Dr Phil Hammond, broadcaster and sessional GP in Bristol

Advise patients with STIs to be honest with their partners
 

Will you change the advice on genital herpes that you give to patients? In August, Northampton traffic officer, David Golding, pleaded guilty to a charge of grievous bodily harm because he had failed to inform his partner of his previous herpes infection; she claims that she would never have had sex with him had she known (even with a condom). Golding was sentenced for reckless transmission of a sexually transmitted infection (STI), under a law that dates back to 1861.

I have campaigned publicly against this ruling for a number of reasons. Everyone accepts that if you know you are HIV positive, you should tell your sexual partner and take steps to minimise the risk of transmission. When HIV became prevalent, the Home Office consulted experts to amend the law. Specific diseases weren’t mentioned, but the guidance stated: ‘The courts have recognised that person-to-person transmission of a sexual infection that will have serious, perhaps life-threatening, consequences for the infected person’s health can amount to grievous bodily harm under the Offences against the Person Act 1861 ... Therefore, the transmission of that infection can constitute the offence of inflicting or causing grievous bodily harm, which when intentional can attract a sentence of life imprisonment.1

Genital herpes isn’t life threatening, so the debate is whether it is ‘serious.’ It can occasionally be very unpleasant, but the vast majority of the 6 million people in the UK who have had the infection either have minor outbreaks or don’t know they’ve got it. A diagnosis of herpes can also cause deep-seated psychological problems that date back to the media stigma in the eighties. Time magazine gave it the cover story and described herpes as ‘the new sexual leprosy’ and ‘the new Scarlet Letter’. It’s hard to see how imprisoning someone for passing on herpes will reduce this stigma, but it seems that if the patient judges the effect on them to be serious, then the court will follow suit.

This potentially has a huge impact on the advice we give to patients when they are diagnosed with any STI. Chlamydia usually isn’t serious, but it can cause pelvic inflammatory disease and infertility, and I have seen joint problems end the career of a professional footballer. Gonorrhoea and syphilis can both have very serious consequences, and sex lives and relationships are destroyed by florid, recurrent genital warts. If everyone who had a serious consequence from an STI went to court to try to prove that it was passed on recklessly by someone who knew or had indicative symptoms that they carried the infection, the courts would do little else.

Sexual health experts spend a lot of their lives trying to destigmatise STIs so we view them like other infectious diseases. After the judgment, some people argued that the courts might just as well prosecute for the transmission of cold sores, head lice, and flu. Influenza kills thousands of people each year, and yet people go to work on crowded buses and tubes knowing that they are infected and recklessly passing it onto others. The uptake of flu vaccines by NHS staff each year is pitiful, recklessly endangering the lives of our more vulnerable patients. How long before the lawyers anticipate the flu season with glee?

You’d think it would be easier to prove who’d passed on an STI than an airborne bug but you’d be wrong. Genital herpes can lie dormant for years and the first outbreak in a relationship doesn’t imply infidelity. You don’t even need intercourse since cold sores can be transmitted to the genitals. In the vast majority of cases, herpes is transmitted—either facially or genitally—under the radar without either partner being aware. All we can say for certain is that the lawyers stand to make a fortune trying to attribute blame, patients with herpes will continue to be stigmatised, and we as doctors should advise everyone with an STI to be open and honest with their partners or risk prison.

www.drphilhammond.com

  1. Crown Prosecution Service website. Intentional or reckless sexual transmission of infection. www.cps.gov.uk/legal/h_to_k/intentional_or_reckless_sexual_transmission_of_infection_guidance/ (accessed 7 September 2011)G

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