Dr Aisling Loy is a sexual health and HIV specialist working in Dublin. Here, she gives a snapshot of the clients she saw over one week this month at her Heytesbury street clinic.
MANY OF THE patients I see daily are very anxious.
Most people who come to me have self-diagnosed, usually with HIV or Syphilis through the internet.
The power of Dr Google.
Many opt for the rapid HIV test, where they can find out the result in 10 minutes (the two week wait that is often the case in other clinics is too much to bear).
Often, I am the only person they will ever confide in about such personal matters. Many find it cathartic to talk to someone they most likely won’t see again about their sexual affairs and problems.
So what are the trends? Who comes in for testing? What infections are we seeing? What does testing involve?
Irish people in general still have a very unevolved attitude to sexual health maintenance.
I see many men; young and old; single and married; who use sex workers.
For the most part, they have used a condom but generally not for oral sex, which can leave them vulnerable to infections such as chlamydia, gonorrhoea and syphilis. Many patients are back from group holidays – namely golf trips or stags – where, with drink and peer pressure, they made choices that they wouldn’t have normally.
Often in the cold light of day, they are upset and worried and convince themselves they have something.
Young women, in general, are becoming better at screening as they have regular contact with their doctors for contraception and smears and this seems to make them more comfortable discussing sexual health.
Here’s a snapshot of who’s attending one day at an STI clinic (all names, locations and any other identifying facts have been altered):
Aoife
Aoife who is having her first smear test now that she is 25 years old and is using the opportunity to have a sexual health screen. She has recently broken up with her boyfriend of five years and wants to move on with a clean bill of health. She thinks he may have cheated on her.
Colm
Colm – who was in London on business and had sex with a pre-op transgender sex worker – is now worried he has HIV, or something else and will give it to his wife. He needs to go on HIV post exposure prophylaxis (PEP), have hepatitis B vaccinations and use condoms with his wife for the next three months. He is pondering how to explain this as they are trying to conceive. He is very upset and guilt-ridden over what has happened.
Mary
Mary is 50 years old, she travelled from Leitrim for a cervical smear but when examined, she was found to have genital warts. She was too embarrassed to attend her local GP. She had recently separated and met someone new. She hasn’t been able to talk to anyone else about her new relationship for fear of being judged.
The whole concept of being in an STI clinic was upsetting, but she left a much happier person having been diagnosed and treated.
Georgio
Georgio recently got a text from a guy he had slept with telling him that he had tested positive for Gonorrhoea and Syphilis. Georgio has no symptoms and wouldn’t have tested only he got the text. He turns out to be positive for both also and receives treatment.
Mark
Mark who is home for two weeks from Abu Dhabi where he is too afraid to have screening carried out in case he gets deported if an infection is found. He wants to make sure he is “still in the clear”.
Carmen and Peter
Carmen and Peter, come together as a couple. She’s Brazilian and tests yearly, he’s Irish and has never tested. He is there at her insistence. He is a reluctant patient and says he has “never tested because he only sleeps with pretty girls”.
Carmen is shocked at the attitudes of Irish men to testing.
Alex
Alex, from California, is one of the many who work in the Silicon Docks. He just wants his yearly screen. He always uses condoms but likes to know he’s in the clear.
David
David has recently developed warts having started a new relationship in the last three months. He has tried treating them himself at home with all sorts of home-made concoctions from the internet – some include duct tape. Finally, he decided to have them frozen off.
Conor
Conor is 23 and has developed a rash in his groin area. He believes he has HIV and wants a rapid test. When examined, he has a shaving rash from removing all his pubic hair, a recent common trend. He is very relieved to the point of tears, but still insists on having a rapid HIV test.
Kate
Kate has been referred by her GP she has a chronic vulval itch which has been treated as candida (thrush). Kate is married and worried she has herpes.
When examined she has a skin condition (lichen simplex chronicus). She is started on treatment and should make a full recovery.
For some people, the barrier to testing is the worry that it is painful or they are too embarrassed to be examined. For those that are asymptomatic, they can opt for self screening which does not include a genital examination. The old “umbrella test” that guys fear is now gone. For the most part, it is painless and takes about 10 minutes with results in three to five days.
Dr Aisling Loy is the Medical Director of Himerus Health STI clinic.
Cost should not be prohibitive as there are lots of free clinics around the country. For more information see www.himerushealth.ie
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