EARLIER THIS year, a team of Swedish researchers discovered that chlamydia can affect male fertility. Such a discovery asks a question about whether sexual health campaigns and warnings have focused too much on women to the exclusion of men. Although the stereotype says that men are not as receptive to public health drives as women, the chlamydia findings have prompted health professionals to reconsider whether men may be worth targeting more specifically. After all, if more sexually active men realise that infection could bring greater difficulties than mild discomfort, and more long-term consequences than a visit to the GUM clinic, they may be more open to clinical advice.

Researchers from the Umeå University in Sweden announced in late April that they had found that male infection with chlamydia reduced a couple’s chances of conceiving by around a third. They confidently claimed that this was not because the man had passed the infection on to his partner.

“Importantly, as well as the expected finding of antibodies among the female partners we found that antibodies in the male partner were significantly inversely correlated to the overall pregnancy rate,” said Professor Jan Oloffson, part of the scientific team that published the data. “Men need to be aware that this is potentially serious for them as well.”

If the findings are correct, the message that men are at risk of lower fertility if they catch one of the most common STIs will be difficult to get out. At the moment, men are blasé about most sexually transmitted infections as long as they aren’t HIV/Aids. Dr Ian Banks, a spokesman on men’s health for the British Medical Association, illustrates how men generally consider an infection such as chlamydia to be little more than an  embarrassing inconvenience, and that’s if they are aware of it at all. “The sexually transmitted infection chlamydia is the single greatest cause of ectopic pregnancy in women but for men, it just causes an itch. They don’t think about it. We did one study in the Far East that showed that 80 per cent of men thought chlamydia was an edible shellfish”, he says.

It is not just reduced fertility that lower-end STIs cause. Chlamydia carries with it a host of unpleasantness. It can cause epididymitis and Reiter’s syndrome – a condition where sufferers endure conjunctivitis and inflammation of multiple joints (polyarthritis). More importantly, it can cause an infection around the liver and much higher rates of infertility in women. When it’s taken into consideration that the spread of chlamydia beats the spread of herpes six to one, and that it’s 30 times as common as syphilis, it is clear to see that men have the right, and the responsibility, to be told that they may be not only hosting but spreading a very damaging bacterium.

As men are unlikely, on past form, to begin educating themselves about the intricacies of sexual health, there is clearly a need for a proactive strategy in this area. At the moment this isn’t happening. The Department of Health’s sexual health strategy proposes a national chlamydia screening programme for women but makes no mention of men. The Men’s Health Forum has suggested measures to improve the government’s treatment of this issue. They propose tackling the delay in access to GUM facilities, where currently one-in-five aren’t seen within 48 hours, and greater marketing of their services. They advise boosting the capacity of pharmacies to dispense advice in a confidential manner. They advocate a more diverse range of sexual health services for men, and suggest making guidance available to men in more informal, comfortable environments, such as pubs and sports venues.

However, it is difficult to know whether men are willing to talk about sexual health, whatever the environment. Whereas women have generally been conscious of their sexual health because of concerns over fertility and infection, and consequently more receptive to government advice, men as a group are harder to reach. Male peer pressure might even, as the House of Commons health select committee report suggested in 2003, make boys more sexually vulnerable than women. Bravado amongst boys and adult males makes it difficult to get the message of sensible sexual practice through. It is not a priority in male culture. The health select committee suggested that “young men’s needs were not met by sex education that was usually very female orientated”, and it seems that it is taken as read that boys will not treat sexual health as seriously as girls, so consequently efforts to reach them are half-hearted. The Men’s Health Forum argues that it is possible to bridge the gap to the male population, but it needs “accessible, innovative services that men are more likely to use”.

Clearly there is an argument that the current model of sex education is not working. But will alternative  approaches stand a better chance of closing the gap between expectations and reality? Is expecting men as a group to change risk-taking sexual habits that could be characterised (at their worst) as almost instinctively irresponsible, genetically and culturally, unrealistic? Do co-ed sex education and pioneering theory on changing at-attitudes, and enabling access to information, promise healthier sexual behaviour? It’s a difficult question, but if STIs such as chlamydia start affecting public fertility to an even more pernicious  extent, it’s a question the government may have to try to answer. Source: HPA, www. hap. org. uk (November 2003)