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The incidence of sexually transmitted infections is cyclical and is subject to complex interactions between adaptations of their causative microbes, medication, cultural patterns, demography and economics. While STIs have their most severe impact upon those disadvantaged by socio-economic deprivation, STIs may also flourish during periods of economic growth and societal transformation. While the recent decline in gonorrhoea incidence in many Western countries preceded the worldwide economic recession, the current search for cost-savings in sexual health may leave us less able to recognise and manage the inevitable future resurgence of gonorrhoea.
Pharyngeal infection, as a potential asymptomatic reservoir that sustains the community prevalence of gonorrhoea, is a particular area for concern, especially for high-risk groups such as men who have sex with men (MSM) and commercial sex workers (CSW). Orogenital sex also appears to be practised increasingly in heterosexual couples of all ages. Certainly, the current predominance of HSV-1 as a cause of primary genital herpes supports an increase in oral sex. Among teenagers, oral sex may precede and substitute for genital penetrative intercourse at their sexual debut. It obviates the risk of pregnancy. Moreover, teaching about safer sexual practises may misleadingly suggest that it is safe from the risk of HIV and other STIs, and does not require condom use. In MSM, …
Competing interests None.
Provenance and peer review Commissioned; externally peer reviewed.