Bad sex

The waiting room of Barcelona’s Unit for Sexually Transmitted Infections (UITS) is full of people and yet completely silent. The patients waiting are mostly men with a few women amongst them, a small group that represents an impressive range of ages and races. In the city’s STD clinic there is no confusion about what the wait is for. But unlike other patients readily sharing the details of their sufferings with one another, the STD patients kill time looking at AIDS prevention brochures and condom posters.

Once behind closed doors, one-on-one with the medical staff, they don’t feel any discomfort going into detail about their symptoms and the stories that produced them. “It is one of the things I love about my job,” said María Jesús Barberá, director of the unit. “Absolute strangers talk about sex with me openly and without holding back.”

These urgent conversations about sex keep the four doctors and four nurses of the clinic busy full time, more so with every passing year. The rise in the number of sexually transmitted diseases is a tendency not only in Spain, but also in the rest of Europe, said Barberá. Since 2000, every year has seen an increase in the number of patients. In 2007, the Barcelona clinic had 24,000 visits compared to some 15,000 in 2004. Such statistics come as a bit of a shock given the expansive outreach of STD educational campaigns and the unprecedented level of sex literacy. How is it possible that people continue to suffer an ever-growing number of sexually transmitted infections?

Partly it is because advances in HIV antiviral medication mean AIDS patients have been living more healthily and with a much lower risk of mortality in recent years. As a result, people have become less fearful about the deadly disease. Condoms are being ignored more often than they should be, warned Barberá. In addition, many people continue to subscribe to the erroneous idea that oral sex is safe sex, while in reality many STDs (like gonorrhea, syphilis and genital herpes) are easily transmitted through oral sex practices, especially to men. Using a condom while practising oral sex is the only way to be completely safe.

Finally, a big factor in the rise of sexually transmitted infections is the growing number of people who change partners with regularity, or have more than one at a time. No matter how insistently the doctors might advise sticking with old-fashioned monogamous behaviour, the reality of modern metropolitan life is quite different. Being one of Europe’s most desirable tourist destinations, Barcelona also ranks high among the Old Continent’s party and romance capitals. Endless nights spark new connections and, further fueled by a lot of ‘Sex on the Beach’ cocktails, they quickly grow into one-night affairs whose heroes and heroines often end up in the UITS waiting room.

Gay men frequent Barcelona’s clinic most often. Men make up between 60 and 70 percent of the unit’s patients, and homosexuals are largely responsible for the high number. Gay men often have a greater number of partners and are exposed to more aggressive infections because of their sex practices. This year, along with the more common STDs, the Barcelona unit has registered an outbreak of a newer disease amongst gay patients, which has only recently become known in Europe. LGV (or linfogranuloma venereo) is an infection involving the rectum and can have severe complications if not treated in a timely manner.

The other STDs on the list are the usual suspects. At the top of the chart for the most common ones in Barcelona are genital warts, followed by syphilis, gonorrhea, genital herpes, chlamydia and HIV. And having any of these infections makes a person more susceptible to others. Many times a patient diagnosed with syphilis, for example, will have also contracted the HIV virus.

“Another thing people don’t seem to fully grasp is that a lot of the commonly known sexually transmitted infections are silent and invisible,” added Barberá. “They can live in one’s body without symptoms. This makes them easier to pass to a partner as the virus and bacteria carriers are unaware of their existence. The bacteria causing syphilis and gonorrhea, for example, can thrive in the throat and the mouth without making one feel sick or uncomfortable. and it becomes easy for the infections to be transmitted through oral sex.

“The asymptomatic nature of some infections makes them not only easier to pass on, but dangerous for the complications that may occur later, particularly in women. They may suffer a higher risk of cervical cancer, pelvic inflammation and sterility, among other consequences.”

 She also noted that doctors often miss important clues when it comes to diagnosing STDs. Doctors without a speciality in the field may not listen carefully enough to patients, or examine them completely, said Barberá. Syphilis, for example, has been called ‘the grand simulator’ for its sneaky ability to disguise itself as a skin infection. “This is why my plea to colleagues who are not STD specialists is always to listen and examine carefully before they rule an STD out. It can hide under many layers.”

At the end of the day, the message is a clear one: when with a new partner, never forget to bring along a condom, even when only oral sex is on the agenda. And, for maximum safety, stick with a monogamous relationship. But since life has a way of proving this simple recipe hard to follow, keep in mind that those whose sexual experiences lead them to the UITS waiting room are in good hands. The clinic is free for patients with a tarjeta sanitaria (a valid health card), and provides both planned and walk-in emergency medical attention. What’s even better is that most members of the clinic’s staff speak fluent English, so angloparlantes won’t have to struggle with explaining the ‘inconvenient truth’ in a second language.

You can call the Unit for Sexually Transmitted Infections for an appointment (93 441 4612) or, for emergencies, drop by the centre (Avenida Drassanes 19-21). The clinic’s hours of operation are 8am-8pm, with walk-ins encouraged to try and come in between 11am-1pm and 4pm-6pm.

Free HIV testing:

A group of 20 Catalan pharmacies will participate in a 2009 pilot project to offer rapid, free HIV testing, which provides results in 15 minutes. The testing, done on a finger prick’s worth of blood, is mostly aimed at immigrant and marginal populations whose members may be reluctant to go to public health clinics.

Initially, none of the pharmacies are in the city, although a spokesperson for the Col.legi de Farmacèutics (www.farmaceuticonline.com) told Metropolitan that if the pilot project works well, within six months it could be expanded to include Barcelona. The costs of the initial programme will be born by the pharmaceutical companies that manufacture the tests.

“Pharmacists want to do something to encourage prevention and early detection,” said the spokeswoman. “We believe this is a way to do that. Until now, the test was much slower and people had to go to through the Seguridad Social.”

The tests will be conducted in a space in the pharmacies set apart for that purpose, and results will be given to the patients on the spot, she said. The pharmacist will not keep any records of the tests or the results. If a result is positive, the individual will be told by the pharmacist to visit a hospital and get tested again, and see a doctor.

An ounce of prevention:

The use of a condom has two immediate benefits: it protects against disease and prevents unwanted pregnancy. As the number of abortions performed on teenagers rises year after year, Catalan authorities want to increase condom usage among sexually active teenagers, and recently announced that 150 new condom dispensers would be installed in places where young people can access them, such as public libraries and metro stations. They will offer condoms at prices ranging between 30 and 50 cents apiece. Currently, according an article in La Vanguardia, there are 520 such machines in Catalunya.

First published December 2008.