Morbidity and Mortality Rates:Morbidity rates for STIshave 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 2017there was a 6% increase(HPSC, 2017)The above table indicatesdramatic increases in Gonorrhoea, LGV notifications and significant increasesin Syphilis notifications.Table 2: Notification Of STIs by year 1995-2012Table 2 also indicates thegeneral increasing trend of STIs in the last number of years with the highesttotal 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 isalso 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. Theyalso found that 15-24 year olds accountedfor almost half of the Chlamydia cases, 43% of herpes simplex cases and 37% of gonorrhoea cases notified in 2016.Sexual Orientation: Menwho have sex with men (MSM) accounted for 100% of LGV cases, 88% of earlyinfectious syphilis cases and 63% of gonorrhea cases in 2016 were in MSM (where mode of transmission was known)Sex: (HPSC, 2017)The table above indicatesthat certain STIs affect one sex more than the other. Gonorrhoea, LGV, and Syphilis affected males more so thanfemales. Herpes Simplex and trichomoniasis affected females more frequentlythan men. Chlamydia seems to affect both males and females relatively equally.
Most Common STIs According to Table 2 themost 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 indicatesthat from 1995 to 2012 there were increasesin reported cases of almost all of the listed STIs with especially dramaticincreases in Gonorrhoea (91 to 1108), Herpes Simplex (198 to 1326), Chlamydia(245 to 6162) and finally Syphilis(11 to 518).STIs InternationallyInEurope, the number of STI cases is increasing, with an estimated 17,000,000 newcases per annum in Western Europe alone (Euroclinix, 2017)TheWorld Health Organization (2016) reported that over 1,000,000 sexuallytransmitted infections are acquired worldwide every day.In the UnitedStates of America, more than 2,000,000 cases of Chlamydia, gonorrhoea, andsyphilis were reported in 2016, the highest number ever (Centres for DiseaseControl and Prevention/CDC,2017). The same report indicated that syphilis rates increased in the US by nearly18% from 2015 to 2016.Overall it isclear that there’s a general increasingtrend of STI morbidity across the world. Sexual risk-taking behaviorand substance abuseA majorcontributor to the increase in STI rates globally the prevalence of sexual risk-taking behavioramongst younger age groups.
Substance abuse has been found to be associatedwith sexual risk-taking by many studies.Many studiesindicate drug use is a major contributorto increased sexual risk-taking behavior. A study carried out by KarenMcElrath,(2009) found that Sexual risk-taking(eg. having multiple partners, engaging in sex without a condom) was prevalentamong respondents who did engage in sexual activity during MDMA episodes.CDC (2012) alsofound that, amongst the 34% of sexually active high school students, 22%reported drinking or using drugs the last time they had sexual intercourse.
Stueve andO’Donnell (2005) found that there was a positive correlation between earlydrinking and unprotected sex.Another study of33,000 Danish men found that men reporting greater than 8-lifetime partners or 2 or more recent sex partners were morelikely to have other risk-taking behaviors such as early sexual debut, currentsmoking and regular binge drinking (Buttman et al,2011).Finding a directcausal 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 associationbetween the two. As a result we cannot explicitly state that there is causationbetween the two behaviors, but there is most certainly an association.Current Government Policy-IrelandAs a result of thegeneral increasing trend in the prevalence of STIs in Ireland, in October 2015the Department of Health published a two-yearaction plan with a National Sexual Health strategy plan.
The Strategy hasthree main goals:1. Sexual health promotion,education, and prevention2. Sexual Health services3. Sexual Health IntelligenceThese goals quite clearlyencompass some of the strategies of the Ottawa Charter for health promotion.· Creating SupportiveEnvironments: This aspect of the Ottawa charter is represented by the second goal ofthe strategy ‘Sexual Health Services’. The second goal of the strategy aims tomake “Equitable” and “accessible” sexual health services of a high quality toeveryone. This would most certainly enable and support the population in eitherfinding help if diagnosed with an STI or preventing them in the first placethrough checkups.
· Develop personal skills: Goal 3 is in sync with this strategy ofthe Ottawa charter. This goal aims to ensure the population has high qualityand comprehensive sexual health information. Sexual health intelligence,according to the strategy “supports good decision making for better health andhealth outcomes”. By advocating sexualhealth intelligence and providing access to information (goal 1), the strategy enables the wider population to develop their own skills and behaviorsregarding sexual risk-taking and alsopractices that prevent the transmission of STIs in the first place.· Building healthy publicpolicy/Strengthening Community action: These strategies of the Ottawacharter are aligned with the first goal,’Sexual health promotion, education, andprevention’. Sexual health promotion, education, and prevention strategies work to address a range of issues such as challenging stigma ordiscrimination and promoting healthy attitudes andvalues.
Working to lessen the stigma associated with Sexual health andSTIs will undoubtedly make help or advice from non-professional sources such asfamily members and teachers more accessible which in turn will hopefully leadto prevention. Also the fact that a 5-yearplan which includes numerous recommendations and 18 priority actions provesthat sexual health is now on the agenda of policymakers in Ireland where it may not have been in previous years.