A review of sex education in schools should be key to any National Sexual Health Policy because a section of very young people were having high-risk, casual sex while being clueless about the consequences, Philip Carabot, GU Clinic consultant, has warned.

"I have no illusion that I would be able to write this policy, in fact I believe we need to seek foreign expert advice, but the topmost priority has to be a review of sex education in our schools," he told The Times.

"Just starting from this would already be a huge step forward. And, I stress, it's not just a question of condoms. I'm in no way promoting condoms; they're just one detail in a much bigger picture," he added.

Two months ago, health director general Ray Busuttil said the policy should be "finalised in the coming weeks" after some seven years in gestation. To date it remains unpublished.

Dr Busuttil also said that, once published, "the policy will provide the framework and overall direction of where Malta should be going on sexual health but not the strategy."

This comment is of concern to Dr Carabot, who believes a policy should spell out both the direction and overall strategy. "This is a huge undertaking and should look at every aspect of sexuality in the country from the education of parents and students, gays, the situation in prisons...," he said.

He is also cynical about what the policy will contain once published.

"The last policy, which was updated six years ago, was full of holes and inaccuracies, so I hope it's been revisited since. I'd rather we do nothing if we're merely going to publish a piece of paper to pretend we're tackling the issue," he said.

"If there is no political will or determination to see the policy through we may as well go without."

He believes the policy's success hinges on the authorities' commitment to keep reassessing the situation and ensuring that any measures introduced were actually being implemented.

Dr Carabot is tired of sounding like a broken record, but the cases of unprotected sex he has been seeing each year at the GU Clinic force him to keep raising the alarm bells.

According to the clinic's latest report probing Malta's sexual habits, the number of people infected with gonorrhoea through casual, unprotected sex more than doubled in one year (between 2006 and 2007).

The report also highlighted more worrying facts but Dr Carabot is especially worried about underage casual sex.

An unpublished report on underage sex among patients attending the GU Clinic in 2006, seen by The Times, shows that 60 (4.4 per cent) of the 1,374 new patients were under 18 - the majority (35) were female.

He saw a patient as young as 13, three patients aged 14, nine 15-year-olds, 18 were aged 16, and 29 had turned 17. The majority, 70 per cent, were self-referrals and 65 per cent were still attending school.

"The kids I'm seeing at the clinic are totally unprepared for sex. I have witnessed enormous changes in behaviour and attitude in the last 10 years. They have acquired the lifestyle - both the good and the bad - of the rest of Europe without the necessary education," he said.

"There are certain youngsters who are having rampant sex, dabbling in drugs and getting drunk without a clue as to the consequences of their actions. When it comes to responsibilities they are clueless," he said, adding that students were leaving school totally unprepared.

The study shows that the majority of these ill-equipped youngsters (66.6 per cent) never used a condom even though 50 per cent admitted to vaginal sex and 32 per cent occasionally practised high-risk anal sex.

Another 28 per cent admitted to the use of illicit drugs, mostly marijuana, while other adolescents even dabbled in cocaine (four patients), ecstasy (two) and heroin (two).

What was even more disturbing was that 50 per cent of the underage patients described their last partner as causal and in many cases they did not even know the first name of the person they had been intimate with. Dr Carabot said this made partner notification (contact tracing to inform the other person to get themselves checked for sexually-transmitted infections) impossible.

"We rely on the patient's good nature to inform their partner to come forward to receive treatment. But the patients either have no clue as to who they slept with or they simply refuse to inform them because they do not realise the seriousness of the situation," he said.

As a result, the infected person remains at large, infecting more people in the process, and Dr Carabot said it was practically impossible to get to the source of the infection.

The rates of casual sex and condom non-use were "depressingly consistent" over the years and Dr Carabot felt it was clear that whatever efforts were being made in terms of sex education in schools and health promotion were clearly not enough or not working.

"It is high time we thoroughly revised both with an open mind - the overriding agenda should be the well-being of our young people," he said.

"This we need to do with urgency before we are hit by a crisis and then forced into counter-productive and knee-jerk measures."