Breaking through the taboo

01 February 2017

As STIs appear to be on the rise among young people in the UK, Rebecca Grant explores why community practitioners need to talk about sex.

We need to talk about sex. It may not be an easy conversation to have – a recent survey by sexual health charity the Family Planning Association (FPA) revealed that almost one-third of people would prefer to do the deed rather than talk about it – but with rates of sexually transmitted infection (STI) diagnoses reportedly on the rise in some parts of the UK, it’s never been more important to speak up and try to abolish the taboos surrounding the issue.

The statistics indicate that sexual health remains a topic that people feel ashamed about, especially the younger generation– the FPA’s survey revealed that 26% of 16- to 24-year-olds admitted they did not want to be tested for an STI because they were too embarrassed, and a fifth were reluctant to be tested because they feared the results.

Cause for concern

On a national level, the fight against STIs is being taken very seriously. In London, where STIs rose by 2% between 2014 and 2015, a city-wide initiative called ‘Do It London’ is helping to raise awareness of safe sex and encourage those most at risk – including teens and young adults – to get tested. 

The introduction of a human papillomavirus (HPV) vaccine could also be helping to reduce the number of cases of genital warts, the UK’s most common STI.

Dr Neil Irvine, from the Public Health Agency in Belfast, believes the vaccine may be a reason why they saw a slight decline in the number of cases of genital warts reported last year.

However, despite Northern Ireland’s most recent data revealing a 13% overall decrease in the number of STI cases, healthcare workers must remain vigilant.

‘We’re certainly not thinking: “Oh great, there’s been a decrease, we can relax,”’ he says. ‘Some of the infection rates are signs of encouragement, but if you look at gonorrhoea, syphilis and HIV, the number of cases has increased. There is no room for complacency here, it is still important for us to get the safe sex message across.’

Breaking the ice

Paul Casey, the FPA’s head of training and programmes, believes community practitioners are well placed to spread the message. ‘I think community practitioners can really help, because often they are better known to the individual than a stranger in a sexual health clinic,’ he says.

Unlike the specialists at a sexual health clinic, however, many practitioners working in the community may not be used to discussing sexual health queries on a daily basis, so often it can be quite difficult to find the words to start these conversations. Paul’s advice is to ‘be bold’.

‘It can be slightly overwhelming to start saying the words “sex”, “sexual health” or “condoms” if it’s not something that you’re used to doing regularly, but the only way someone will know you are up for a conversation about it is if you signal it, and there is no better way of signalling it other than using the words.’

He suggests giving patients a gentle reminder at the end of an appointment that you’re able to help with any other concerns they might have, sexual health being among them.

Gill Bell, nurse consultant and sexual health adviser at Sexual Health Sheffield, agrees that it’s important to show patients that you’re open to listening to any concerns they have.

‘I wouldn’t necessarily expect community nurses to be routinely asking people about their sex life, but to be receptive and be aware, and to give patients the opportunity to talk about things that might be bothering them.’

Although it’s not expected of any healthcare practitioner who’s not a specialist in sexual health to have extensive knowledge of STIs, Gill says it’s vital for them to have a ‘reasonable grasp’ of the signs and symptoms to look out for (see box), and to also be aware that many people with infections may not have any signs or symptoms at all. 

It’s also important for any community practitioners to be mindful of the particular indicators of STIs among the demographic they are working with. School nurses, for example, are well placed to talk to teens about chlamydia, which is most prevalent among that age group. Health visitors also need to be aware of signs that might indicate an STI has been passed from mother to baby – conjunctivitis in an infant, for example, could be a symptom of gonorrhoea.

According to Gill, the underlying rule should be: ‘If you are talking to a patient who has concerns because they have had unprotected sex with somebody, the advice is always to seek a routine check-up if there are any concerns at all.’ 

And for those reluctant to seek a test, Paul says that a little knowledge about the screening process can help put a patient’s mind at ease.

‘It’s good to explain what a sexual health check-up might involve, because young people worry. Young men especially have this idea that some umbrella is going to be stuck up their urethra, so they just won’t go and get tested. 

‘I think it’s helpful to tell them that most clinics, if you go for a general sexual health screen, will offer a simple urine or blood test, and, if you’ve not got any symptoms, you will not be asked to take your clothes off or show any part of yourself.’

Most importantly, says Gill, community practitioners have a duty to spread the word that help is out there. ‘I think anybody working in health care can play a vital role in giving people brief advice and signposting them to appropriate specialist services as and when they may need them.’

STIs at a glance


One of the most common STIs, particularly in teens and early 20s. Every sexually active person under 25 should be routinely tested every year.

What are the symptoms?
Although most people don’t notice any symptoms, warning signs include pain when urinating or discharge from the genitals. Men may also have pain or swelling in the testicles, while women may experience bleeding before or after sex, or in between periods.

Is it serious?
If treated early, no. It will usually clear up after a short course of antibiotics. But it can lead to pelvic inflammatory disease, reactive arthritis or fertility problems.


Syphilis is less common than other STIs, but still easily spread through sexual contact with an infected person.

What are the symptoms?
Early signs include sores developing on or around the area where the bacteria entered the body. It can also cause a painless rash and flu-like symptoms.

Is it serious?
Although long-term complications are now rare in the UK, if left untreated it’s been known to cause serious damage to the heart, brain, bones and nervous system. Syphilis can also be passed on to a fetus during pregnancy, which can lead to miscarriage or stillbirth.

Genital herpes 

Caused by the same viral infection as cold sores (herpes simplex).

What are the symptoms?
At first, it may cause flu-like symptoms. This will lead to a tingling feeling in the genital area followed by blisters.

Is it serious?
It often clears up without treatment, but measures can be taken to relieve symptoms and stop it spreading.


A bacterial infection that can be spread by sharing sex toys, as well as through intercourse and oral sex.

What are the symptoms?
They often go unnoticed, but signs include yellow or green discharge from the genitals, and pain passing urine. It may also cause throat or eye infections.

Is it serious?
Antibiotic treatment is around 95% effective, but early treatment is crucial as long-term complications, such as infertility, inflammation of the joints and tendons, or skin lesions, may occur.

Genital warts 

The most common UK STI, caused by human papillomavirus.

What are the symptoms?
Bumps appear around the genitals. They are usually painless, but may itch.

Is it serious?
Long-term effects are rare, and the warts usually disappear on their own.


The human immunodeficiency virus is probably one of the most well-known STIs, as a positive diagnosis is life-changing.

What are the symptoms?
Symptoms might not be obvious, but 70% to 90% of people experience flu-like symptoms when first infected.

Is it serious?
There is no cure, but antiretroviral drugs can prevent or delay HIV from developing to the later stages of infection, when it can lead to death.

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