Playing safe

GINNI Smith remembers one young 15-year-old boy who came to her for advice. He was worried that he might have picked up chlamydia, a common sexually transmitted infection that if left untreated can cause fertility problems later in life.

Despite his concerns, he was reluctant to be tested. Ginni asked why. "He said it was because they shoved an umbrella into your penis," she says.

Presumably he meant a medical instrument used for taking swabs. It's an eye-watering thought, even so - but the boy was wrong, says Ginni. To be screened for chlamydia all you need to do is give a urine sample. Once he realised that, he was quite happy to be tested.

It's a classic example of the kind of misinformation that can make it so difficult for health workers trying to cope with the rising levels of sexually-transmitted infections (STIs) among young people in England.

A hard-hitting report from the Parliamentary Health Select Committee last week revealed a rising tide of sexually transmitted diseases, as MPs warned of an "appalling" crisis in the nation's sexual health.

One in ten young women in England was infected with chlamydia, the report said - while syphilis had increased by 500 per cent in the last six years and gonorrhoea rates had doubled. HIV rates were also on the increase. Ignorance of the dangers of unprotected sex was most alarming among young people, especially men, the report noted.

On the face of it the figures seem to show that the safe sex message taken on board by a generation at the height of the Aids scare has been well and truly forgotten.

Actually, that's not necessarily true, says Ginni, a nurse adviser for teenage sexual health based in York. In many ways, young people are more aware than ever about the risks of sexually transmitted infections - and part of the reason for the rise in figures may be that more people are coming forward to be tested.

It's not true either, she says firmly, that young people are necessarily more sexually active than they were a few years ago. Young people may think that up to 80 or 90 per cent of teenagers have sex before the age of 16. The reality is closer to one third.

Ginnie admits there is still genuine cause for concern.

One of the problems with chlamydia is that a young person can be infected without showing any symptoms. Experts believe as many as three-quarters of sufferers in York may be unaware they have the condition.

That means they can pass it on by having unprotected sex without ever realising.

Another major problem is that, while some young people are more aware of the health risks of unprotected sex, there is still a lot of ignorance around - and may myths are passed about.

"Knowledge about sex varies a lot," she says. "Some young people do remain quite ignorant about the risks of unprotected sex and sexual activity in general."

Among the myths that many teenagers still believe is the one that says you can't get pregnant the first time you have sex, says Ginni - which simply isn't true.

"Another myth says that you cannot get pregnant if you stand on your head afterwards," she says. She gives a small smile. "Frankly, you're probably more likely to get pregnant if you do that!"

When it comes to sexually-transmitted infections, there is also a fairly common belief among young people that you can't pick up an infection if you don't have full intercourse.

Again, Ginni says, that simply isn't true. You can get a sexually transmitted infection through having oral sex. "And if you take all your clothes off with somebody and rub your body next to them, if they have a viral infection or genital warts it is possible to pass this on, even if you don't have full intercourse."

There are also people who believe you can protect against infection by washing yourself thoroughly after sex. Ginni says it doesn't work.

"There are only two ways of protecting yourself: abstention, and using a condom," she says.

As a nurse adviser to teenagers on sexual health, her main job is to give out good, reliable information to young people who need it.

Her motto is simple: "If you're going to have sex, use your head - use a condom."

It may sound straightforward enough but sometimes getting that information to the people who need it is not that easy.

Contraception and family planning advice is more readily available for teenagers now than in the past. And despite national concerns about sexual health clinics being unable to cope with the demands placed on them, in York there is actually a very good service, says Ginnis.

The city has been chosen to lead the way in the fight against chlamydia, having been named as one of ten areas natiowide selected to launch a pilot screening programme. Screening is expected to begin in the autumn - good news, because once chlamydia is detected using a urine test it is very easily treatable with antibiotics.

There are also regular sexual health clinics in York devoted to teenagers under 18. For those worried they may be at risk of a sexually transmitted infection the genito-urinary medicine (GUM) clinic in Monkgate, York, holds a confidential drop-in service for under-18s two evenings a week.

The family planning clinic next door, meanwhile, holds a drop-in clinic every weekday afternoon from 4-6pm and on Saturday afternoons for teenagers worried about pregnancy.

The problem is that very often, young people - who may be trying to access health care without their parents for the first time - are too scared or nervous to use the services that are available.

"Young people are often embarrassed," says Ginnis. "It is difficult enough for any of us to be examined. When that examination is very personal, and when you are quite young, it can be very embarrassing."

For those who live in rural areas, a long way from cities such as York, the clinics can also be difficult to get to, she adds.

Her job, therefore, is to take her message about sexual health out to the teenagers who need it.

She offers an outreach service, taking referrals from parents, teachers, social workers, or young people themselves and talking in confidence to youngsters in their own homes, at college, or even in pre-arranged meeting places such as coffee bars.

She advises on everything from pregnancy, to the risks of infection and the need for girls to be assertive when insisting a boy should wear a condom.

Sitting in a nice office it sounds very easy to say girls should always insist on a boy wearing a condom, she says. "In fact, it is incredibly difficult to do. But we can help young people develop the assertiveness they need - and that is going to help them in adult life, too."

Young people under 18 who are worried about sex, pregnancy or sexually transmitted infections can phone Ginni in confidence on 01904 725444. They can also drop in to the afternoon family planning or GUM clinics for teenagers in Monkgate.

The under-18 GUM clinics are held from 4pm to 6pm on Monday and Wednesday evenings.

The under-18 family planning clinics are held every weekday afternoon from 4-6pm, and on Saturday afternoons from 12.30pm to 3pm

Updated: 10:29 Monday, June 16, 2003