Yvonne Clowsley, manager of Hereford's Gaol Street clinic is in the front line for the city's sexual health services. Tucked discreetly aside of the clinic's main desk, arrowed so that no one has to ask.

Of the 60 patients the clinic's Tuesday, Wednesday and Friday STD (sexually transmitted diseases) sessions can expect each week around 28 will be new appointments.

"The only generalisation you can make (about the clinic) is that there isn't one," says Yvonne. Young people are having sex. They are not encouraged to, but they are.''

A lot of that work, particularly with the younger patients, is reassurance.

She added: "They don't want another's moral values, they want advice and relevant to their own relationships. We don't have to treat people to have done a good job."

IT'S hard to say how the young people using Gaol Street clinic contribute to an overall trend. By its very nature the real extent of STD defies exact diagnosis.

According to national headlines there's a soaring sexual health crisis. Herefordshire would certainly be expected to reflect that trend - it's how that reflection is seen.

Clinic attendance alone would show symptoms on the up. Divide that attendance by those actually affected and its clear many are coming to clinic because they think they need to, not because they have to.

No bad thing says clinic manager Yvonne Clowsley. If the sessions are stretched its probably because there aren't enough of them, not necessarily because infection rates are rising.

With a new consultant on the way and moves toward more nurse-led sessions for routine screening pressure should ease.

Infertility

Right now local attention is on an infection that doesn't make itself known - Chlamydia.

It's the so-called 'silent disease' with the majority of those infected women showing no symptoms at all. Where there are symptoms - cystitis, abdominal pain - they are often so general they are easily confused with other problems.

A laboratory swab test is the only proof of presence.

The risk otherwise is - at worst - infertility.

Chlamydia can catch men where it hurts too. Acutely inflamed testicles being one offshoot.

But more often than not it works the way it does with women - no symptoms, no signs.

Scary when a recent survey suggested that one man in 10 is a carrier.

The numbers game, though, applies across the board says Yvonne.

On average, for every one STD case confirmed a further six could be 'out there'.

Contraception has to be available

CONTRACEPTIVES come out of the (water) closet under new ideas to improve Herefordshire's sexual health.

The plan pitched by the Primary Care Trust (PCT) puts condom dispensers into or outside the county's public buildings - and that doesn't mean the toilets.

Better, says Dr Mike Deakin, Director of Public Health, if the dispensers are on show, if only to ease a taboo subject out of the dark.

There's talk too of taking this 'taboo' to pubs and clubs promoting safe sex and screening for Sexually Transmitted Disease (STD).

Because it's time Herefordshire had a 'grown up' look at its sexual health says Dr Deakin.

And there's still some growing up to do given criticism the Trust took over making 'morning after' pills available through clinics at county high schools.

Some of those critics came after the Hereford Times. It was the HT that broke the story last August.

The 'respect and protect' approach most county schools offer sex education gets a wider application with the sexual health initiative, late teens and early 20s being the targeted age group.

An age group keeping Hereford's Gaol Street genito-urinary clinic busy when the whole country's sexual health is said to be in crisis.