Sat, Jul 24, 2004 - Page 9 News List

Young, free and infected: UK faces teenage sexual health crisis

By Julie Wheelwright  /  THE GUARDIAN , LONDON

Jasmine crosses her legs and shifts her gym bag more comfortably on her lap. She sits opposite Dr Emma Fox, the specialist doctor who runs Bridge, a pioneering sexual health clinic for under-20s at Guy's Hospital in London.

Jasmine explains tentatively that her contraceptive pill has been causing irregular bleeding and she doesn't know why. Fox notes her symptoms and runs through a list of questions. "Is this a regular sexual partner?"; "Is he from another country?"; "Do you use condoms?"; "Have you had any other sexual partners?"

At the last question, Jasmine gives a wobbly smile. This is her first boyfriend and she was sexually inexperienced before they got together. Fox assesses that her patient is low-risk for HIV but suggests running a screen for syphilis and gonorrhea because either of these infections could explain the bleeding.

Her next patient had unprotected sex with a stranger in March and is concerned that she might be at risk of HIV or chlamydia. She just wants to be "totally safe," and Fox orders the tests.

The need for a clinic aimed at young people could not be more stark. Britain has the worst sexual health in Europe, and its boroughs of Lambeth, Southwark and Lewisham have the highest rates of sexually transmitted infections (STIs) in the country.

The incidence of chlamydia has risen by 50 percent in teenagers in the past three years alone. Fox, who has headed Bridge since its opening in February, says an estimated 15 percent of her patients have this infection, which can be asymptomatic and lead to infertility in women if untreated. These south London boroughs also have a quarter of all UK gonorrhea cases.

"Having more services isn't the answer to improving teenage sexual health," says Fox. "The government has got the right idea with strategies that recognize the link between poverty, social exclusion and poor sexual health, but changing things is actually quite difficult."

The young people who attend Bridge, however, are fortunate because they can avoid the waiting lists that affect genito-urinary medicine clinics throughout the UK. As STI rates soar, with cases of chlamydia having increased by 140 percent between 1996 and 2002, and HIV diagnoses by 200 percent, clinics are burdened with huge increases in their caseloads.

Even worse, as patients are turned away from overcrowded clinics before they can be diagnosed or treated, they run the risk of infecting others; studies suggest that approximately a third of patients with symptomatic STIs continue to have sexual intercourse.

The consequences can be devastating. Rebecca, 23, slept with a former boyfriend who claimed he hadn't been with anyone else since their split. "He wanted to break it off so he could have told me anything and I would have had him back," she says. "We slept together and then I started having really painful cramping, even when it wasn't my period." Rebecca's test proved positive for chlamydia, but after a course of antibiotics she got the all-clear.

Rebecca regards herself as fortunate because an untreated STI can lead to chronic illness or permanent damage. "It can take a lot of courage to turn up to one of these places, and if you're told to come back in six weeks, that person might not come back," says Jan Barlow, chief executive of the Brook advisory service. "We certainly hear cases of people being turned away" from clinics.

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