Thursday 19 December 2013

clap ... clap

I was coming back from work last week when I heard Dr Derek Freedman interviewed on RTE's Drive Time With Mary Wilson.  You can get the thrust of the interview's information on the Indo. Freedman is the Sexually Transmitted Disease/Infection STI bloke in St James's Hospital in Dublin. Apparently he pushed hard for condoms to be available from vending machines in pubs and clubs.  And it is now so.  So thank you Dr Freedman.  Freedman was being interviewed because the STI statistics for 2012 were out and gonorrhoea was up 33%.  Wilson was brought up sharpish by Freedman when she implied in the most oblique way that sex was bad. Freedman grew up in an Ireland where that was true and he wasn't going to have any of that nowadays: he made it clear that sex was fun and generally a Good Thing.  He then went on to deplore the fact that a disease that was treated with expedition and effectiveness by, say, a short course of oral penicillin now requires "injectable gentamicin 240 mg combined with oral azithromycin 2 g showed 100% effectiveness".  I ranted about how the casual use of cheap-and-cheerful antibiotics for "trivial" infections has rendered them obsolete for STIs and other life-threatening infections. Hence the slow hand-clap in the title. But try telling a parent that their infant's ear-infection is trivial. For my Russian and Ukrainian readers, I should explain that The Clap is one of numerous English synonyms for gonorrhoea,; The Pox is usually reserved for syphilis.

Gonorrhoea is caused by Neisseria gonorrhoeae which is closely related to Neisseria meningitidis one cause of bacterial meningitis.  Whatever about treating a case of the clap, there is some urgency in dealing with infection of the lining of the brain.  Years ago, The Beloved's brother went in to see the results after his business partner's wife died of meningitis and strongly advised the husband not to go view the body.  It's the stuff of nightmares.  Another issue is that if you have acquired Neisseria you have quite possibly acquired Chlamidia at the same time which is also a Gram-negative bacterium but susceptible to a different range of antibiotics.  In Ireland Chlamidia is 5x more common than Neisseria and 10x more common than Treponema (syphilis).

But back to Freedman, who seemed positively avuncular in his good-will towards those who have made a wrong call up against a wall outside a disco but firm in his belief that the consequences had to be faced up to.  He has been positively cited in a discussion about where to go for help/advice/treatment when you suspect you may have acquired a dose.  That discussion is interesting because of the dilemmas that folk face - your own GP may be obliged to shop you to insurance companies; everyone knows why you're going to visit a STI clinic; GPs don't really know enough; nurses at STI clinics are really supportive etc etc. Freedman's advice is both before and after. First off he acknowledges that drink can fling sense out the window for 'before', but urges us to be especially careful with people we don't know well.

"What constitutes safe sex? Knowing your partner, at least their first name and phone number. Starting any relationship with a condom and keep it on until you know them really well. "Going bare is something special for somebody special." Give breakfast. At least then you can talk and get to know the person you have just been with. Like any sport a return match is proper etiquette and it gives you both an opportunity to meet again without the overlay of alcohol, and to see if it is worthwhile going on with." From below the break in the Indo Article.

For 'after' the advice for worried punter and for health care practitioner his advice is quite stern and uncompromising:
  • keep yourself in your trousers until you get a clean bill of health
  • wait a week for things to incubate
  • get all your orifices checked out (this is no time to be shy - you weren't last Saturday)
  • get a blood test as well
  • get an appropriate course of treatment
  • get rechecked after 12 weeks
The characteristic discharge isn't always present especially if the infection is lodged in the throat or what doctors refer to as the back passage.  For us horse-riding protestants, the back passage is the corridor between the kitchen and the wine cellar where we used to down the old jodhpurs and roger the maids.  For some more down with the hood advice in more direct language ('back passage' is here 'bum') look to SpunOut the not-for-profit website created by young people for young people. And for the attention limited Tweeting generation, just get the T-shirt: "Gonorrhoea: hard to spell, easy to catch"


  1. The closest (mercifully) I came to an STI clinic, was a trip to a consultant some years back when WRH was Ardkeen hospital. The queue in the corridor went down both sides, and being late I ended up in the far off end where I found a nice comfortable chair. I was a little confused as to why I was all alone, many choosing to stand further up the corridor, which I put down to the fact that they might have been worried at missing their turn! Having come out of my appointment some time later I was asked to retake my seat, for a follow up appointment to be scheduled, when I noticed the sign for the STI clinic, something I had missed in my relief to find a seat earlier, I was sitting right under it! The reasons for the vacant chairs was that it didn't run that day of the week. At this stage of my life that's probably the closet I will get (potential mid life crisis excepted)

    1. Woot! You could have put a sign round your neck saying "I am a poxed sinner" then you could have sat anywhere you wanted and still been shunned. I find I need at least three seats for my capacious backside.