Author: Emi Yokoyama, RN, MA
Editor: Tetsuya Tanimoto, MD
The number of people suffering from sexually transmitted infections (STIs) has been increasing worldwide, and Japan is not an exception. For example, the reported annual number of patients with syphilis in Japan was 4,559 in 2016, 3.7 times more than in 2013. Among various STIs, the most common is a bacterial infection called chlamydia. The reported number of patients with chlamydia in Japan was approximately 24,000 in 2016, and about half of them were in their 20s and 60% were women. Because most patients with chlamydia don’t have symptoms, it is hard to notice even if they are infected. As a result, it is presumed that more patients would be undiagnosed than the reported number. If left untreated, chlamydia may lead to infertility in the future, and early detection and early treatment are very important.
However, such medical knowledge is not sufficiently shared among the general public. To improve the situation even a little, I contributed an opinion piece on STIs in one of the most influential Japanese newspapers, Asahi Shimbun (“Let’s talk about STIs more openly,” March 30, 2018. https://www.asahi.com/articles/DA3S13427211.html). Thanks to the publication, surprisingly enough, I have had more chances than before to talk with my friends, colleagues, and acquaintances around me about STIs. In the present article, I would like to show briefly what is being done to raise awareness, including education on STIs in Japan as well as how we should utilize clinical laboratory tests of STIs.
Awareness-raising activities for STIs
Education on STIs in Japan is often carried out in conjunction with sex education, which mainly occurs in health education classes. In addition, as STI awareness-raising activities for the general public, various posters and slides are freely available as downloadable materials on the webpages of the Ministry of Health, Labor and Welfare (http://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/kenkou/kekkaku-kansenshou/seikansenshou/index.html), as well as on those of various educational organizations (http://jssti.umin.jp/pdf/keihatu20160630.pdf). On the other hand, one of my friends who is a nursing school teacher and also a qualified midwife told me the following: “When I had a group study of STIs in my school lesson, I found that a lot of students had never seen a condom. Even nursing school students are in such a situation in Japan! We need to have discussion more openly about sex and life.” When I heard this, I felt a sense of disappointment, as if the gears of “those providing education” and “those being educated” do not match at all.
The cause of my emotion is that, despite the numerous and free information available on the web, many people do not search for information unless they have a certain kind of nudge to take a look at STIs in their daily lives. Actually, I did not know that so many posters and slides on the web are provided by various awareness-raising organizations until I started to investigate to write my opinion piece the other day. These materials make it very easy to learn about STIs, and I myself gained much knowledge. However, such materials are meaningless if people don’t search for them. Isn’t it necessary for awareness-raising activities to have more opportunities to introduce and popularize message related to STIs to the public? In that sense, considering the fact that younger generations are more susceptible to STIs than older ones, it would be an effective way to educate people if more public service announcements related to STIs are disseminated through TV advertisements, publications in fashion magazines, and YouTube videos that are popular among younger generations.
Clinical laboratory tests for STIs
As I mentioned before, early detection is crucial for the timely treatment of STIs. Of course, I am aware that some people would underscore the need for effective prophylaxis before discussing early detection. However, although using a condom is the most popular method of prophylaxis in Japan, it is also true that a condom is not a magic bullet for prevention because some types of STIs involve the oral cavity, pharynx, and pubic hair. Therefore, more attention should be paid to the significance of clinical laboratory tests for STIs. Nevertheless, friends of mine often tell me the following: “I would like to try tests for STIs once, but I cannot visit a gynecologist without hesitation, and I feel awkward visiting her only for that reason. A desire for such examination will appear as if I am stigmatized by too much sexual intercourse.” Other friends also say, “I do not know the methods of testing, and I am just afraid.” As such, a barrier to clinical laboratory tests for STIs seems to exist.
One solution to the problem is to have tests that can be done anonymously at home by oneself. Depending on a test item, various commercial kits for blood and urine tests are available at various prices. The bottleneck is that prices are generally higher than at a medical institution because self-examination kits are not covered by health insurance and are paid for out of pocket. Ideal self-examination kits would be something like a pregnancy test kit that one can easily buy at a drugstore and promptly check the result within a day without any trouble. A doctor I know also says, “It would be rational if test kits were available in hotel rooms in which couples usually stay so they can check each other.”
On the other hand, some friends proactively have tests for STIs. One of my nurse colleagues said, “As I do not have a partner now, I tested for STIs the other day. I am glad that the results were immediately shown by blood and urine tests. In case of chlamydia, they inform me only if the test result was positive within 2 weeks, but I have not yet received any notification.” Another friend said that she and her partner had tests together, and they turned out to be positive. As a result, they also received treatment together. Of course, they were surprised when they actually had the result, but she said, “It is very natural to have more sexual intercourse as one gets older, and it is useless to dig into the past. If you get a positive result, you just accept the fact and just treat it, that’s it. Successful treatment can erase the disease, and I am satisfied with having tests after all.”
This sounds like a truly constructive and mature argument, doesn’t it? Generally speaking, the morbidity of STIs may increase when you have more opportunities for sexual intercourse, but it does not mean that you do not contract a disease if you have less experience. Furthermore, because the chances of contracting a disease is affected by a partner’s past experience, people should recognize that the risk of infection exists even after only one experience of sexual intercourse and that the barrier for tests should be reduced as much as possible in Japanese society.
According to the World Health Organization (http://www.who.int/mediacentre/factsheets/fs110/en/), more than 1 million STIs are acquired every day worldwide, and an estimated 357 million new infections of one of four STIs (chlamydia, gonorrhea, syphilis, and trichomoniasis) occur each year. Such huge numbers suggest that, rather than having tests when you feel anxious, it would be more natural and reasonable to have tests once you have sexual intercourse with a new partner.
I declare that I have no conflict of interest.