8. Sexually transmitted Diseases Flashcards
Who gets STIs?
young age (<20 years) - low age at 1st intercourse - coitarche
frequent partner change, high no. lifetime partners, concurrency (simultaneous partners)
sexual orientation
ethnicity for some STIs
use of non barrier contraception
residence in inner city/ deprivation
history of previous STI
Age at first intercourse
Initiation of sex at earlier ages throughout W. Europe
UK showed continuing decline
Median age now 16ys (~30% <16ys)
Higher rate teenage pregnancy in UK (2x Germany, 3x France, 6x Holland)
Young people
Early age associated with poor subsequent sexual health status
Behaviourally more vulnerable to STI acquisition
- higher numbers of sexual partners / partners change
- greater numbers of concurrent partners
- yet to develop skills and confidence to use condoms, negotiate safe sex,
- more risk-taking behaviour/ experimentation
- poor contraception awareness
Physiology
Early intercourse
The earlier intercourse occurs, the higher the proportion express regret & report being more or less willing than their partner
20% men; 42% women express regret they had not waited longer
Vulnerabilities associated with early intercourse
Associated with vulnerabilities:
leaving home / not living with parents before 16 years
leaving school early
family disruption & disadvantage
lack of nurturing relationships
those whose main source of information on sex was not school / parents
Where do young people get information from?
25% daily searches access porn sites
Most common Google search term: “sex”
40 billion hits/month for popular sites
Unintended exposure – reported by 70% of 15-17yo while searching or checking e-mails
Intended viewing
58% teenagers view porn regularly; 1:10 every day
Free, unrestricted, uncensored
Boy’s use and attitudes to porn
Average age first seen 10 ys1
Main reasons: learn about sex / how to give pleasure, gain status in peer group
Younger age, more impressionable; less likely to have received sex education
Young men consuming a lot of porn
more likely to have earlier sex, certain sexual activities, less condom use
6x more likely to access then women
Girls use and attitude to porn
Average age 14 ys
Use also increasing but many women mixed feelings
More likely to see as degrading
Many afraid to show concerns
Both have mixed feelings about their partners using it
negative aspects of porn
Unrealistic nature & expectations
Self-image / performance anxiety
Lack of censorship / boundaries – hardcore material becomes addictive / normalised
Ethical issues e.g. exploitation of women
Sexual consent blurred
Lack of condom use = reduced risk perception / perceived need to practice safe sex
main messages to get across to young people
Don’t rush into it – avoid peer pressure
Use a condom with all new partners - continue until both screened
Sort out contraception
Avoid overlapping sexual relationships
Get screened for chlamydia/gonorrhoea when you have a new partner
MSM should have regular sexual health screens, including HIV, get vaccinated for hepatitis A/B and HPV & consider PrEP for HIV prevention
Concurrent (simultaenous) partners
Individuals engaged in >1 sexual partnership at once
Important in STI epidemiology opportunity for transmission
NATSAL 14.6 % men & 9% women had concurrent partnerships within last 5 years
Higher rates concurrence in the younger age range
Whats a core group?
sub-group of the population – high turnover not a static entity highly sexually active individuals high prevalence of infection reservoirs of infection high frequency of transmission
Effective control at the population level based on targeting core groups
GMC guidance on sexual examinations
Offer a chaperone
Explain to patient why examination is necessary & what it will involve
Give patient privacy to undress & dress
Obtain patient’s permission before the examination - discontinue if patient asks you to
Keep discussion relevant - avoid unnecessary comments
GMC guidance on examinations
Offer a chaperone
Explain to patient why examination is necessary & what it will involve
Give patient privacy to undress & dress
Obtain patient’s permission before the examination - discontinue if patient asks you to
Keep discussion relevant - avoid unnecessary comments
Female genital examination
Inspect pubic area, labia majora & minora & perianal area
Inspect & palpate inguinal region
Leg rests - allow better visualisation
Speculum examination (use water as lubricant - gels can interfere with tests)
Bimanual examination (if indicated)
