When safe sex doesn't matter

Annabel, a 27-year-old on the rebound, is just the kind of girl who is keeping the medical authorities awake at night. While they are frantically trying to tackle the epidemic of sexually transmitted infections (STIs) stealing through the capital, Annabel is having the time of her life.

She has just come out of a five-year monogamous relationship and, as if to make up for lost time, the junior advertising executive from north London has had unprotected sex with two different men in the last two months.

"Yup! I'm on the rebound!" she beams. "And by the way, one of the men was 21, the other was 40, and safe sex just wasn't a question with either of them.

"I've always said I'd never sleep with someone unprotected. But when that moment arrived, I thought 'It doesn't matter' ... and I did."

Annabel, like hundreds of thousands of young women in Britain today, is at risk from a host of STIs, including HIV/Aids, gonorrhoea, syphilis, herpes and now one of the most worrying - chlamydia.

Chlamydia, which spreads fast and shows few symptoms, is now responsible for a third of infertility cases in women.

Nine per cent of sexually-active women under 25 have it. If untreated, it can cause scarring of the fallopian tubes and result in a life-threatening ectopic pregnancy.

According to the British Medical Association's (BMA) recent report, the number of STIs has increased in the UK by almost 300,000 between 1995 and 2000.

While the 18-24 age group is most at risk, both the under-16s and those aged 30-plus are more at risk than they ever have been in the past, with sexual precocity among teenagers and the increased sexual activity of women both contributory factors.

"There is a public health crisis in relation to sexual health," says Professor Michael Adler of the Mortimer Market Centre, part of University College Hospital.

Eighty thousand men and women turned up at his drop-in clinic for genito-urinary medicine (GUM) last year. "It's a flagship centre," he explains. "It has a very high reputation - too high, unfortunately. It is very hard to try to maintain standards.

"Eighty to 85 per cent of patients refer themselves and just walk in off the street. Our workload has doubled in the last 10 years and, increasingly, here and elsewhere in the UK, patients are being turned away.

"In the UK over 40 per cent of GUM clinics are unable to see urgent cases within 24 hours."

Let's say you're an urgent case, having just had a holiday fling and suspect you might have come back with an STI as a souvenir, maybe even Aids (the number of heterosexuals contracting the HIV virus since 1999 has outstripped that of gay men).

Once you had managed to track down Mortimer Market, hidden, as if in shame, down a back street off Tottenham Court Road, you'd get a friendly enough reception.

In fact, if it weren't for the rack of leaflets about sexual health and the free postcards emblazoned with GET IT ON and a Durex logo (just in case you thought of dropping your granny a line), you could be in any NHS waiting room.

Such a place is not something Annabel would want to discuss with her friends. "STIs are a complete taboo," she says. "I just never talk about them, not even with my girlfriends.

"We discuss our fears of getting pregnant - I'm still on the Pill myself - but if I had to go to a clinic, I'd go on my own and wouldn't tell my friends about it."

Perhaps women like Annabel should talk to 28-year-old internet executive Melinda, from north London, who had her own very unpleasant STI episode.

"When I got chlamydia two years ago I was horrified," shudders Melinda. "I'd been working as a ski guide in Switzerland and yes, I'd been having fun, but I was by no means what you'd call promiscuous.

"I'd had a series of steady, long-term relationships before becoming single and I only slept with two men over the season.

"When I got back to London," says Melinda, who is getting married later this year, "I started to get really bad pains in what turned out to be my fallopian tubes. Within three days I had a fever and blinding headaches and chronic diarrhoea. I had no idea what was wrong. I went to my GP, who gave me a very alarming internal examination. He then sent me straight to an STI clinic.

"An STI clinic," she says, emphasising the letters with great deliberation. "I couldn't believe it. I was shocked. I never thought I was the kind of woman who would get a sexually transmitted disease.

I was then hospitalised and given intravenous antibiotics for 10 days, which was very painful. I had a pelvic inflammatory disease (PID) as a result of the chlamydia. I had a massive infection of my fallopian tubes; the infection was so big that it pushed by womb inwards, making it smaller.

"I then had six months of antibiotics and constant monitoring. I have just had the allclear and been told it has cleared up. My greatest fear was that I would be infertile. I was told my fallopian tubes were very badly scarred. I spent two years not knowing if I'd ever be able to have children. I lost a stone in weight.

"I now know I am not infertile, but what people don't realise is how major chlamydia is.

"I did tell a couple of girlfriends what I had, two quite straightlaced, 'proper' girls and guess what, one of them said she'd had it, too.

"To this day I don't know who I got the chlamydia from. I've never been able to trace it. Unless you have radical symptoms, like I did, you just don't know you've got it. You could be walking around with it for years."

Melinda's story does not surprise Prof Adler, who is working on the government's national strategy for sexual health. Sexual behaviour is changing and those who contract STIs are changing too. "Women, for example, have a lot more partners nowadays," he says. "But we're not frightfully good at facing up to the fact that people even have a sexual life. We now need to tell people how to be sexually healthy and to develop a culture that destigmatises becoming infected."

As for de-stigmatising promiscuous women, the capital is already ahead of the game. Ethan, 31, talks about the women he meets and goes home with once or twice a week in West End bars.

"I meet smart, intelligent beautiful young professionals - women who are not interested in shacking up and are very happy to play.

"It is now more acceptable for women to explore their sexuality and to take the same liberties as men. In fact, they are more likely to have one-night stands than men. They are more liberal."

Which is presumably why they are happy to get their sexual fix with Ethan, who happens to be bisexual. Ethan himself threw caution to the winds when he visited a London bath house three weeks ago and had unprotected sex with two Belgian men he met there. Result: he contracted gonorrhea.

Does he regret his behaviour? "I don't regret what I did. I regret having got gonorrhoea. It was very unpleasant and unnerving."

Tell that to Grub Smith, 39-year-old "bachelor" and FHM magazine writer.

According to this bon viveur, most men talk about STIs with "a certain amount of pride". He said: "They're a badge of honour. If someone were to confess to catching crabs, someone else would chip in and do one better. But no one would confess to having Aids or herpes."

As for using condoms, "the general rule is, if she looks a bit rough, like she's been around the track a bit, use one. If she looks like a nice girl, you're probably all right". Joanna, a 39-year-old interior designer from West London, fits firmly in the "been around the track" category.

"An old flatmate of mine once said I behaved like a man," she says, and he wasn't thinking of her penchant for liquor, though that's another cultural shift currently flooring the NHS.

"I was promiscuous, I had fun. I wasn't having one-night-stands so much as relationships that weren't much more than sexual.

"I didn't know the men's backgrounds or if they were sleeping with somebody else. I didn't want to know and I didn't ask."

Did she use condoms? "Not really. I don't like them, they're annoying, technical. Great sex is supposed to be spontaneous, edgy, dangerous.

"Those sort of relationships often start when you're completely plastered. You're not really thinking straight. Besides, when you've done it once, what's the point the next time round?" It was only her decision to have children with her partner of the last three years that made Joanna reconsider her past.

"When I had blood tests after I became pregnant, I was really nervous. I didn't think I had syphilis or Aids, but I thought I might have chlamydia.

"I could have had a test before but because I hadn't been living that kind of lifestyle for some time I didn't want to be reminded of it. I wanted to wipe the slate clean."

Joanna has also never forgotten how humiliated she felt on the one occasion she did visit an STI clinic. "I felt like a was on a conveyor belt," she says of St Mary's clinic.

"You don't have to give your real name, they give you a number. That made me feel like there was a stigma just being there. I found the ease of being able to see someone a bit degrading and dehumanising. You feel the doctors must think, here comes another one."

That's just one of the misconceptions public health experts hope the Department of Health's £4.75 million two-year campaign will correct.

But we all know misunderstandings and sex often go hand in hand, as Annabel's attitude to safer sex testifies.

"If a bloke did have a condom in his pocket," she says, "I'd think one of three things: either, 'that's a bit presumptuous', 'what have you got to hide?', or 'you're a bit square'.

"I mean, if he's all prepared he's probably a bit nerdy and not the man you thought you were going home with. Let's face it, if he's Jack the lad, he ain't going to give a s**t."

All the interviewees' names have been changed.