'We are not the sex police'

The STI clinic in St James’s has seen it all and is expert at treating sexually transmitted diseases as well as putting patients at ease, writes JOANNE HUNT

‘WE’VE SEEN it all and we’ve heard it all, we’re not in for any surprises,” says Dr Fiona Lyons of her work at the sexually transmitted infections clinic at St James’s Hospital.

As a consultant in genitourinary medicine at the hospital’s specialist STI unit, the Guide Clinic, every day she meets people who she knows would rather be anywhere else.

“One of the most rewarding things for me is the ability to make something that is really big for somebody, less big,” says Lyons. “Very often people have a huge amount of anxiety.”

In the clinic waiting room late morning on a Friday, there are certainly one or two anxious faces, but the staff here are all about putting people at ease.

“We will go through with them their number of sexual partners and what type of sex they had,” says Lyons. “We ask lots of questions about sex. We are very comfortable with those questions – but we are not the sex police,” she says matter-of-factly.

“People needn’t be frightened about what they’ve done. We’re very comfortable with people telling us whatever they do. Human nature is very diverse.”

Visitors to the clinic, which is walk-in and free to all, range from those proactive about their sexual health wanting an MOT before entering a new relationship to those who have symptoms of infection.

She says ages range from 16 upwards, stressing, “There is no upper limit. There really isn’t.”

With genital warts and Chlamydia the most common infections the clinic staff see, the latter often in those who are under 25 and more likely to be changing sexual partners regularly, Lyons says a worrying trend at the moment is the number of cases of syphilis, particularly in young gay men.

“With syphilis there may be no symptoms at all and that’s the really big problem,” she explains.

While within nine to 90 days those infected may develop an ulcer or break in the skin at the site of infection, usually the genitals, if the ulcer heals it doesn’t mean the infection has gone.

“Then it moves on to the next stage where the syphilis has basically entered the body and can manifest in lots of different ways like a skin rash.”

The symptoms of gonorrhoea, which she sees increasingly in young heterosexuals, can include a discharge in both men and women, and in women, a change in menstrual bleeding or bleeding after sex.

But Lyons warns that sometimes there are no symptoms for women. The infection, she says, is increasingly resistant to antibiotics.

“The bug is becoming clever to the antibiotics so it’s really important that people are treated appropriately and that the people who are treating it are aware of the changes in the bugs.”

As all STIs carry risks, she urges that it’s important to get them checked quickly.

“With Chlamydia and gonorrhoea, certainly infertility can be a risk for women and it can be complicated for men as well,” says Lyons.

“Pelvic damage in women with unrecognised Chlamydia is a huge cause of morbidity for women later on in their lives,” and she says untreated syphilis is “potentially fatal”.

Of course those infected are a risk to others too and the clinic’s staff will even help with the thorny task of telling former partners.

“By and large, we encourage people to tell their partners themselves,” says Lyons, but for those who find it difficult, the clinic assists in two ways.

Working with the infected person to identify former partners at risk, staff will give them a slip with a confidential code to pass on to those partners. When brought to the clinic, the code is immediately recognised.

Lyons says this is a way for those infected to break the news without directly revealing their own diagnosis.

For patients who find this too difficult, the clinic provides a referral service where its trained health advisers will make a confidential and tactful cold call to a former partner.

“Our experience would be that when people are contacted, they realise we are not the sex police,” says Lyons. “They recognise the good in what is being done.”

And of course there are ongoing cases of HIV. Lyons says the clinic is continuing to see evidence of young gay men “engaging in very high-risk behaviour and getting infected” but she says the clinic is also seeing an increasing number of Irish heterosexuals putting themselves at risk.

With huge advances being made in the disease, she says it’s “not the ultimate death sentence it used to be.

“The are studies going on to see if it is safe for people who are HIV positive on treatment that is working to have a normal sex life and engage in unprotected sex and not transmit HIV.

“We’re not there yet but there is reassuring data coming out to suggest the risk of transmission – in a heterosexual couple in the context of the person who is positive taking treatment – is very low and that treatment is protective against infection,” she says.

“We’re trying to get the message out that you don’t want to get HIV. It’s manageable if you do, but you are better off not getting it.”

Lyons says while as a country we’re getting better at acknowledging that “people in Ireland do actually have sex”, she says that we still have a way to go.

She says she still hears phrases like “we only did it once” and “he didn’t come inside me”.

“I think for young women, their biggest fear is still getting pregnant, they are less concerned about the risk of sexual transmitted infection.”

With the Guide Clinic now in fundraising mode, Lyons hopes with public support it can be made as welcoming and supportive as possible to those in need. “We never forget people don’t want to be here.”

For more information, visit guideclinic.ie or contact Billy O’Keeffe on 01-4284395.

AINE (20)

My boyfriend of a year and a half cheated on me while I was on my J1.

He visited me there and I had symptoms a week after. I thought it might be thrush or something but when I got home I had a few more symptoms like burning when I urinated and the area was sore. I went to a private clinic, and they referred me to St James’s.

It was gonorrhoea. The service was really good; I should have gone there first because the treatment is free. I never thought I’d contract something, especially being in a relationship where I trusted the person.

I tell people to use protection and be smart about what you do, because you might think you know someone but then this happens.

John(30), from the Czech Republic, has been living in Dublin for six years

I used protection with partners in the past, but then I met somebody and it looked like it might be a prospective relationship.

After a year the relationship didn’t work out. I started dating someone else and he wanted to be free in the bed so I went to get tested. I tested positive for HIV. My previous boyfriend had had it and I got it from him. I was not angry because my view is I am responsible for what happens in bed the same way as the other person. I can’t blame him because I make my decisions.

I don’t want this to sound like an advertisement for HIV, but with new drugs you can live a normal life.

If I could advise anything to people, I would say it’s not a terminal disease, not going to kill you.

I would say in Dublin, and in small towns, people feel they cannot talk about themselves or develop relationships because people don’t know it’s not as bad as it used to be.

I have a boyfriend who is negative and he’s somebody who is just giving me loads of love, so I am really good.

SHARON (21)

My boyfriend cheated on me. He had sex with two other people in the one night and I only found out a few months later. I was on the Pill and I trusted him so I had unprotected sex with him.

I started to get pains in my lower stomach and I bled after sex. I thought it was cancer or something. I didn’t tell him about the symptoms in case it was something to do with me.

When he told me he cheated, I made him go to the clinic to get tested and he lied and said he just had a urinary infection.

I went to my GP and was referred to the Guide Clinic, I was nervous going in but I heard it can be really serious if you don’t treat it fast.

I had Chlamydia.

The clinic was brilliant, they told me everything and gave me medicine and said they’d call me back for regular check-ups, which is good.

The advice I’d give is the Pill isn’t the only thing you need to protect you, and never trust a fella.