Sex, booze and STIs

This is the time of year when students break free of the scholastic routine and switch to party mode. Philip Carabot, who runs the Genitourinary (GU) Clinic, has learnt that, for some of these young people, fun translates into intoxication and casual sex. The irony is that, fresh out of exams, these youngsters have not yet learnt - or have not been taught - that with sex comes the risk of infection.

Each year, hundreds of patients, encouraged by the guaranteed confidentiality and free service, go to the GU Clinic because they fear they might have contracted a sexually-transmitted infection (STI).

Of course, it does not come as a surprise that a large number of these patients are under 25. But alarm bells start to ring when this is seen in light of the fact that, as research carried out by the clinic shows, almost 50 per cent of patients admit to casual sex and about 75 per cent never use a condom.

While it is positive that such youngsters are taking the initiative to monitor their health once they are sexually active, it seems that their main concern is the fear of having a baby whereas the risk of STIs rarely crosses their mind, Dr Carabot has noticed during his seven years at the GU Clinic.

In fact, some of the young people he met tell him they are using contraceptive methods such as the pill or simply relying on withdrawal without realising that such methods do not protect them from infection.

As he sat at his desk in the clinic, Dr Carabot stressed that he was basing his observations on what he saw at the clinic and, although such observations were not proven to reflect what was happening in society, he believed they gave a clear indication.

"With most young people who walk in here I often hear the same story - that, come the weekend, it's time to drink, have a good time and have sex. It's rather tragic that, as some young ones tell me, these 13- and 14-year-olds simply do it because it's expected of them not because they enjoy it.

"It's almost become 'fashionable' to have sex. You're out to get plastered. Drugs are very, very common - a lot of my patients admit to having drugs. Practically everybody smokes cannabis and cocaine apparently is very affordable... and, yet, they can't afford a condom," he commented in a tone of frustration.

Dr Carabot feels that one of the main problems is that these people are not being educated well enough or, as he puts it, they are not being "brainwashed" enough as to the reality of STIs.

He suspects that parents believe that their children will receive sex education at school but, if the parents are involved, these programmes would have a much higher chance of working.

"This means that there needs to be a system that educates the parents, as well as the teachers, to ensure they are trained to talk about topics such as STIs to young people," he said.

He then recounted a couple of "sad" cases that highlighted the ignorance of some parents.

"I've seen an alarming number of cases when young girls, aged 13 or 14, are accompanied to the clinic by their mothers who know they are having sex with an older boyfriend, often in his late 20s. And the mothers' concern is that the daughter has not yet become pregnant. They actually ask: 'What's wrong with my daughter and can you test her for fertility?' It's sad," he recalled.

As for the campaigns launched by the health authorities, Dr Carabot felt they were not really getting through to young people because the fact remained that many were neither abstaining nor using condoms.

"The use of condoms in Malta is absolutely abysmal. Unfortunately, the vast majority of people, say 75 to 80 per cent, do not use a condom despite the fact that more than 50 per cent admit to casual sex," he explained.

While adding that, on the whole, condom machines were available to young people, he thought it was absurd that there was still no such vending machine on the university campus.

"This is ridiculous when there are thousands of people bubbling with hormones on the best pulling ground on earth," he said, stressing that the reality of the situation was that - with or without the condom machine - these young people were going to have sex.

And, it seems, the reality of the situation is that there are large numbers of young people having casual sex without condoms and that STIs are out there.

How effective would it be to tell them to stop having sex?

"Actually sometimes I do. If a patient is very young I do encourage them not to have sex. Abstinence certainly does have an important role to play in the prevention of infection, but not alone.

"Research shows that preaching abstinence by itself is, in fact, counterproductive. People who have been encouraged simply not to have sex are more likely to have earlier sex and less likely to use a condom.

"Basically we don't know what is the best way forward. Nobody has a magic formula. Taking the UK, they have lots of sex education and condoms are freely available, yet, they have one of the highest rates of STIs among teens. We know what doesn't work. That is, teaching solely abstinence. But neither is the answer to dish out condoms with their breakfast.

"What's for sure is that people need to be educated that there are STIs to be contracted out there and that many of them are asymptomatic, that is, their presence is not obvious," he stressed.

At the GU Clinic, Dr Carabot sees a variety of STIs with the common ones being syphilis, chlamydia and genital warts.

Then there is gonorrhoea, a bacterial infection he observed has risen in frequency.

"This year I've seen many more cases of gonorrhoea. It has suddenly become more common and virulent. The antibiotics I used a few months ago no longer work and I have to use stronger antibiotics. This could be because the bacteria is acquiring resistance and doctors don't help by over prescribing antibiotics," he said.

Dr Carabot had no doubt that there were loads of other cases of gonorrhoea he was not aware of as many patients went to their GP rather than to the clinic. This, he said, may be because they do not know about the GU Clinic or because they feel they would have to wait too long.

He explained that, although serious cases were seen with urgency, usually patients who phoned for an appointment at the clinic had to wait two to three weeks for a routine check-up.

Then he paused and commented: "Let's be clear. In the cases of syphilis and gonorrhoea, let's not blame the foreigner. Most of it is home grown. We're actually exporting it," he said.

In the summer months, Dr Carabot expected to see more STIs. "Tourists and students who come to Malta want to have a good time and some will have sex. So I expect to see more infection over the summer period. Of course, some is imported but, equally, I've seen a lot of students leave the country with a souvenir they hadn't bargained for," he said, adding that even these foreigners were eligible for the clinic's services.

Speaking about the clinic, he said that although it was successful, it was not half as successful as he would like it to be.

"It's still a one-doctor-one-nurse show. It needs at least two doctors. I would like to see more patients. While I encourage the healthy behaviour that brings patients in for check-ups, I would also like to be able to treat more acute cases which I suspect are out there," he said.

He also wanted to clarify that minors can turn up alone at the clinic. Under Maltese law everyone has a right to medical treatment and, therefore, minors did not need their parent's consent in such matters. Although he had the obligation to ask minors if they would rather go back with a parent, the minors' health was his first priority and confidentiality was also guaranteed.

Health check

If you fear that you may have contracted a STI, or want to put your mind at rest with a regular check-up, you can visit the GU Clinic situated at Sir Paul Boffa Hospital, Floriana. This clinic can diagnose and treat STIs, guaranteeing absolute confidentiality. Treatment and counselling is given for free.

The clinic can be contacted on 2298 7115 or one can call to make an appointment on 2122 7981. When calling the second number you may get through to an answering machine, which is only used by the doctor in charge. Patients can, therefore, confidently leave their contact details.