Irish people are more aware of the need to be screened for STIs, but potentially infected people still aren't being tested. Ali Bracken reports
Ireland lags many of its European counterparts and the US in providing accessible sexually transmitted infection (STI) screening. Waiting lists for public STI testing in hospitals around the Republic are as long as six weeks.
"STIs are a major public health concern," says Dr Mary Cronin, an expert in the field of STIs in Ireland. "Four to six weeks waiting times are not acceptable."
STIs have been steadily on the increase in the Republic since 1994. The most recent statistics, for 2003, show that over 11,000 people were diagnosed with an STI, an increase of over six per cent on the previous year. Dr Cronin, one of the authors of the 2003 annual STI report compiled by the Health Protection Surveillance Centre (HPSC), says that all indicators suggest that STIs are continuing to rise into 2005.
More worrying is the finding that the number of STI diagnoses "is an underestimate of true incidences". Dr Cronin believes that although awareness about the importance of screening has risen, many potentially infected people still aren't getting tested.
"Anecdotally, we know that people have more sexual partners than in the past," says Dr Cronin. Between 2000 and 2003, 60 per cent of STIs occurred in 20-29 year olds.
The GUIDE sexual health clinic in St James's Hospital in Dublin provides the largest STI screening programme in the country. When contacted by The Irish Times, the next available appointment was in six weeks. However, from August 18th, the clinic will offer a walk-in service on Thursday afternoons and Friday mornings.
The infectious disease clinic in the Mater Misercordiae Hospital in Dublin has a waiting time of four weeks for a full STI screen. In contrast, the Royal London Hospital offers a free walk-in service for those who require a full STI screen five days a week. University Hospital London can pencil people in for a full STI test within 10 days and also provides walk-in testing for those under 22 years of age. All full STI screens include an HIV test.
Outside Dublin, the waiting times can be shorter. At Waterford Regional Hospital, people can expect to wait over two weeks to be seen. In South Infirmary, Cork, the waiting time for an appointment is five weeks.
One adverse result of waiting times for STI testing, Dr Cronin believes, is that people who make the decision to get tested don't always follow through with their intentions. "Many people may have symptoms so they make an appointment," she says. "But often the symptoms can go away. So people are lulled into a false sense of security and don't bother keeping their appointment."
Jane, who is in her mid-twenties, decided to go for her first STI test last year after having unprotected sex on two occasions with different people in a short space of time. She contacted the GUIDE clinic at St James's and was offered an appointment for six weeks later. However, when Jane arrived, she felt uncomfortable with the surroundings and quickly left.
"The place was a bit run down in my view and a lot of people there looked really sick. I just freaked out and left." St James's management has acknowledged the clinic is in need of refurbishment.
Jane (26) was seen within days at a private clinic where she paid €140 for a test and was relieved to find she did not have any STI. But the six weeks approaching her first appointment, she says, were extremely stressful. Because of the waiting times and the degree of anxiety they experience, some feel they have no choice but to go for private screening, she says.
However, the private option isn't for all. Kevin (23) noticed that he had contracted genital warts in March and booked an appointment at St James's. As he faced a four-week wait, he decided to go to a private clinic instead. "But they were terrible," he says. The staff in the private clinic were rude and unhelpful and he didn't get the appropriate treatment, he believes. "I went to them three times. Each time they froze the warts, which was extremely painful, and didn't get rid of them. That's why I had to keep going back. For each visit I got charged €70." At this stage, a month had passed and Kevin decided to keep his appointment at St James's. "They examined me properly, talked to me about the problem and then gave me an injection," he says. Kevin only had to wait about half an hour to be seen. "They looked after me in St. James's a lot better than in the private clinic," he adds.
Figures show that people are still having unprotected and unsafe sex, says Dr Cronin. But the most worrying recent statistic is the dramatic increase in cases of chlamydia, says Dr Cronin, which rose by over 17 per cent in 2003.
"It's known as the silent epidemic and it's widespread," she says, "It's most prevalent in young people." Seventy per cent of women and half of of men who contracted chlamydia in 2003 showed absolutely no symptoms, adds Dr Cronin.
"Chlamydia is rampant," says Dr Tom Kelly, director of the Everyman Centre in Dublin, a private clinic that deals with men's sexual health, including STI screening. "I believe many people at risk are not getting tested."
Sweden, the Netherlands, the US and, most recently, Britain, have introduced "opportunistic screening" for chlamydia, says Dr Cronin. "This means that when people come into the contact with the health service in any way, they are offered a test for chlamydia, as it is very easy to test for it," she says. "We are looking into introducing opportunistic screening in Ireland too." Although it is treatable, women who contract and remain unaware of chlamydia can suffer fertility problems, ectopic pregnancies and, on rare occasions, death.
In a bid to shorten STI testing waiting lists in clinics, the Irish College of General Practitioners (ICGP) is trying to encourage GPs to provide STI testing, says Dr Rita Galmberti of the ICPG: "We need GPs to be doing more screenings, and we need the clinics to deal more with people who have tested positive and need treatment." However, some GPs automatically refer patients to clinics if they request an STI test because if GPs carry out the testing, the information is documented on the patient's permanent medical records. When applying for mortgages over a certain value, life insurance is required and people's medical records are assessed.
"Sometimes, I will recommend patients who want an HIV test to a clinic," says Dublin GP, Dr Ray Murphy. "Not just because it goes on their private medical attendance (PMA) form, but also because clinics are more specialised." He added that when he refers patients to an STI clinic, this information is not included on their medical records.
Karen (23) went to her doctor asking for an STI test last year but was advised to go to St James's. "My doctor told me that this could go against me if I was looking for insurance in the future and said it would be better to go to a clinic." Karen too, said she felt uncomfortable at St James's. "But the staff are great and very friendly. They just have an unbelievable amount of people to deal with."
Ciara, who is in her mid-twenties, went for an STI test in a private clinic and gave a false name. Her friend, a mortgage adviser, suggested she do so rather than be tested by her GP. "I was afraid that after having had the test, regardless of the results, I would be penalised if they carry out background checks on me if I apply for a mortgage."
If information relating to STIs appears on a person's medical records, depending on what disease it is, they may be assessed as a possible risk factor, says a spokesman from the Irish Insurance Federation (IIF). "But I don't think if someone has chlamydia it'll go against them."