30,000 young males are infected with a disease that could leave them and their partners infertile ... and they don't know
By Judith Duffy, Health Correspondent

SCOTLAND is facing an infertility "time bomb" following a rise in cases of the sexually transmitted infection chlamydia among young men that are being undiagnosed and untreated.

Experts have warned up to 30,000 men under 25 could be carrying the infection. The majority - around 70% - do not show any symptoms and only one in 10 cases is being detected.

While chlamydia has long been known to have a potential impact on women's fertility, scientists are uncovering increasing evidence of its damaging effect on sperm.

The shocking picture, which has been uncovered by an investigation for BBC Radio Scotland, has led to calls for a national screening programme for chlamydia north of the Border, similar to that which has already been introduced in England and Wales.

Health workers have also warned improved education is vital to change ingrained attitudes where young men are encouraged to sleep around and treat women as "sexual conquests".

Dr Allan Pacey, secretary of the British Fertility Society, told the Sunday Herald: "What we don't want is this cohort of chlamydia-infected individuals just carrying on, because they will get older and try to conceive and find out they have got trouble."

He said: "The males will be less fertile, the women may be damaged reproductively and it will just be a horrible mess that we will have to sort out in 20 years time."

Chlamydia is the most common sexually transmitted infection in the UK, with the majority of cases diagnosed in young people aged under 25. Figures show 17,298 diagnoses were reported in Scotland last year, compared to around 7600 in 2000. Between 2006 and 2007, the number of female diagnoses decreased from 11,416 to 11,111, while the number of male diagnoses continued to rise from 6366 to 6576.

Pacey, a senior lecturer in andrology, has been investigating the impact of chlamydia on men along with colleagues at Sheffield University. He said although the infection had traditionally been perceived as a disease that damages the female reproductive system, there was growing evidence of its effect on male fertility.

"The kind of research we have been doing is uncovering slowly the fact that men aren't immune," he said. "What we have found is that if you have chlamydia, your sperm is more likely to be defective."

Chlamydia is diagnosed by a simple urine test and easily treated with a course of antibiotics, but figures show women are three times more likely to come forward for testing. However one study conducted by researchers at Glasgow University found when screening was offered in alternative settings, such as health clubs and gyms, 40% of men said they were willing to do the test compared to 27% of women.

A national screening programme for chlamydia developed south of the border over the past decade is targeting men in particular. It focuses on offering opportunities for testing those aged under 25 outside of traditional health care settings, such as at university freshers' fairs, pharmacies and armed forces bases.

Researcher Dr Adrian Eley, a senior lecturer in infection and immunity at the University of Sheffield, told the BBC documentary a similar screening policy should be set up in Scotland.

"We have shown already there is quite a success story now with our chlamydia screening programme in England and Wales," he said. "It raises the awareness and of course it also catches a lot of these so-called asymptomatic cases and therefore they are treatable. In the longer term, the number of infected patients will decrease."

Stuart Rivans, producer of The Investigation - Chlamydia', which will be broadcast tomorrow at 9.05am on BBC Radio Scotland, argued much of the research and planning around chlamydia had been focused on women, resulting in men being "pretty much sidelined".

"Health professionals we spoke to were in agreement that men must be placed on the screening agenda," he said. "What's more, it's actually primary prevention for women as it reduces the pool of infection."

One initiative that has been introduced in Scotland is free postal testing kits for chlamydia, which been rolled out across nine health boards to date with the aim of making screening more accessible to young people. Kit users supply a urine sample by post and can receive results by phone, letter or text.

Hawys Kilday, chief executive of sexual health service Caledonia Youth, backed any initiatives to improve access to testing, but cautioned that postal kits also meant an opportunity to offer advice to young people may be missed.

"They have a place, but for young people particularly we need to be very careful about the information, advice and support that they are given," she said. "If you get a positive result, would you definitely go back for treatment or just put in the drawer and think I'll deal with that later'?"

Kilday added that while the sexual health strategy published under the previous government had improved clinical services, the focus should now be on bringing about a change in attitudes to improve Scotland's appalling record on sexual health.

"If you look at countries like Sweden and Holland, where they have had a big investment in both educational and clinical services focusing particularly on young people, they have made a massive difference," she said.

That view was echoed by Tim Street, chair of Men's Health Forum Scotland, who said there was still a continuing problem of women being treated as "sexual objects" by young men in sections of communities in Scotland and pointed to a lack of adult role models for young people.

"We still have the situation where young men are encouraged and expected to sleep with as many people as possible and not really worry about who that is," he said. "And if you go out on a Friday or Saturday night, there are lots of teenagers out - but the majority of people who are getting drunk and misbehaving are adults."

Street argued while there had been some moves towards better sex education in schools, there is still a limited availability' of high quality sex and relationships education across the school system.

"Guys have been saying to me of late, yes I know what condoms are for but I just never use them because I don't want to'," he said. "So they have no real sense of why they should do that for themselves or their partners."

Public health minister Shona Robison, said some of the rise in sexually transmitted infections in Scotland reflected improved testing, as well as an actual increase in the number of cases.

"NHS Boards are, in line with the recently published sexual health standards, working to increase testing for STIs especially in those under the age of 25," she said. "Historically, contraception has always been dealt with by women and recent efforts have included encouraging men to take equal responsibility for their own and their partner's sexual health."