When should you tell someone you have a sexually transmitted infection?

All new couples should visit a sexual health clinic for a full check-up before they start to engage in sex without condom use

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Last week STI dating site PositiveSingles was fined $16.5m (£10.4m) after losing a privacy case. The lawsuit alleged a number of users were misled about their privacy rights on the site, which advertised itself as a confidential service connecting single adults with sexually transmitted infections.

The topic of STIs is always an emotive and sensitive one. When is the right time to tell someone you have a sexually transmitted infection? “Yes I would love to go for a drink…oh! By the way, I have herpes.”

There were 446,253 sexually transmitted infections (STIs) diagnosed in England in 2013, according to Public Health England data.

Chlamydia (which is easily treated with antibiotics) was the most common STI in 2013, making up 47% of all diagnoses. Gonorrhoea diagnoses saw a large rise, up 15% from 2012 to 2013. Though normally treated with a single antibiotic injection and a single antibiotic tablet, a new strain of gonorrhea that is resistant to multiple antibiotics has been identified in Australia, according to a new study.

Many people suffer from cold sores or Whitlows on the fingers which are caused by the same virus which cause genital herpes. Apart from the discomfort and embarrassment at the time, they do not feel they are socially tainted for life as many do with genital herpes.

The herpes virus in the mouth and finger can be transferred to the genital area of another person during oral sex and digital stimulation. Genital herpes can be transferred by someone who may not know they have the herpes virus. It has been found that women who are self-treating thrush have often misdiagnosed the condition they have. A person can have had symptoms of herpes many years ago, never have sought help and never had a recurrence, therefore never having being diagnosed and may have forgotten the incidence completely - but can still transfer the virus.

It is thought that women who have had sex have a 50-75 per cent chance of having HPV, meaning a large proportion of the population have the virus. There are over 120 different HPV viruses and most of these causes no problems to health. These viruses can lie dormant for years and the person may never be aware they have them but for whatever reason the virus may become active and cause changes within the cell. Some cause warts, verrucae and others are linked to cancer of the mouth, cervix and anus. However the greatest risk of developing cancer of the mouth is smoking and this risk increases with high alcohol intake.

The HPV responsible for warts is easily diagnosed (if a person has visible warts they have the virus), however, subclinical warts mean that the virus is present but the wart is not visible to the naked eye. HPV related to cancer of the cervix cannot be seen and women are encouraged to have cervical sampling as requested to prevent negative out comes of the HPV . HPV has also been linked to anal cancer and anyone having anal sex should be aware of an increased risk.

The incident of HIV is increasing in the heterosexual population. The human immunodeficiency virus (HIV) is relatively delicate and cannot live for any length of time outside the body. The virus can be transferred during sex but is also transferred in blood. The medical screening of all blood products makes use safe within a hospital setting.

The ease of sexually transmitted infection transfer is difficult to research due to the repertoire of sex. We tend to replicate our sexual behaviour within our relationship but behaviour is different from couple to couple. Some sex acts appears to carry more risk than others in transference of sexually transmitted infection. However no sex is completely safe if one of the partners has a virus.

Dating sites that are set up for people who have been diagnosed with a sexually transmitted infection may reduce the individual’s burden of having to give this information to a person at the beginning of a new relationship, however, this makes the assumption that everyone who has a viral infection is aware of it - which is not necessarily the case. Also there is the assumption that all infections are disclosed which, again, may not be the case.

Dating sites that hold sexual information need to be very aware of confidentiality and the potential harm that could be caused if this information were to be given to others. Within a hospital setting confidentiality is so valued, and of such importance, that the sexual health clinics often have a completely different computer system so no one else within the hospital can access patient information.

On the legal side of things, in this country there is no legal requirement for a person who is diagnosed with HIV to tell their partner, nor is there a legal requirement for any sexual health staff to have to inform them. But people can be prosecuted for HIV transmission under the Offences Against the Person Act 1861 (OAPA 1861), for grievous bodily harm. There are two possible offences – reckless transmission (under section 20) and intentional transmission (under section 18). You must have actually transmitted HIV to be successfully prosecuted.

Staff spend a lot of time with patients who are newly diagnosed with HIV discussing the issues and give support and information for partner notification which is encouraged. Consensual contact tracing is the norm within clinics. Giving non-consensual information about diagnosis to others is seen to fatally undermine what is a confidential service as there is no control over information given and this information could be maliciously used by others.

In 2010, German singer Nadja Benaissa was found guilty of grievous bodily harm and attempted bodily harm, and was given a a two-year suspended sentence after admitting failing to tell ex-lovers she had HIV. Protection of children is highlighted in the guidance which was one of the reasons Nadja Benaissa gave for not divulged her HIV status, in order to protect her child.

It is a difficult ethical dilemma for staff working in sexual health as patient confidentiality is a fundamental requirement of the service. The issue is further complicated where the doctor has clinical responsibility both for the patient and the identified partner, as there is probably a legal responsibility on the doctor to inform the partner without the patient’s consent if the patient consistently refuses to do so, or gives consent for the doctor to do so. However, if patients thought others would be told of their diagnosis, it may stop them being tested, or not give a correct sexual history, which could put others at risk.

When it comes to dating sites, people might feel that this may be a future relationship in the making, and so to care for and disclose to another person is a high priority. However a drunken or casual sexual encounter may not aspire to these ideals. This sex may be just as risky in relation to infection transfer and all sex in whatever context should be safe.

Condom use is a must in any new relationship to protect not only ourselves but others too. All new couples, no matter how they meet, should visit a sexual health clinic for a full check-up before they start to engage in sex without condom use. If this became custom and practice, embarrassment may be reduced and discussion could take place with a professional to give clear information about the impact on the future sexual health for both partners.

For more information visit http://www.nhs.uk/conditions/Sexually-transmitted-infections