What TF is going on with Sexual Health in NZ?

The Burnett Foundation has been Aotearoa’s national HIV prevention and healthcare since 1985. Source: The Burnett Foundation. 

It’s time to have a chat about the birds and the bees. But more specifically, the uncomfortable and sometimes smelly issues that may arise when getting with birds or bees. And no, this is not the kind of chat where your B.O smelling P.E teacher tells you how to put a condom on, this is about sexual health, to just see how everything’s going. And to be honest with you, there are a couple of things to worry about.  

I took a wander to the sexual health clinic neatly bestowed beside Upper Riccarton’s favourite liquor store, to ask them what the hell is going on at the moment. And there’s one prominent concern: Syphilis – an infectious, stealthy and serious STI. 

The Riccarton Sexual Health Clinic in Christchurch has seen a significant increase in STI diagnoses and patient presentations from 2018 to 2023, with a 64% increase in STI diagnoses from 2021 to 2023. This rise correlates with a 60% increase in overall patient presentations, which includes patients visiting the clinic for various health issues. Practice Co-Ordinator Kim Sampson, said they have noted a “significant increase in syphilis over the last couple of years, and are definitely treating more people than previously.” A peak in syphilis diagnoses last occurred in 2019, and with the current increase in patients suffering from this STI, they “are testing more people for Syphilis by prompting them to have blood tests as well,” Sampson said. Syphilis is largely diagnosed by blood tests, but many people only have self-collected swabs and urine tests when getting an STI test. However, these test for chlamydia and gonorrhoea, not for syphilis, HIV, and hepatitis which can be found by having a blood test.  

But what the hell is Syphilis? 

Syphilis is a sketchy STI that begins with painless sores, often on your junk or mouth. It can lead to serious health problems if ignored, like brain and organ damage. The biggest problem is, symptoms can take up to 90 days to show, if at all. So it is awfully easy to spread and contract it without any knowledge at all. Syphilis spreads mainly through unprotected sex; including oral, vaginal, and anal. Complications of syphilis are significant, with the possibility to cause permanent visual loss and hearing loss if not treated early. As well as this, pregnant women can pass it on to their babies resulting in stillbirth or congenital syphilis infection. Anyone who is sexually active can get it, but it's more common among men who have sex with men (MSM). Condoms only partially protect against syphilis, but since it can spread from external sores – no one is 100% safe. Regular testing is the real hero here, catching and treating syphilis early to halt its sneaky spread. Luckily, syphilis is treatable with antibiotics, usually penicillin. But the sooner you get treated, the better.  

The Burnett Foundation Aotearoa - formerly the New Zealand AIDS Foundation, leads efforts to end HIV transmission and support those affected. They have also noticed a rise of syphilis in MSM. They offer HIV testing, counselling, advocacy, and education, promoting sexual health and reducing stigma for the LGBTQ+ community through research and outreach. Here in Otautahi, their centre on Cashel Street provides free and confidential sexual health testing for MSM and their sexual networks. These legends pour their time and effort into making sex safer for everyone, and they possess similar concerns about the rise in syphilis.  

Gynaecologist and Sexual Health Physician, Anne Robertson, said the increase in syphilis cases is a worldwide issue, post COVID-19, as is for other STIs. And although the symptoms are discrete, they can be incredibly harmful. 

“[Syphilis] is often called the great masquerader or mimicker, and testing for syphilis can be overlooked. When it does cause symptoms, it can mimic a wide range of other clinical conditions.” 

Robertson said global travel and mixing of sexual networks contribute to the increases in syphilis prevalence, but it is still treatable with your general antibiotic, penicillin. 

So what’s the problem? 

“Not enough sexual health services”, Robertson said. A lot of STI management can occur in primary care, youth health, and family planning clinics. However, Robertson says syphilis management often requires “higher level advice.” 

“Syphilis test results require interpretation because of some interactions with other antibodies and infections, and are not as straightforward as the positive and negative results of say gonorrhoea and chlamydia. Testing of the latter are often delegated to health care assistants and peer workers.”  

Robertson explains that when syphilis first made a “comeback”, it was easier to define “at risk” sub-populations for targeted testing. 

“Now that syphilis is occurring in all genders and ages, but still less common than gonorrhoea and chlamydia, it makes it harder to give recommendations on who and how often people should be tested.” 

Robertson said if one reads historical accounts of royalty and the wealthy over the last couple of centuries, sexual health practices may not have changed that much. 

“But the way people meet is different and our sexual and social networks are geographically larger.” 

In the early days of the HIV epidemic and before good medications became available, fear increased condom use and reduced the incidence of STIs. Robertson said, “we have gone back to what it was like prior to the discovery of HIV.” 

She also noted the increase of STIs at time of war and disasters, which she notes “our world is very unsettled now.” 

So how we can we prevent the further increase of syphilis? 

Use condoms and get tested. It’s as simple as that.  

Head of Services and Outreach at the Burnett Foundation, Rodrigo Olin, acknowledges the challenges surrounding accessing care in Otautahi and nationwide. Stigma manifests in discussion of STIs, and with men having sex with men, the issues don’t stop at stigma. 

Stigma can play a role in why people aren’t getting tested for STIs as often as they should be. Source: The Burnett Foundation. 

“[MSM] might not be out or feel comfortable disclosing their sexuality to their doctor, the prohibitive cost of a doctor’s appointment, or even finding a GP who is taking new patients”, Olin said. 

Olin passes on the most important things to remember when people are trying to be healthy as sexual beings. 

“Talk openly about sex, sexual health, and wellbeing helps to combat [the] stigma, which in turn encourages more people to access testing, treatment, and care. We also recommend testing for HIV and STIs regularly and finding prevention methods that work for you like condoms, PrEP, or having an undetectable viral load [people living with HIV on effective treatment cannot pass HIV to their sexual partners].” 

Burnett Foundation Te Toka Centre in Cashel Street provides free and confidential sexual health testing for MSM and their sexual networks. They also offer a pop-up testing clinic at the University of Canterbury on the first Tuesday afternoon of every month - go visit!