Progress has an underbelly. Although Ireland now has a more affluent and mobile young society than at any previous time in history, it is a fact that sexually-transmitted diseases (STDs) are on the increase throughout the State among people aged between 20 and 30.
The STD clinic based in Limerick Regional Hospital opened in 1987 and covers counties Limerick, Clare and Tipperary. Eleven years ago, the clinic was treating "less than 400 patients" a year, according to Dr Catherine O'Connor, its director. "We're now treating up to 3,000 patients a year. The average age of our patients is 24 to 25." The ratio between males and females attending the clinic is almost exactly 50/50.
What does she put the increase in patients down to? "For a start, I think that people are better at accessing services these days, as well as being more aware of them. They're well informed, and lots of magazines and newspapers run articles now on STDs. Younger people - by that, I mean people under 25 - have a whole different attitude to sex than people of an older generation. They wouldn't have taboos about talking about sex, whereas the older generation would. They don't get so embarrassed.
"Also, people are marrying later now, so it follows that they are having more sexual partners. And people are travelling abroad a lot more now, not just for holidays, but to work in places like Russia, the Middle East, Eastern Europe."
Dr O'Connor points out that people are bringing back diseases they may pick up when they are abroad. "We would always ask people where they have travelled. We're all on the move now. People are so much more mobile now for work, not just locally, but internationally as well."
The most common disease is a bacterial infection called Chlamydia Trachomitis. Repeated recurrence of this infection, the cause of which is often difficult to identify, can result in infertility. The other main disease being treated is genital warts. "They would be the two main problems, but we have also had a steady increase in the number of gonorrhoea cases", she says.
What exactly are these diseases which can be transmitted through sexual intercourse and oralgenital contact? The bacterial infection Chlamydia is one of those collectively known as non-specific urethritis (NSUs). Symptoms include abnormal discharge from the vagina, urethra, penis or anal passage. If left untreated, infertility can occur. The fallopian tubes are also at risk of becoming infected.
Sterility can occur if gonorrhoea is left untreated. Fever, chill, abdominal pain and joint pains can be symptoms of this bacterial disease; however, sometimes there are no symptoms at all.
Genital warts are caused by a virus similar to the one which causes ordinary warts.
The recent pattern of increased patient attendance at STD clinics is consistent around the State. Dr Therese Wilson has been working at the STD clinic in Waterford since it opened in 1988. In 1989, they had 82 new patients. By 1997, the number of new patients they were seeing each year had risen to 405. In total, the number of people attending their clinic last year was 1,558.
Like her colleagues, Dr Wilson agrees that people are better informed of the services which are available now. "They're less embarrassed. Before, people usually never told anyone if they had an STD. Now, we're seeing return visits of people who sometimes bring a friend with them, who they've told about the service."
She also agrees that there is an increased sexual activity among young people. "While they would be protecting themselves against pregnancy by taking the pill, the pill isn't a barrier method like condoms, so they're more open to picking up STDs."
Although HIV tests are routinely offered to all those who come to the clinic, Dr Wilson says that only 40 per cent of people opt for testing. "This says something about people's attitudes", she remarks. "They don't seem to think they're at any risk at all to HIV, even though a lot would be having unprotected sex, sometimes with partners they don't know."
STDs are co-factors in contracting the HIV virus; for those who already have an STD, the risk of contracting HIV is heightened because of open sores.
Why does she think there has been an increase in the spread of STDs? "People are definitely having sex earlier these days. We've seen some 16-year-old girls here. Boys come to us at about 18. We would routinely ask people who come to us about their sexual activities: when they started having sex, do they use condoms, all that. We need to know. So I would definitely know that people are starting to have sex earlier. Certainly the people who come to see us.
"And we know also, because patients tell us, that they'll have been out at the weekend and hadn't intended having sex at all. But if they had drink taken, or drugs - I mean soft drugs - well, their caution is gone then. The other side of that situation is that sometimes they may not know their sexual partners at all, which is a problem for us, because it makes partner notification very difficult. If someone comes to us with an STD, we always try to inform the partner. All clinics do that."
Mr James Hegarty, a welfare officer at University College, Cork, emphasises that alcohol plays a large part in student life. "With students, so much revolves around drink. And I suppose people are less careful when they've been drinking. I mean, they wouldn't maybe be taking precautions."
While they have had students coming to them who have become pregnant, he is less sure of how many people avail of the the STD services. "That's a more private thing", he says.
Dr Emer MacHale is senior area medical officer for the Western Health Board, responsible for an area including counties Galway, Mayo and Roscommon. The Galway STD clinic has been open since 1984. The Mayo clinic, which is based in Castlebar, opened in 1995. "It opened because there was a definite need for it", Dr MacHale says.
Between the two clinics, Dr MacHale sees 1,700 patients a year. Like Dr O'Connor, she reports that the breakdown in the sexes of those attending is almost exactly 50/50. "Sixty-five per cent of those attending the Galway clinic are aged between 20 and 30." She points out that Galway is one of the fastest-growing cities in Europe, with a very young population.
Dr MacHale is anxious to stress there is no charge to attend an STD clinic. "I don't think the general public are really aware that these clinics are free. There is no charge and all testing is done anonymously. When tests go out to labs, they're identified only by numbers, not names. We feel anonymity is an essential part of the service. And we see all the socio-economic groups at these clinics. STDs are certainly not confined to any one group of people."
In 1994, Dr MacHale conducted research into the sexual behaviour and sex education of children attending Galway schools. The sample consisted of almost 2,800 schoolchildren. Her results revealed that 21 per cent of these pupils had had sex between the ages of 15 and 18, with the mean age of first sexual intercourse being 15.