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The sex partners of people who have chlamydia may receive free medication for their own treatment without ever seeing a doctor, under a new health program in Kitsap County.

The initiative, pioneered in Seattle, is designed to stem the spread of chlamydia trachomatis, the germ behind the most common sexually transmitted bacterial infection in the United States.

The approach presumes that the partner of an infected person is likely to be infected, too, and puts a priority on being practical.

“Some (people) don’t have good access to medical care,” said Matthew Golden, an associate professor of medicine at the University of Washington and one of a team of infectious disease and public health specialists in the country who came up with the program.

“We’re not telling people not to see their doctor. We’re telling them to see their doctor,” Golden said. “But if that’s not happening right away, they need to be treated.”

The program, known in medical circles as “expedited partner therapy,” began June 1 in Kitsap County, where the rate of chlamydia (kluh-MID-ee-uh) among residents ages 15 to 24 has risen an average of 5 percent a year in the past decade.

Left untreated, the infection can lead to pelvic inflammatory disease in women, which may result in sterility. More rarely, chlamydia can cause infertility in men, too. Symptoms for men and women alike include discharge from the sex organs and a burning sensation while urinating. But frequently, the pathogen lurks in the body without any signs, making it possible for an infected person to pass on the disease unknowingly.

Nationally, more than 1 million chlamydial infections were reported in 2006, but the U.S. Centers for Disease Prevention and Control estimates that 19 million new infections occur each year.

In Kitsap County, 350 cases of chlamydia were reported in the first five months of the year alone — making it far and away the most commonly reported sexually transmitted infection. By comparison, there were 33 cases of herpes, 30 cases of gonorrhea and one case of syphilis in the same period.

Expedited partner therapy aims to make treatment as available and convenient as possible for chlamydia as well as for gonorrhea. It starts when a patient who has symptoms seeks a doctor’s care, or — in the case of women — is found during her annual gynecological exam to have one or both infections.

A patient with chlamydia can be treated immediately with a single dose of the antibiotic azithromycin (sold in this country under the brand name Zithromax), said Beth Phipps, a nurse epidemiologist and chlamydia project point person at the Kitsap County Health District.

Gonorrhea also may be treated instantly with a second antibiotic.

Phipps said patients may then obtain free “Partner Packs” containing antibiotics, information about the medicine and the

disease, and a pair of condoms, directly from the health district clinic in downtown Bremerton or through their own physicians, who may call in prescriptions to any of seven Rite-Aid pharmacies in the county.

The partners never have to be identified. The patient simply gives a name under which the prescription should be written, and the person picking up the prescription asks for the packet under that name. Nor does the partner need to be the one to pick it up. “The prescription could be for Joe Schmo, but Minnie Mouse can pick it up,” Phipps said.

Phipps said discretion, delicacy and confidentiality are paramount.

When she started the job, Phipps admitted, she was abashed by the questions she had to ask her clients.

“I’m asking them about their sexual practices,” said Phipps, a grandmother who has been with the health district for 13 years. “I’m asking them about the frequency, the type, male, female, both; and that, actually, to start, was hard for me. It took me two days to call my first person.”

She has since learned to conduct interviews matter-of-factly and without judgment, as casually as if she were asking what the person had for lunch.

She’s also found that people of all types are vulnerable to sexually transmitted infections. “The perception would be icky, dirty, but not necessarily,” Phipps said. “I probably talk to more people who are regular Kitsap County citizens — professional people who just had a mishap.”

Nor are they necessarily promiscuous. One woman who had been to Harrison Medical Center’s emergency department three months in a row with a recurring chlamydia infection was, Phipps found, in a steady relationship. And her partner had been treated, too.

The problem was, the couple weren’t treated for the infection at the same time. “So they were passing it back and forth,” Phipps said. The trick was to treat them simultaneously, and counsel them to abstain from sex for one week until the infections cleared.

Golden at the UW, who also directs the sexually transmitted disease control program at Public Health-Seattle & King County, said that in the search for methods to slow the spread of chlamydia, he and a colleague at the U.S. Centers for Disease Control and Prevention found in a study that about half of all physicians at least occasionally give medicine to patients to take to their partners.

Until the advent of expedited partner therapy, the practice was done informally, under the radar. In fact, in some states, it is illegal to provide prescription drugs to someone who has not been evaluated by a health-care professional, although Golden said laws are changing because of the growing popularity of the formal program and its support from federal health agencies.

In Washington, the spread of partner therapy is funded largely through a five-year, $2.5 million grant from the National Institutes of Health, Golden said. Kitsap is part of a second wave of counties to join. The approach is now available in 18 counties in the state, including Clallam, Jefferson and Pierce. All of Washington is expected to be involved by the middle of 2009.

With 261 cases per 100,000 people, Kitsap’s chlamydia incidence rate is lower than the state’s rate of 283 per 100,000, which in turn is lower than the national rate of about 348 per 100,000.

However, Phipps said she expects Kitsap’s numbers to go up before they go down because of her concentrated efforts to track down infections.

In King County, where partner therapy has been available in some fashion since 1998, Golden said, the infection rate has been stable since 2002. He said researchers should be able to tell how well the program works statewide by 2011.

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During your teens you become sexually mature. If you’re a girl, you develop breasts and begin to get your period. If you’re a boy, your penis and testicles become larger. If you have sex, you could get pregnant or get someone pregnant. Whether you choose to have sex or not, it is a good idea to know about safe sex and how sex affects your health. Besides pregnancy, having sex puts you at risk of getting a sexually transmitted disease, such as herpes or genital warts, or HIV, the virus that causes AIDS.

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Both men and women need to look after their sexual health and take time to understand the issues that surround contraception and sexually transmitted infections (STIs). For instance there are some STIs, such as Chlamydia, that you could be carrying without having any symptoms. This infection can affect fertility, so it’s important to make use of the sexual health services available for free on the NHS.

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Almost half (48%) of high school teens say they have had sex–an increase of 2% between 2005 and 2007, according to data released by the Centers for Disease Control and Prevention. During the same time period, the proportion of high school teens who say they used a condom the last time they had sex decreased 2%.

Sex education: Talking to your teen about sex:

You understand the importance of sex education. But don’t count on classroom instruction alone. Although the basics may be covered in health class, your child might not hear or understand everything he or she needs to know. That’s where you come in. Awkward as it may be, sex education is a parent’s responsibility. By reinforcing and supplementing what your child learns in school, you can help your child.

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During your teens you become sexually mature. If you’re a girl, you develop breasts and begin to get your period. If you’re a boy, your penis and testicles become larger. If you have sex, you could get pregnant or get someone pregnant. Whether you choose to have sex or not, it is a good idea to know about safe sex and how sex affects your health. Besides pregnancy, having sex puts you at risk of getting a sexually transmitted disease, such as herpes or genital warts, or HIV, the virus that causes AIDS.

Teens don’t need a sexual predator to introduce them to online pornography. It comes to them through porn spam on their e-mail or by inadvertently clicking on a link to a porn site. Through pornography, young people get a twisted view of what constitutes normal relationships. In fact, pornography is directly related to sexual abuse, rape, and sexual violence.

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Herpes, both oral and genital, are highly communicable diseases caused by the two strains of the Herpes Simplex Virus: HSV-1 and HSV-2. Genital herpes is transmitted sexually and is rarely transmitted from a pregnant mother to her unborn child, but could prove fatal for the unborn infant if it is transmitted.

It is possible, though unlikely that someone can transmit the virus through the placenta during pregnancy. If this happens, chances of the baby being born with a defect or a miscarriage increase.

The transmission also depends upon the stage of pregnancy in which the primary episode of herpes sets in. If the women had primary genital herpes during the first trimester, then there are less chances of the baby being infected. This is because it usually takes the body three to four weeks to buildup antibodies against the virus.

So if herpes happens at the onset of pregnancy, the body gets enough time to build up the immune system. As a result, these antibodies are also passed onto the baby. Generally, mothers can have a normal vaginal delivery.

But this is not so if the woman gets the infection in the second or third trimester of pregnancy. If the blood tests confirm that the women has never had herpes before the experts will recommend a caesarian delivery. This is because at these stages, the body does not get enough time to build up the immune system and the chances of transmission are extremely high.

It is easier to prevent herpes than it is to cure it. The highest risk to an infant comes from an infected mother who contracts HSV-1 or 2 during pregnancy and the best way to avoid this is by preventing this situation. Since Genital Herpes is a sexually transmitted disease, steps should be taken to ensure that you don’t transmit herpes during this crucial time.

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Young people blamed for rise in sex infection rates

Casual sex is fuelling a big rise in sexual disease among young people, health experts warned today, as figures showed a 6% increase in infections.

Young people, aged 16 to 24, accounted for half of all newly diagnosed sexually transmitted infections (STIs) in 2007, though they make up only one-eighth of the population.

Infections rose across the UK, figures from the Health Protection Agency (HPA) show.

Professor Peter Borriello, the director of the HPA centre for infections, blamed the rise among young people on the prevalence of unsafe sex.

“It’s increasingly the case that among young people a casual shag is part of the territory, it’s part of life,” he said.

“Increasingly a shag now stands for syphilis, herpes, anal warts and gonorrhoea.

“If you are going to go swimming, dive into the pool, make sure you know how to swim, be safe. That really means wear a condom.”

There were 397,990 newly diagnosed STIs in clinics last year, up from 375,843 in 2006.

New cases of genital herpes rose 20% while there was a 7% rise in genital warts and chlamydia.

Young people accounted for 65% of all chlamydia, 50% of genital warts and 50% of gonorrhoea infections diagnosed in genitourinary medicine clinics across the UK last year, the HPA said.

This is the eleventh year in a row that STIs have risen year-on-year.

And young people are not the only group affected. Sexually transmitted infections among people over 45 have doubled in under a decade, a recent study showed.

The HPA said increases in testing and diagnoses accounted for some of the rise.

But Borriello called for a strong message to be delivered to those who engage in casual encounters without taking proper precautions.

The HPA want sexually active young people to be screened for chlamydia annually and every time they change their sexual partner.

Chlamydia, which often has no symptoms, remains the most common STI in the UK.

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Sexually transmitted diseases have risen to record high despite high profile advertising campaigns aimed at young people.

Almost 400,000 new infections were diagnosed last year - a six per cent increase on the previous year - and the highest since records began.

Half of all new cases were found in young people aged 16 to 24, despite them only accounting for 12 per cent of the population, prompting calls for them to be screened every year.

Casual sex and having multiple partners are driving the rate of sexually transmitted infections higher than ever and it is time people started taking responsibility for their own health, Government scientists said.

In 2006 the Government launched a high profile advertising campaign showing young people together in nightclubs and bars displaying the names of sexually transmitted infections like Chlamydia and gonorrhoea on their clothes to get the message across that it is not easy to tell who has an infection and that condoms should be ‘essential wear’ for a night out.

But despite this infections are rising faster.

The Health Protection Agency recommended all young people should be tested for Chlamydia every year as part of the national screening programme.

But Government targets to test just 15 per cent of 16 to 24-year-olds last year was missed and a significant increase in testing is needed.

Gwenda Hughes, from the Health Protection Agency Centre for Infections, said: “Young people are disproportionately affected by sexually transmitted infections. This is because they are more sexually active, have more sexual partners, they have a tendency to have overlapping sexual partners and they are more likely to have casual sex partnerships.”

Professor Peter Borriello, Director of the Agency’s Centre for Infections, said even though young people have the most infections it is still a minority of that age groups. He said most young people do abide by the safe sex message.

“We really should applaud and be proud of the way young people do overcome some of these problems and do take responsibility and don’t come away with a sexual infection.”

Around one in ten 16 to 24-year-olds is thought to be infected with Chlamydia, which is the most prevalent infection.

The HPA report said while just one in eight of the population are aged 16 to 24 years old, this age group accounts for around half of all newly diagnosed STIs in the UK including 65 per cent of all new Chlamydia cases, 55 per cent of all genital warts and 50 per cent of gonorrhoea infections diagnosed in specialist clinics last year.

Some of the increase is down to more sensitive tests being used which detect cases that would not have been picked up before and more people coming forward for testing, but this cannot account for all of the rise.

There were 397,990 new sexually transmitted infections diagnosed in genito-urinary clinics last year.

The biggest rise was in genital herpes which has risen by 20 per cent in one year to reach 26,062 new cases in 2007. Chlamydia rose by seven per cent to reach 121,986 new cases and genital warts rose by seven per cent to 89,838 new diagnoses.

New cases of gonorrhoea and syphilis dropped slightly.

Chris Plummer of the sexual healthcare charity British Pregnancy Advisory Service, said: “It is difficult to assess the true picture of sexually transmitted infections, because part of the increase in diagnosed infections is undoubtedly due to improvements in access to STI screening, which has been targeted at 16-24 year olds. However, simply advocating condom use and better sex and relationships education does not seem to prevent young people spreading infections- nor does suggesting that they should abstain from sex.

“Getting young people screened and treated with an accessible, discreet and quick service is the answer.”

Shadow Health Minister Anne Milton, said: “The Government has been shamefully complacent about tackling public health problems like sexually transmitted infections, and these latest statistics show the cost of their failure.

“Chlamydia accounts for almost a third of new infections, proof that the Government have let down young people with their dithering and delays to their Chlamydia screening programme.

“Their fifteen per cent target was modest and they’re still nowhere near meeting it. Meanwhile we’re seeing thousands of new Chlamydia infections every year, with the potential to leave patients with very serious health problems.

“The Government urgently need to get their screening programme back on track.”

Health minister Dawn Primarolo said: “It is a concern that the number of diagnoses of levels of sexually transmitted infections have increased - but these figures must be set in context.

“There has been a 16% increase in the number of people accessing sexual health clinics since 2006.

“That means more people are being screened and therefore detected. It also means more people than ever before are getting the information, tests and advice they need.

“Rapid treatment and detection cuts the risk of transmitting sexually transmitted infections.

“If this increased access is maintained, it could have a significant impact on the control of sexually transmitted infections.”

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Do you remember herpes? You’ll need to be of a certain age to conjure the particular memory I have in mind, which is of the spasm of sexual anxiety that went round when the disease first really made it into the public consciousness, after the incidence of infections leapt in America. Yikes, I can remember thinking. Weeping sores (routinely described as “agonising”), no prospect of a cure, the perpetual moral duty, ever after, to inform prospective sexual partners of your potentially hazardous condition.

It was attended by the whole paraphernalia of a modern media health scare – first person confessions by “anonymous” sufferers, dire predictions of future spread. And then herpes was upstaged by a much more frightening disease – Aids effortlessly taking top billing as spectre at the orgy. And for a while you could have been forgiven for thinking that herpes wasn’t a problem any more.

It wasn’t true, of course. A recent study by New York City’s health department suggested that an astonishing 26 per cent of the city’s adult residents are infected with the herpes virus and the ailment also turned out to be well represented in the Midlands study which has just revealed that sexually transmitted infections are on the rise among older people. Genital warts took the top spot, apparently, accounting for nearly half of the cases, but herpes came second in driving patients over the age of 45 to attend their local genito-urinary clinic. These people were certainly old enough to remember the public health campaigns that attended the first big wave of herpes infections – before it got pushed into the small print of the health warnings – but it didn’t seem to have done much to protect them.

I couldn’t help wondering whether there might be a psychological connection, in fact – between the endemic wariness of disease that such health campaigns attempt to promulgate and the kind of irrational relief that occurs when the gloomier predictions don’t seem to be borne out. Could it be that sexually transmitted infections among over-45s have increased because these patients have survived at least two big sexual disease scares and – unfortunately for them – wrongly assumed that it is safe to unclench?

The Health Protection Agency speculated that at least one possible cause for the doubling of infections was that as the fear of pregnancy disappears, it takes with it one of the most powerful motives for condom use. The other possibility, of course, being that older people are not having more unsafe sex than they used to – just having more sex full stop, an increase in activity that you would expect to bring a proportionate increase in infections.

I suspect it is the latter – and it isn’t just the arrival of Viagra and online chat rooms that have done it (as some reports suggested) but a sustained and unyielding behavioural campaign that dwarfs the impact of sporadic health education programmes. The latter we’re inclined to forget as soon as the advertising fades from the mind, assisted by the human instinct to ignore unpleasant truths. But nobody could have missed the diffuse lobbying operation which exists to persuade us that it is our duty to have more sex, more often and later in life than our parents did.

The social obligation to have sex responsibly – intermittently conveyed by educational campaigns – is barely audible beneath the blizzard of messages, in commercials, fiction and the general culture, which encourage us simply to have sex, and imply that retirement from the game isn’t any longer an option.

How very big of you, Jane

“Doing TV commercials has allowed me to take stage roles for which I’m paid very little,” said Jane Horrocks, left, in a recent newspaper interview. Give us a break, Jane. The logic of this seems to be that if Tesco hadn’t come calling, Horrocks would have been forced wistfully to turn down leading roles on the London stage, which seems implausible to say the least.

I wonder what her fellow actresses will make of her suggestion that accepting excellent parts in interesting plays constitutes a kind of charitable outreach programme.

The truth is surely exactly the other way round: doing the stage roles allows her, with a clear conscience, to take advertising jobs which earn her a small fortune.

* People rightly dislike the idea that politicians are just a set of pre-programmed responses, and yet politicians seem deeply reluctant to abandon the set plays of political life. The other day, for example, David Cameron greeted the result of the Henley by-election by pointing out that it had been “disastrous” for Labour. Thanks for that insight, Mr Cameron. Even our dog understood that much. Wouldn’t it have been more entertaining, just for once, to sidestep the clichés?

If I had been Mr Cameron, I would have congratulated my own candidate on his victory and then smiled sympathetically and said that, in the circumstances, the Labour candidate had really done awfully well. Indeed he should be congratulated, given his party leader’s recent poll ratings, on staying 223 votes clear of the UKIP candidate.

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New research suggests that having a family history of shingles increases your risk of developing the disease.

According to the case-controlled study published in the Archives of Dermatology (144: 603-608), patients with herpes zoster were almost four times more likely to have a blood relative who had also experienced the disease than those patients with no such family history.

While it is known that herpes zoster is more likely with increasing age and in patients with cell-mediated immunosuppressive disorders such as AIDS and cancer, it has only recently been suggested that there could be a genetic predisposition to the disease.

US researchers interviewed over 500 patients with herpes zoster and a similar number of controls. A significantly higher proportion of cases reported having a family history of herpes zoster (39.3% vs 10.5%).

The findings add to the increasing amount of evidence that infectious and dermatological diseases have genetic associations, the researchers said, and are particularly important in light of the new preventative herpes zoster vaccine now available.

“Such patients [with a family history of herpes zoster] represent a population that may be at increased risk of developing herpes zoster and therefore have a greater need for vaccination,” the study authors concluded.

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