The number of people infected with gonorrhoea through casual, unprotected sex has more than doubled in one year, according to a report probing Malta's sexual habits.

The Genitourinary report, seen by The Sunday Times, reinforced the worrying trend of rampant casual sex and young people's lack of the most fundamental social and sexual skills, including basic genital hygiene.

The report should serve as a wake-up call to authorities to act urgently, as GU Clinic chairman Philip Carabot believed the problem of sexually transmitted infections was being grossly underestimated.

Dr Carabot was frustrated that each year he emphasised the dire need for a National Sexual Health Policy, based on the realities of Maltese society today, but it fell on deaf ears.

"The policy should be drawn up by experts, unfettered by institutional agendas. The 'revised' document drawn up seven years ago and unanimously rejected by the Sexually Transmitted Infection Prevention Committee as being too weak, should be shelved and re-written," he said.

However, this did not seem to be the government's priority because the STIPC's term of office expired at the end of 2007, and to date it has not been reappointed.

In the meantime, the GU Clinic continued to face an increase in STIs. Gonorrhoea, one such STI that can cause serious health problems, including infertility and chronic pelvic pain, had shot up by 52.4 per cent between 2006 and 2007.

Even more disconcerting was that this prevalent strain had become increasingly virulent and firmly resistant to the commonly used antibiotics.

Dr Carabot said that in the mid-1980s both gonorrhoea and syphilis - another STI that can cause serious damage to the heart, brain, eyes and internal organs if left untreated - had been practically eradicated, but they have now resurfaced with a vengeance.

"In the 1980s there were several campaigns to raise awareness on HIV and AIDS, so people were careful about having unprotected sex and these two STIs were drastically reduced. However, both have resurfaced probably due to information fatigue and indifference," he told.

Last year, there were 61 cases of gonorrhoea mostly affecting males (83.6 per cent), and young people aged 20-34 (73.7 per cent), while there were 18 cases of syphilis, an STI which is being increasingly diagnosed in pregnant women.

The practice of prescribing antibiotics blindly was also contributing significantly to gonorrhoea's increasing resistance to treatment.

"The actual number of infections is seemingly small, and at first reassuring. However, when adjusted in terms of population size, they give a more realistic and sobering picture," Dr Carabot said.

He stressed that the clinic's figures were not representative of the community at large, and were almost certainly the very tip of the iceberg.

"According to estimates by the World Health Organisation there is a potential of 13,000 new cases (of STIs) per year in Malta. However, we only saw some 2,000 patients, so obviously the vast bulk is out there in the community," he added.

The clinic, situated within Boffa Hospital, last year saw 2,221 patients, 71 per cent of whom were single, 89 per cent were heterosexual, 37 per cent were aged between 15 and 24, and 7.2 per cent were men who had sex with men.

In the married group, 28 per cent admitted to sleeping around, with 37 per cent of these having sex with prostitutes. A high 74 per cent never used a condom, putting themselves at risk of contracting an infection. In the group of men who had sex with men, more than half never used protection, even though 70 per cent had casual sex.

The trend persisted with married bisexual men (19 per cent) who practised homosexual sex anonymously with strangers in high-risk locations, such as saunas and clubs in Amsterdam and London.

Many, especially the older ones, admitted to getting married because of the stigma attached to being gay in Malta.

"The majority of bisexual men only admit to having sex with men, which begs the question of how many of these are actually gay, but find it hard to admit it, even to themselves," Dr Carabot pointed out.

Meanwhile, last year there were 77 cases of Chlamydia, which can lead to pelvic inflammatory disease, ectopic pregnancy and infertility, and was mostly asymptomatic.

The worrying trend of casual, unprotected sex among the patients who visited the clinic "is a serious indictment of our country's entire sex education programme.

"Assuming we're doing anything, whatever we're doing, is not working.

"We have not seen an improvement in the figures over eight years, so we need to stop and see what's wrong," he added.

Dr Carabot referred to the dire lack of resources to promote sexual awareness - serious campaigns, required serious money.

"We know the odd poster here and there doesn't work. Ideally, we should spend the money on advertising the clinic's services so that we can at least focus on harm limitation," he said.

"We need to qualify the problem and decide how to address it. Before we have a national prevalence study we will never know the sheer number of STIs."

Factbox: A sexual profile of young people

• 37 per cent of the GU Clinic's new patients for 2007 were aged 15 to 24. Young people are more susceptible to the complications of untreated STIs.

• Males' first sexual experience peaked at the age of 16, while females tended to have sex aged 16-19.

• Overall, 87.5 per cent said their first sexual act was voluntary. However, 12.5 per cent (16 per cent females and nine per cent males) were forced or coerced.

• Overall, 17 per cent (majority were girls) regretted their first experience, with "being too young" cited as the main reason.

• 42 per cent described their last partner as casual.

• 64 per cent admitted to never using a condom.

• 28 per cent admitted to anal sex, at least occasionally.

• 27.5 per cent admitted to illicit drug use, marijuana being the most popular (69 per cent), while 20 per cent were heroin users.