity during MDMA episodes.
CDC (2012) also
found that, amongst the 34% of sexually active high school students, 22%
reported drinking or using drugs the last time they had sexual intercourse.
O’Donnell (2005) found that there was a positive correlation between early
drinking and unprotected sex.
Another study of
33,000 Danish men found that men reporting greater than 8-lifetime partners or 2 or more recent sex partners were more
likely to have other risk-taking behaviors such as early sexual debut, current
smoking and regular binge drinking (Buttman et al,2011).
Finding a direct
causal relationship between substance abuse and sexual risk-taking is a rather difficult task especially through studies.
That is why most studies, including the ones mentioned above, are focused on finding an association
between the two. As a result we cannot explicitly state that there is causation
between the two behaviors, but there is most certainly an association.
Current Government Policy-Ireland
As a result of the
general increasing trend in the prevalence of STIs in Ireland, in October 2015
the Department of Health published a two-year
action plan with a National Sexual Health strategy plan.
The Strategy has
three main goals:
1. Sexual health promotion,
education, and prevention
2. Sexual Health services
3. Sexual Health Intelligence
These goals quite clearly
encompass some of the strategies of the Ottawa Charter for health promotion.
Environments: This aspect of the Ottawa charter is represented by the second goal of
the strategy ‘Sexual Health Services’. The second goal of the strategy aims to
make “Equitable” and “accessible” sexual health services of a high quality to
everyone. This would most certainly enable and support the population in either
finding help if diagnosed with an STI or preventing them in the first place
Develop personal skills: Goal 3 is in sync with this strategy of
the Ottawa charter. This goal aims to ensure the population has high quality
and comprehensive sexual health information. Sexual health intelligence,
according to the strategy “supports good decision making for better health and
health outcomes”. By advocating sexual
health intelligence and providing access to information (goal 1), the strategy enables the wider population to develop their own skills and behaviors
regarding sexual risk-taking and also
practices that prevent the transmission of STIs in the first place.
Building healthy public
policy/Strengthening Community action: These strategies of the Ottawa
charter are aligned with the first goal,
‘Sexual health promotion, education, and
prevention’. Sexual health promotion, education, and prevention strategies work to address a range of issues such as challenging stigma or
discrimination and promoting healthy attitudes and
values. Working to lessen the stigma associated with Sexual health and
STIs will undoubtedly make help or advice from non-professional sources such as
family members and teachers more accessible which in turn will hopefully lead
to prevention. Also the fact that a 5-year
plan which includes numerous recommendations and 18 priority actions proves
that sexual health is now on the agenda of policy
makers in Ireland where it may not have been in previous years.