The Big Question: Why are sexually transmitted infections rising, and what can the Government do?

Why are we asking this now?

We are in the grip of an epidemic of sexual infections and all attempts to curb it have failed. The overall toll of sex diseases has been rising since the 1990s and is up 63 per cent in a decade. New cases of syphilis, herpes, genital warts and chlamydia are at record levels and HIV and gonorrhoea are close to their record. There were 621,300 diagnoses of sex diseases last year, up 2.4 per cent on 2005, of which 376,508 were new infections. Today the Government's Independent Advisory Group on Sexual Health and HIV calls for urgent action to tackle the epidemic. Among 27 recommendations are national performance indicators for clinics, and the removal of restrictions on condom advertising.

What is driving this sex-disease epidemic?

In one word, the answer is complacency. In the late 1980s and early 1990s, fears about HIV led sexually active young people to exercise greater care over whom they went to bed with, what they did with them once there, and to use condoms. Since then, the success of antiretroviral drugs against HIV has led to the perception that it is a treatable disease that has lost its sting, like other sexually transmitted infections. Young people are bombarded with messages encouraging them to have sex and binge drinking is endemic. The combination may explain why Britain has the highest rate of teenage pregnancy in Europe. In the last decade, a more relaxed attitude to casual sex, an increase in risky behaviour, and a perception that sexual infections are trivial have all contributed to the rise in the number of sex disease cases.

Which diseases have seen the biggest rises?

Syphilis, which fell sharply during the 1980s, coinciding with the Aids awareness campaigns, has made an astonishing comeback, rising from 301 cases in 1997 to 3,702 cases in 2006. The disease is commonest in gay men and is concentrated in the cities. Herpes has also risen rapidly in recent years, especially among teenage girls. Genital herpes is caused by a virus and is incurable. The virus remains in the body for life and sufferers experience repeated recurrences which can be severe. The one encouraging trend has been in gonorrhoea, which peaked in 2003 at 25,000 cases and has since declined to 19,000 cases last year. The fall has been confined to heterosexual men and women – among gay men the disease has continued to rise.

What about HIV?

The story here is complicated because most people infected with HIV contracted the infection abroad or from a partner who was infected abroad. As a result, migration patterns, especially from sub-Saharan Africa, have a big impact. Overall, new infections with HIV fell for the first time last year, from 7,900 cases in 2005 to an estimated 7,800 in 2006, the first decline since the global epidemic began 25 years ago. New infections among heterosexuals, three-fifths of whom were infected outside the UK, have been falling since 2003, and the reduction in migration from Zimbabwe in particular is thought to be a key reason. Among gay men, the group at highest risk, the infection rate has increased by 20 per cent in the last five years and is continuing to rise. Heterosexual infections contracted in the UK have also risen. Among the most worrying statistics is that a third of those infected with HIV do not know that they are – and are therefore at greater risk of passing the virus on.

Which is the commonest sexually transmitted disease?

Chlamydia, which accounts for 30 per cent of all new cases of sex diseases. It is dangerous because it is often symptomless and can cause pelvic inflammatory disease in women which may lead to infertility. But it is easy to treat with a single dose of antibiotics. There were 113,000 cases in 2006, a 4 per cent increase on the previous year. One in ten young adults screened in 2006 under the national chlamydia screening programme, which is being phased in, tested positive.

Has the Government done anything to combat the epidemic?

Yes. It launched a £300 million sexual health campaign in 2004, the biggest for 20 years, to modernise STI clinics and run an awareness campaign. Last week, the Health Protection Agency reported that 80 per cent of clinics were now seeing and treating patients within 48 hours – yet the number of new infections has continued to soar.

Which groups are at greatest risk?

Young people, unsurprisingly, as they are the most sexually active and most likely to have multiple partners. But within this group, gay men and black Africans and Caribbeans are at highest risk. HIV, gonorrhoea and syphilis are concentrated in gay men and are continuing to rise. Gay men accounted for 63 per cent of all HIV infections acquired in the UK last year. Black Caribbeans have among the highest rates of sexually transmitted infections and almost half of new HIV diagnoses last year were among black Africans.

What are the risks from sexually transmitted infections?

They vary. Infection with HIV is lifelong – the virus cannot be eradicated – and while it is no longer the death sentence that it once was, it still means long-term drug treatment with a high likelihood of progressively declining health. Other infections can mostly be treated with antibiotics – provided they are diagnosed before they cause damage.

What can be done to improve sexual health?

In the long term, the introduction of compulsory sex and relationships education in schools is crucial. Anne Weyman, chief executive of the Family Planning Association said: "There needs to be a much broader programme across all schools which provides the skills and knowledge needed to negotiate relationships."

Should condoms be advertised on TV?

They offer the best protection against sexually transmitted infections, as well as being effective contraceptives. But there is a ban on advertising them on TV before the watershed. Young people need to grow up in a culture where they see and talk about condoms and, most importantly, use them.

Should the Government do more to protect the sexual health of young people?

Yes...

* The ban on television advertising of condoms before the watershed should be lifted

* A broader programme of sex and relationships education should be introduced in schools

* Testing for HIV and chlamydia should be stepped up and local provision of services increased

No...

* Sexual health is a matter of individual responsibility which should be negotiated in each relationship.

* The Government's role should be limited to providing individuals with information to protect themselves

* Expanding the sexual health service will encourage more unsafe sex