A grey area of sexually transmitted infections

The increasing number of people visiting the Genitourinary (GU) Clinic at Boffa Hospital points toward more awareness of sexually transmitted infections (STIs).

However, unless regular national prevalence studies are carried out, there is no way to know what the situation with regard to STIs is, the doctor in charge of the clinic, Philip Carabot, said.

Speaking to The Times, Dr Carabot said that just because it did not seem that there was a major problem in Malta one should not be complacent and think that everything was well.

"Other countries started with few infections and when the problem exploded it was too late to do anything about it," he said.

The number of cases in Malta seems small but this is precisely when action should be taken, he stressed.

Dr Carabot explained that when considering that about 70 per cent of drug users who attended the substance misuse unit were infected with Hepatitis C, there was a vast potential for an epidemic of HIV.

Since 1985, 235 HIV tests have proved positive. Asked whether this was the tip of the iceberg, Dr Carabot said he believed this was the case. However, he reiterated that before being able to say whether an infection was common or not, the country needed to carry out a national prevalence study. "At the moment we only have the worry of the possibility but it is not based on scientific evidence," he said.

Dr Carabot said the fact that Malta was a small country would facilitate carrying out such tests but funding was needed to do them.

He said it was impossible to come up with nation-wide statistics based on the number of people who went to the GU Clinic, although attendance has more than doubled since this started operating in 2000. In fact, in its first year about 550 people went to the clinic, while last year the attendance was more than 1,200. Dr Carabot said that in the first six months of this year he has already seen 870 people.

However, he added, this did not mean that the number of infections was increasing. He said many people still went to their family doctor, and women tend to visit their gynaecologist, and it was impossible to say whether there was an increase just by the figures of people calling at the clinic.

Dr Carabot said the majority of the clinic's patients were self-referred, adding that a formal referral ticket was not needed for a person to make an appointment at the clinic.

Most of the people go to the clinic because they are worried about their last sexual contact. He said about 40 per cent of patients described their last sexual encounter as casual. "This is a big problem, especially if they do not even know the partner's name, making it next to impossible to trace these people down. If there is a significant infection, it is my duty to try and trace back as many as possible so that any other infected people are treated."

He said it was also very worrying that apart from the 40 per cent of patients who admit that their last sexual encounter was casual, 64.6 per cent say they never use condoms. "Only 12 per cent say they use condoms consistently and this is very worrying as there is a high potential for disease to spread," he said.

Asked whether people usually go to the clinic because they feel or see something unusual, Dr Carabot said the problem with STIs was that the majority of them were completely silent and gave no signs of being there.

"The golden rule is to encourage people to get a check up if they are remotely worried, for example if they had casual sex without the use of condoms. If they wait for symptoms to appear it might be too late to do anything," he said.

He explained that while in the case of gonorrhoea in men symptoms were likely to appear after a few days, weeks or months could pass before a woman felt any symptoms of chlamydia, and months or years could go by before genital warts manifested themselves.

Dr Carabot explained that while some STIs, including HIV, were not curable, the majority were and the earlier they were detected the higher the chance of curing the infection and avoiding complications.

The doctor said the most common STIs were non-specific urethritis in men and non-specific genital infection in females, while genital warts were common in both sexes.

Dr Carabot said more men than women went to the clinic, even though women were considered to be more health-conscious. He explained that women usually went to a gynaecologist but added that the number of women visiting the clinic was increasing every year. He said that last year 38 per cent of the clinic's patients were women.

The youngest patient to go to the clinic last year was 13 years old and the oldest was in his 80s. Just over 10 per cent of patients who visit the GU Clinic were teenagers, Dr Carabot said. "This is a good thing because teenagers are a very vulnerable group," he said.

Dr Carabot said he was obliged to urge a minor to inform a parent and to ensure that the minor was fully understanding the facts. But other than that, he said, it was a doctor's duty to cure the patient and respect the patient's confidentiality. "This means that a minor can come here without the parents knowing. Although it would be ideal to have the perfect home background where the child is able to confide in the parents, the first priority is the well-being of the child," he said.

Dr Carabot said the main problem among youngsters was the lack of sex education. "It should be drilled into their brains that if they want to have sex, then it is imperative to use a condom," he said.

Abstinence was also important, especially among young people whose immune systems would not be mature enough to deal with infections. He explained that sexual relationships had psychological implications, especially when the people were very young. "Sometimes young people are not sure they want to have sex but give in to peer pressure and media images. We need to reassure these people that it is perfectly normal not to have sex if they do not feel ready," he said.