Gaydos1 highlights the barriers to discussing sexual health issues openly and teenagers' lack of awareness of the high prevalence of STIs and potential adverse reproductive sequelae. Addressing these barriers is one solution to the 'Hidden Epidemic' of STIs. In the UK as in the USA, STI rates remain highest among sexually active teenagers, particularly those from deprived inner city areas and black ethnic minority groups.2 Ensuring a high standard of Sex and Relationships Education (SRE) may contribute to reducing risky sexual behaviour.3

During December 2010 for a medical student research project, we conducted a cross-sectional questionnaire survey to investigate high-risk teenagers' experience of SRE. Consecutive male and female patients aged 14-19 years attending Adolescent Genito-Urinary Medicine Clinics in Wandsworth, South London were asked to complete a questionnaire survey on their experience of SRE at school. The questionnaire asked if they had received SRE, the topics covered, timings, perceptions of SRE and where sexual health information was accessed. Data were entered and analysed using SPSS.

The response rate was 94% (97/103). The mean age of responders was 16 years (range 14-19), and 69% were female. Of 97 responders, 41% described their ethnicity as white, 49% black and 10% as other ethnic group. Although 99% had received SRE at school, 69% said the quality of SRE was average or poor. Median age at first SRE in school was 11 years (range 5- 16). Teenagers reported a desire to be taught earlier (by aged 12) about menstruation, teenage pregnancy, STIs, HIV and relationships. The biological topics, menstruation, contraception and STIs were found the most useful at school, but 30% said they were not taught about emergency contraception. Sexual health clinics, school lessons and friends were the main sources of sexual health information (91%, 77% and 74%, respectively). Only 30% felt comfortable accessing information from school. Over half the respondents accessed the media and internet which may not be reliable.

This survey found that most of these high risk, sexually active teenagers had received some SRE, but the standard was inconsistent and often too late. It suggests that in the UK, SRE should be taught as a statutory part of the national curriculum. We agree with Gaydos that special education tools such as effective SRE are needed to tackle the epidemic of STIs. In Holland SRE starts at the age of five and the country has the lowest teenage pregnancy rate in Europe.4 Providing SRE earlier at school backed up by easily accessible information from sexual health clinics might help to decrease STI rates among teenagers in the UK, North America and elsewhere.

Aneeta Kaneshanathan, Katia Prime, Phillip E Hay and Pippa Oakeshott

ACKNOWLEDGEMENTS We thank staff at Courtyard Clinic, St George's Hospital London - Wendy Majewska and Charlotte Jackson for their help with this project.

Population Health Sciences and Education, St George's University of London, London, SW17 ORE, UK Correspondence to: A Kaneshanathan Email: m0700538@sgul.ac.uk

REFERENCES

1. Gaydos. STI management and control in North America IUSTI region. Sex Transm Infect 2011;87:ii2-ii6.

2. Health Protection Agency. Acute STI diagnoses by PCT of residence, 2009 (England). Health Protection Report Vol 4 No. 34 - 27 August 2010.

3. Wellings K, Nanchahal K, Macdowall W, McManus S, Erens B, Mercer C, Johnson A, Copas A, Korovessis C, Fenton K, Field J. Sexual behaviour in Britain: early heterosexual experience. Lancet 2001; 358, 1843-1850.

4. UK Youth Parliament. SRE - Are you getting it? London; June 2007

Conflict of Interest:

None declared