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Editor,—An interesting observation was noted about patients with genital piercing in our clinic. We looked at 12 case notes of patients retrospectively who attended our clinic for sexual health screening in the past 12 months. There were seven males and five females in the age group 22–36. Looking at the results of their screening tests for STIs, none of the males had chlamydia. Interestingly, four out of six female contacts of these males, who also attended for screening, were found to be positive for chlamydia detected by enzyme immunoassay (EIA). None had gonorrhoea. It was also noted that none of these female contacts had their genitals pierced. Of the five females who had their genitals pierced, three had chlamydia, one had genital warts, and one was found to have bacterial vaginosis. Their corresponding male contacts again with no genital piercing also had chlamydia and genital warts. Two other contacts did not attend but were said to be asymptomatic. The method of genital piercing in males was with the so called Prince Albert ring (famously worn by Prince Albert) where the metal ring is inserted through the external urethra and glans penis (fig 1). In the females, however the urethra is not involved and the piercing is mostly through the clitoris or vulva. We wondered whether this involvement of the urethra in males was significant. It appeared that there was a protective effect in males despite having chlamydia positive female sexual partners. Possible mechanisms could be slow release of metal ions having an antibacterial effect, the presence of epithelial metaplasia or a chronic inflammatory process contributing to a local immune response. We do acknowledge that this is a very small cohort and these findings may be by chance or can be explained by the low sensitivity of EIA.
Genital piercing is becoming more fashionable in the Western world and is performed to enhance sexual pleasure and also for cosmetic effect. It was traditionally practised in the tribal population of India and Africa, mostly for ritual and cultural reasons. Metal or ivory studs or rings or bars are commonly used. The metals can be made of steel or various other alloys containing iron, copper, zinc, and even gold or silver. Currently, there are very few data in the literature about STIs and genital piercing but it has been postulated that there can be an increase in the risk of transmission of blood borne viruses as well as other STIs because of damage to condoms caused by these objects. A recent study1 also did not find any association between body piercing and genital infections in general; however, we wondered whether genital piercing should be included in the KC 60 data collection. We would welcome observations from the readers of STI on this subject.