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Sexual Health (young people)

STIs: ideas about risk and decisions to test

Sexually transmitted infections (STIs) include chlamydia, genital warts, syphilis, herpes and HIV. If caught early most are easily treatable with antibiotics, but if left untreated they can have serious consequences including infertility (not being able to have children) and ectopic pregnancy.

Many people we spoke to avoid catching STIs by using condoms, or did not have unprotected sex till both partners had been tested for STIs. The only way to keep safe is to use a condom, particularly if having sex with casual partners.

 

Explains why she and her partner decided to go for a check up before they stopped using condoms. ...

Explains why she and her partner decided to go for a check up before they stopped using condoms. ...

Age at interview: 24
Sex: Female
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The person I'm going out with now, that's been a couple of years, and what we did, well we'd been very good friends for a long time before we ever sort of had a more serious relationship. So we agreed that until we had both been to the STD clinic and been absolutely cleared, that we would use condoms, even though we both hated them. And then after that we went back to using the pill, once we both had a clear certificate of health.

We just thought that this is what we'd hoped was going to be a very important relationship and we hoped to stay together. And we wanted to make sure we did it right, from the beginning, and didn't sort of give the other one anything horrible that we had from our past. We'd never felt comfortable enough to sort of broach that sort of subject with anyone before.  

He was the first person that I sort of felt comfortable enough to say 'actually, I'd rather you went and got tested'.

I think it was because I'd had a scare with someone previously who I had a relationship with and we'd relied on the pill and after we split up I had a lot of low abdominal pain, there was no discharge or anything else like that, but I was scared enough to go and get tested and everything. And there wasn't anything, actually it was fine and they decided it was sort of stress.  

I thought I had Chlamydia or something, I really did. I was really quite scared that I'd done something very stupid.  

 

Says that unprotected sex with casual partners is very risky for gay men.

Says that unprotected sex with casual partners is very risky for gay men.

Age at interview: 23
Sex: Male
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Do you feel at risk or not at risk of a sexually transmitted infection?

 

Definitely at risk.

 

Why because you have had unprotected sex?

 

Yeah, in being a gay male I think you are more at risk if you have, if you have casual partners as well and you don't know where other people have been, if they have gone cruising in parks or, you never know what you're gonna pick up, so the best way I suppose is to use protection to be safe.

 

So why do you say gay people are more at risk?

 

Because a lot of people are frightened of coming out, or having relationships, or a lot of, a lot of gay people are, that are not out, have wives and kids and then they go to toilets or parks to have sex with different partners. And they do it, some people do it every day, some people do it, you know, twice a week, three times a week and have sex with their wife as well, so the different sexual partners they have, you could catch anything, you know, crabs, all sorts.

But young people are often surprised to find out that vaginal sexual intercourse is NOT the only way people can be infected with chlamydia. The National Chlamydia Screening Programme in its website said that people: “can get chlamydia by having unprotected vaginal, anal or oral sex with someone who is already infected. It can also be passed on by sharing sex toys which haven’t been washed or covered with a condom before each use. It can also be passed by a pregnant woman to her baby during pregnancy or at the birth.”

The National Chlamydia Screening Programme recommends that:
if you have oral sex, cover the penis with a condom or the female genitals with a latex or polyurethane (plastic) square (dam).

 

Fiona thought that a condom was sufficient protection against STIs, she had no idea she could be...

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Fiona thought that a condom was sufficient protection against STIs, she had no idea she could be...

Age at interview: 20
Sex: Female
Age at diagnosis: 20
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It’s just that I had no idea and sort of I told these guys. And everyone was very surprised by it so.
 
Even if you sort of religiously use some form of protection?
 
It doesn’t necessarily matter it can be transferred before sex ever happens. So in terms of foreplay in, in that point it can be transmitted then even if you’re then incredibly careful you may have already sort of got it so.
 
What was her explanation or his explanation? Did they have some advice?
 
Because I think Chlamydia is… I can’t really remember how to describe it.
 
It’s a bacteria.
 
Yes, and so because it’s in that area any form of sort of oral sex or foreplay and all that sort of thing it’s possible to be transmitted then because of sort of contact during sex, I think it’s just possible that it can be transmitted sort of thing because a condom obviously is only protecting a certain part [laughs] as it were so.
 
So the message would be you just need to get tested.
 
I think, yeah, I think regular.
 
Regularly?
 
Regular testing sort of once a year you know, to obviously depending on if you’re changing your partner. If you’re not changing your partner then, and you’ve both been tested, then I don’t think it’s something to worry about provided you’re both faithful [laughs]. But if yeah, if you’re changing your partner I think more regular testing is probably necessary and it is, like we’ve said, it’s such a sort of simple process that’s not as terrifying as it seems, yeah.

There are a number of reasons why people we interviewed decide to be tested for STIs. Sometimes they are prompted by symptoms, like pain or bleeding during or after sex, chronic stomach pain, lower abdominal pain, an unusual discharge, itching around the genital area, pain when passing water, heavy periods or bleeding between periods. A sixteen year old girl we talked to had pain when passing water and a blister appeared on the lip part of the vagina.

 

Victoria felt a lump in her cervix and decided to go to the GUM clinic.

Victoria felt a lump in her cervix and decided to go to the GUM clinic.

Age at interview: 24
Sex: Female
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Yes I felt a lump inside me and it was especially uncomfortable when I used a tampon, I could feel it there and it was slightly uncomfortable and I'd been watching 'Embarrassing Bodies' which I found are very interesting, sort of, I like medical documentaries, I find it very interesting and so I felt where it was and I felt that doesn't feel normal to me. I didn't think it was normal. So I went to a GUM clinic to check which was a slightly interesting experience as I'd only gone in there for a lump and I got questioned about my entire sexual history which took you know, a good ten min, a good ten minutes with the two people in the world I've had sex with but they wanted to know what time each relationship started and ended and how long have you been sexually active, what protection had I used and everything. Finally we got to the examination room and they told me it was just my cervix and drew me a picture of why it felt so weird and then tested me for all the STI's.  So they just inserted a swab into my cervix, one swab, about ten seconds in there, that was it and then took a tiny bit of blood to test for HIV.  And they sent me a text, two of my test results saying, "All your test results came back clean." And then handed me a bag of free condoms and I went on my way.

Some go for a test even though they don't have any symptoms or, when invited to take part in the National Chlamydia Screening Programme, some worry they may have contracted an infection because they have not always used condoms. Other times a friend being diagnosed with an STI, or learning about the consequences, can prompt a person to get a check-up. Or they might find out that one of their partners ex's had an STI and have an anxious time waiting for the result.

 

Says that his main motivation for having a check up was to set his mind at rest.

Says that his main motivation for having a check up was to set his mind at rest.

Age at interview: 19
Sex: Male
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Can you tell me, you have come for tests, you had your tests done?

Yeah.

And they were all clear?

All clear.

And you were tested for everything?

Yeah. Well I've only, yeah I was tested for everything, but I'm waiting for the HIV results.  It was offered so I just took it.

OK, but I mean what was your main motivation to come and be tested?

Well my motivation was like I came to England only ten months ago and since I've been in England I have had quite a bit of sex with different women. And I didn't think I had anything, but it's just for a peace of mind, just to feel more relaxed about it, and just to get a test done.

And on those occasions have you used protection or not?

Yeah, only like just, as I say just maybe once or twice I haven't there hasn't been any with us and you just feel comfortable in that situation so you just go for it.
 

Explains that the experience of a friend of hers that contracted Chlamydia prompted her to go and...

Explains that the experience of a friend of hers that contracted Chlamydia prompted her to go and...

Age at interview: 18
Sex: Female
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Can you tell me what prompted you to decide to be tested?

 

One of my friends caught Chlamydia from her boyfriend who had slept with someone else behind her back and she didn't realise she had it until quite late on and I suppose that prompted me and a couple of my friends who've had a few sexual partners, to go and be tested and things even though they didn't really think there was a risk. 

 

Just come and be tested to make sure, because Chlamydia can make you infertile and we hadn't thought about it before until she had said and we'd seen how upset she was and things like that, so I suppose her experience prompted us to do it.

 

So do you feel at risk or not at risk of a STI?

 

I don't feel at risk now, no.

 

Why not?

 

Because I've been tested and because I know that if I had a new sexual partner I would use a condom and things like that.

 

If I thought that there was any risk, if I knew that they'd been with someone else and they had had unprotected sex then yeah, definitely I would say that I wanted them to be tested and I'd probably withhold from sex until they were really.

 

Two nurses approached Hannah and her friend in the park and invited them to do a Chlamydia test....

Two nurses approached Hannah and her friend in the park and invited them to do a Chlamydia test....

Age at interview: 18
Sex: Female
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My Chlamydia test was very, very spur of the moment because I’d seen when I was around at college because I went to a 6th Form college there were people like saying, ‘Come do the Chlamydia test now’. And surrounded by all of those people at college I just didn’t want to like go into the bathrooms and pee in a tub and then give it to someone in front of everybody but...
 
So my Chlamydia test was very odd because I was sitting in a park with a few of my friends and two people actually approached us and were talking to the girls and said, ‘Do any of you want to go get this Chlamydia test done?’ And me and two of my friends were just sitting there and we thought, well why not. We’re here and we want to make sure we don’t have Chlamydia so we basically just filled in some forms. Took the tub and went to the nearby pub that was around the corner and filled the tubs, came back and [ha] gave them it. And them literally the forms we filled in just gave like names, details, all of that stuff and then a couple of weeks later, about 3 weeks later I think it was I just got a text on my mobile. I got two texts saying I’m clear and the test was negative. So it was pretty easy experience to be honest.
 
Ok and who were these two people?
 
They were two of my college friends both the same age as me so I was 17 and they were 17 and 18. And we were all doing the same course together and just hanging out and yeah we just got approached and thought, why not.
 
But the people that approached all of you, who were they?
 
I don’t know. I assumed they worked for the NHS. They had little NHS badges and things like that so nurses I should think. Two women, yeah, two middle-aged women just came up and were speaking to us just saying, ‘Do you want to get the Chlamydia test. It’s really easy. All you have to do is go to the local pub and go to the toilets and then come back in 10 minutes or less depending on how quick you are.’
 
And at college could you explain a bit more about when people were doing it, did you have to go to the toilet and where everybody was peeing into these little cups and that was not something that you wanted to do?
 
No that was a lot more uncomfortable. Like in a pub because it’s like, it was really noisy at the time so and nobody knew what you were there to do so you just walked in as if you were going to the loo and then came out again. Well when you’re at college everybody knew that it was the week that the sexual health people were in and that it was the week that they were doing the Chlamydia testing. So if anybody saw you walk into a toilet like trying to hide something in your bag they’d know exactly why you were there.
 
Ok [laugh].
 
[Laugh] so it’s just things like people staring at you going, ‘Oh god she’s gone for the Chlamydia test. Who’s she been sleeping with?’

 

 

Unprotected sex and a wish to make sure that everything was fine, prompted Katie, Alice and other...

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Age at interview: 22
Sex: Female
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Katie' I think we’re quite clued up on it.
 
Alice' Yeah [laughs] we’re doing quite well.
 
Katie' Yeah I mean we know where like the clinic is in, you know, here so we know where to go if we want information.
 
First, what I would like is for you to tell me the reasons why you decided to go and have a Chlamydia test
 
Katie' Well, unprotected sex and then just wanting to make sure everything was okay.
 
Okay. Was that with a with a partner or?
 
Katie' Yes, it’s just not from, yeah, from not using a condom that so, yeah, wanting to get checked out.
 
Okay, and you.
 
Alice' Yeah, mine is a similar reason. Sort of I mean yeah, well, I’d just sort of unprotected sex with a partner and just sort of thought it definitely should be done sort of thing.
 
Okay.
 
Katie' Because you don’t know if you’ve got.
 
Alice' Yeah.
 
Katie' Anything so.
 
Alice' There are not necessarily signs and I’d rather know. And either be able to do something about it or sort of know that I am clear rather than thinking, “Oh, well, I hope I am.” Sort of thing.

 

Explains how she and her ex-boyfriend had to go and be tested for HIV after he found out that an...

Explains how she and her ex-boyfriend had to go and be tested for HIV after he found out that an...

Age at interview: 21
Sex: Female
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What led you to be scared of Aids, you were presenting some signs or symptoms? 

It was, no, no it was a bloke I was going out with at the time, we'd been going out for quite a while and we'd been, well at first we were using condoms and then I went on the pill, we hadn't got tested for things which I know is a bit silly but you kind of, you know just presume.

I don't know, I just kind of, when you've been seeing someone for a while you start presuming, and I don't think that's really the case. And then he found out that a girl he'd slept with, a couple of years before we'd started seeing each other, was HIV positive.  And he didn't know because he'd found out through a friend of hers, she didn't tell him so he didn't know whether she had Aids, I mean she might not have even known whether she had Aids when' or HIV, at the time.  

But he knew that she was HIV positive now and so wasn't sure if she might've been then, and they hadn't used any contraception. So he tried not to tell me, he tried to go and get tested without telling me but I thought he was being a bit funny and I ended up getting in a bad mood with him, so he had to tell me.  

And then we went and got tested together. I remember it seemed to take quite a while, it took about three or four days because it was the weekend and we couldn't find anywhere to get a test at the weekend. But eventually we did, and it all came back and it was all absolutely fine, we were both fine.  

But that was quite scary and it kind of made me realise I've got to be a bit more sensible. I mean like he's twenty eight, he's quite a bit older, so well it's kind of, he obviously has a bit more experience and probably should have, I don't know' been aware of that.
 

Describes the first signs and symptoms of herpes. Played by an actor.

Describes the first signs and symptoms of herpes. Played by an actor.

Age at interview: 20
Sex: Female
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I think the first time that I felt the problem it was the day after my sixteenth birthday. I had a pain and I went toilet and it was really, really stinging. So, I didn't pay too much attention because I thought it wasn't that bad, and then the following day I was going on holiday I was going with my family to Cyprus, and then I noticed on the plane, when I went to the toilet, that the stinging got really bad every time I went to the toilet. And then, when I got to the holiday, now, that's when I think it completely - the blisters really got big. Because then I couldn't walk, I couldn't do anything. I was laid up for, for the first week of my holiday. And I had a cousin with me, and then I confided in her, "I think I might have a problem", and we went to the chemist over there and we tried to get creams and then to try and stop the stinging, but I knew that there was a problem.

Where exactly was the blister?

It was on - it was on my vagina, but it was on the lip part of the vagina and it looked - it looked like, when I was looking in the mirror it looked like a big -someone had cut me. So that's the excuse I gave to my mum, when she wondered why I couldn't walk, why I wasn't coming down to the pool, or why I was in bed all day. I just said I cut myself with my fingernails.

To suspect you have an STI can be overwhelming for teenagers and often those we talked to did not talk about it with their parents. This often meant dealing with clinic visits, tests and results on their own. But young people, particularly young women may decide to go as a group to a clinic and get tested. Katie, Alice and a couple of other friends from university decided to get tested for STI’s and went to the GUM clinic together. They felt reassured by the mutual support and companionship and it made the experience easier to deal with.

 

Says that her cousin was the only family member that knew and supported her. Played by an actor.

Says that her cousin was the only family member that knew and supported her. Played by an actor.

Age at interview: 20
Sex: Female
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She was the only one who knew. I didn't tell my mum, but it was really strange, because when we was on holiday and we was all sitting talking, she brought up about her friend who - whose husband had given her genital herpes, and she was saying how she couldn't walk and everything. And me and my cousin was kind of giving each other the eye, like "Oh my God, is she hinting or something"? but she didn't relate anything to me, so I just kept it between me and my cousin, then, but now a lot more people know. Because it's something that I wouldn't say I'm ashamed of, but of course you're choosy about who you tell because some people are very small minded, and they'd just be - they'd think you're this really nasty person, when I'm not.

Was your cousin supportive?

Yeah, she was at the time, she was. Yeah, I mean, no-one came with me to the clinic or anything, but she was. If she wasn't there it would have been a lot harder, because we would sit down and think of excuses to tell my mum, and just - yeah - yeah she was supportive.

In general, media campaigns about STIs were seen as a positive thing: it helped young people to be aware of the health risks involved in sexual activity and to talk among friends about it. Some of the young people we talked to attribute their decision to have a STI test to media awareness and peer group discussion.

 

Stefanie indicates that hers and her boyfriend’s decision to test resulted from the awareness...

Stefanie indicates that hers and her boyfriend’s decision to test resulted from the awareness...

Age at interview: 24
Sex: Female
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When you were tested for Chlamydia you asked him [partner] to go to the clinic with you or?
 
No we both went separately actually but he was one of the people I knew that was going and I just thought it was only fair that I do as well.
 
You were together at that time?
 
But yes, yeah. It, it was for no particular reason. It was just because we are both really confident but television is making everyone a bit more aware about it and. Because we knew we wanted to spend the rest of our lives together we thought, “Why not start out with a clean slate”, really. So we know for sure and just made us feel 100% certain that we were fine.
 
It was at university and I think someone put up a sign and a member of the group started talking about it and some people expressed their concerns about doing it and others were saying “Well who had been?”, talked about their experiences and we kind of rallied together and agreed to do it together which I think makes it easier. And I think the adverts, I think that’s the key thing. They are breaking the taboo. They are making people talk about it especially the campaign on the television about, I think, people talking in those clouds. A lot of television programmes now like I mentioned the Channel 4 programme, they went into a nightclub and tested 5 people at random, 5 guys, 5 girls and said. They all thought they would be clean and a few of them weren’t. And it does make you go, ‘Wow’. So I think people just need to talk about it more. And not be afraid.

 

 

Chlamydia is the most common STI infection among young people but Sarah thinks that more...

Chlamydia is the most common STI infection among young people but Sarah thinks that more...

Age at interview: 20
Sex: Female
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When I went in for the pill they asked if I wanted to do like a Chlamydia test or anything like that because I’d obviously never had one before and I think they were quite informative. But then again, I think you only hear about Chlamydia. I think there’s very little information or general information on the other STIs. So I think Chlamydia is definitely the most well known.
 
I think there should be more publicity about everything else.
 
Okay.
 
It is known that Chlamydia is sort of the number one STI but I think they shouldn’t I think everything else should be out there as well because people because some people they have the one Chlamydia test whereas I think everyone should just do the whole, go to the, the clinic and get the whole test done because.
 
Carry on.
 
Well because I think if you just do that one Chlamydia test it’s unlikely but you never know you could you could have AIDS or syphilis or anything like that which you need a blood test for. So I just think there’s no point just doing one. I think you should do all of them but then but then I think there needs to be more information about all of them to make more people go because otherwise people they don’t go for anything else.
 
Do you have any ideas how they should they could reach young people and give this information?
 
I suppose leaflets then. I suppose at the university it’s quite good because you do a lot of there’s a lot of leaflets handing out. In the university they’re quite good at information but then again I think schools should have more on it as well.
 
So would you say that perhaps testing, having regular tests is, is a good idea?
 
Yeah, definitely. I think once you’ve been. I think your first time is very scary and you don’t really know what’s going to happen but after your first time I mean I don’t think you should have any problems with going again. I certainly wouldn’t now. I definitely think it’s a good idea. Even if there is no particular reason why you’re going it’s a just a good idea just to go just to have peace of mind and just to be careful.

 

Students we spoke to said they were ‘clued up’ when it came to STI testing and that this has resulted from public health campaigns and media programmes and knowing where to go to get tested. 

 

Katie compares her home friends to her uni ones when it comes to attitudes regarding STI testing,...

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Katie compares her home friends to her uni ones when it comes to attitudes regarding STI testing,...

Age at interview: 22
Sex: Female
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Alice' We’re all quite open about it.
 
Katie' There’s one regularly, gets tested regularly and…
 
Alice' Although that’s, that’s not university friends. At home, I mentioned to a friend that I’d been to the clinic to be tested but their sort of jaw dropped and they were like, “Really.” It was so it’s, it’s bizarre because within our group it’s very sort of normal to sort of, you know, [laughs] “I’m going to go and sort of get checked out.” Sort of thing. Whereas a lot of my friends from home haven’t ever considered doing anything like that so, I don’t know, it’s bizarre. I think different social crowds but I’ve persuaded quite a few of them to go, which is quite good [laughs]. So…
 
So do you think it’s something sort of that a student sort of population?
 
Alice' [mm] I think it’s a lot more.
 
Katie' Oh, yeah. Definitely.
 
Alice' Common definitely and I mean when we were in halls in the first year Chlamydia pots were sort of, the urine sample pots got handed round.
 
Katie' They were people coming down our road.
 
Alice' Yeah.
 
Katie' The other day.
 
Alice' Yeah, to give out the pots so.
 
Yeah [laughs].
 
Alice' Yeah, so it’s all, you’re made very aware of it I think as a student, which is very good.
 
 
Alice' It’s free as well and I think that’s, I mean when I spoke to home friends about it they didn’t realise it was free.
 
No.
 
Alice' No, so.
 
Katie' That’s strange.
 
Alice' And they didn’t know where they would have to go for it or anything, they just knew very little about it so I think, I don’t know, but I think we’re quite sort of clued up on it. But I think maybe for other people it’s not.

 

Sometimes though media campaigns were seen as adding to the stigma of having an STI. One young woman suggested that scary media campaigns were responsible for some of the misinformation about STIs.

 

Encourages other young people who are living with genital herpes not to feel ashamed. Played by...

Encourages other young people who are living with genital herpes not to feel ashamed. Played by...

Age at interview: 20
Sex: Female
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If a young person said, "What message have you got for me about all this?"

Well that it's not - it's not a bad thing you know, you don't feel ashamed about having it on your lip so why should it be any different? If anything, it's a thing, where, you know, if you've got it on your lips young people are ignorant in the sense that they would be like, "She does this, she does that". So it's really obvious. If you've got it there no-one doesn't know anyway, so it's a lot more - it's a lot - in a sense its not better, but don't feel in any way ashamed or dirty or anything, because it, it's not that, it's just an inconvenience. Same way you know if you get thrush - that's an inconvenience, that's what this is. Sometimes it just comes about for a couple of days and then it goes. If you learned that, it - this is what you've got, then just accept it, then it, I guarantee it won't even count, so'

One thing I really hate, you know, you hear sexual health adverts and you read articles, and they like to put fear into young people about catching these things, but what they need to understand is that this fear leads to stigma and a lot of people - the way that they think, and it's just, you know you think about it'. I heard an advert once, about the 'sex lottery', and you get herpes. It's like so what, you know, why make it into some big scary thing? If you give people the correct information, then they would know about it but they wouldn't look down on other people who's got it. Yeah, they wouldn't look down on other people who's got it, and that's kind of the whole thing that I want to do now, is let people know that it's not dirty, it's not a bad thing that other people make it out to be. It's not.

Last reviewed January 2016.

Last updated August 2012.

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