- STIs are plummeting and lockdown could reduce sexual infection rates for years to come, if we all do the right thing now.
Sex infection rates could be reduced for years to come and HIV effectively ended, if people order a home STI test before lockdown ends.
That’s according to experts at 56 Dean Street, the UK’s largest sexual health center.
The clinic diagnoses quarter of the country’s sexually transmitted infections in gay men. That means it is well placed to see early trends in sexual health, months before official figures come out.
Dr Alan McOwan of 56 Dean Street told GSN that some good can come out of the coronavirus pandemic lockdown – the chance to end new HIV transmissions.
‘We’ll never get another chance like this again. It’s a once in a lifetime opportunity,’ he said.
Massive drop in gonorrhea
56 Dean Street doctors have been particularly monitoring two figures.
Firstly, the number of people they treat for gonorrhea has dropped from 350 to around 50 per week. That’s an 86% drop.
McOwan said this was unlikely to be just because people are not coming in for testing because around nine out of 10 people with gonorrhea in their penis have painful symptoms. These symptoms usually start in a week.
He said: ‘This is something we would expect people to come in for, despite the lockdown.
‘If you have gonorrhea it’s like you are peeing razor blades, there is puss coming out of your penis, it’s extremely painful.’
‘I’ve never seen anything like it in 25 years’
Meanwhile, 56 Dean Street also prescribes a quarter of PEP in the country. That’s a drug you can take after risky sex to reduce your chance of getting HIV. But it has to be started within 72 hours to be effective.
And the clinic has seen PEP prescriptions drop from 50 to around five to 10 per week.
Again McOwan thinks that people will not delay, given how serious the risk is.
He said: ‘The figures started to fall in the week before lockdown. That’s the week everyone was panicking about buying hand gel.
‘They correlated with what men in clinic were telling us about changes in sexual activity on the scene and dating apps. The odd person is still having sex on Grindr. But there has been a notable change and a lot less sex going on.
‘So this is a quick and dirty calculation to work out what’s happening. But I’ve never seen anything like it and I’ve been doing this for 25 years.
‘You saw these massive falls in STIs in the early 80s during the AIDS crisis but that was over a year or so, this was a couple of weeks.’
Likewise, fewer people are taking PrEP – the table to prevent HIV – at the moment. With lockdown making many people stop casual sex, they realize there is no risk of HIV so they are having a PrEP holiday.
McOwan said: ‘We have been trying all we can to keep the PrEP service going. It’s the real world, human beings are human and some people will still be having sex. But where we used to have over 100 people a day coming in for PrEP monitoring we have about three people a day.’
‘Unique opportunity to eliminate infectious HIV’
Now doctors want everyone to order a home HIV and STI test kit before the end of the lockdown.
Now is the perfect moment to test, McOwan said:
‘This gives us a unique opportunity to eliminate infectious HIV from the community. We think very few gay men have caught HIV in the last six weeks.
‘After catching HIV it can take up to four weeks for it to show up in tests. So testing now will pick up nearly everyone who has the virus at the moment.’
And another factor will make testing now particularly effective:
‘People who have recently caught HIV have very high levels of the virus in their body. They are “super infectious” during this period. Half of all HIV in Britain is caught from someone who has recently caught it themselves.
‘So right now the number of “super infectious” people in the population is falling. If they test now, this will reduce transmission even further.’
Meanwhile, the clinic also advises all HIV positive people to continue to take antiretroviral treatment during COVID-19. HIV positive people on effective treatment cannot pass the HIV to others.
This is called ‘undetectable equals untransmittable’ or ‘u=u’. When on effective treatment, HIV positive people’s ‘viral load’ falls to undetectable levels. At this point, they can’t pass the virus on. Indeed, nobody has ever caught HIV from a ‘u=u’ person.
‘PrEP will be HIV’s knockout blow’
So, if people test now before lockdown and get treatment if they need it, HIV and other STIs can fall to record low levels.
And McOwan told GSN that effect may last for years.
STIs will fall anyway during lockdown. But they will shoot back up in the coming months if people don’t do anything. However, with testing, those STIs can be eradicated so you can’t pass them on to others.
And for HIV the change may be even more groundbreaking and long term.
That’s because PrEP, which has already had a dramatic impact on HIV transmission, is becoming more popular. And in the UK, the National Health Service is about to make PrEP available for free.
McOwan predicted: ‘PrEP will come along and do the fatal knockout blow.’
The government promised free PrEP will arrive by April although the coronavirus pandemic shifted that date. Now doctors are hoping it will be in place soon, ideally before lockdown ends, to make the most of this opportunity.
McOwan asks people to order a test here. And he wants people to share on social media and encourage their friends too:
‘Two or three years ago we were diagnosing 60 to 70 people HIV positive a month. I started out my career when literally everybody died. Now it’s in grasp that we can stop everyone from catching it.
‘So we don’t just want you to test, we want you to help us get every gay man to test. That way we can have a dramatic, long-term effect. We’ll never get another chance like this again.’
Meanwhile, people with STI symptoms should still seek help at 56 Dean Street or other clinics, despite lockdown.