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Sexually Transmitted Diseases  during travel

Sexually transmitted diseases (STDs) can be spread by more than 25 infectious organisms.  

Sexual behavior among travelers:

Studies among returning travelers show that  5 to 15% of them admit to intercourse with a new partner during travel..

The percentage is higher in certain groups:

• Long tern travelers: 30-50%
• Military personnel: 50%

Less than 25% of these travelers use condoms regularly, 69% used condoms intermittently

In studies, 40 to 68% had intention of having sex with a new partner, prior to their departure.

Factors promoting sexual activity during travel:

• Anonymity
• Sense of Isolation
• ETOH use
• Loneliness
• Reduced inhibition
• State of relaxation ( on holiday)
• Desire  for unique experience
• Ignorance of global STD risk
• Culture taboo against condoms
• Presence of local males ( hotel – bar workers) praying on traveling females. These males engage in sex with multiple female tourists. They will often have sex with prostitutes during the off season.

Occurrence of STD

Prevalence data must be interpreted very carefully. This data is not always representative of the total population.

Among sex trade workers, STD prevalence:

• Africa :5 to 65%
• Brazil :20%
• South East Asia: 0 to 13.6%

HIV is present in 160 countries. Acquired immunodeficiency syndrome (AIDS) has become a global health problem, and the prevalence of HIV infection in many populations continues to escalate .In developing countries it is found mainly in heterosexual activity.

Among sex trade workers, HIV prevalence:

• Nairobi: 81%
• Bangkok: 44%
• Haiti: 69%

Risk for Travelers

International travelers are at risk of contracting STDs, including HIV, if they have sex with partners who have these diseases. Travelers should be aware that the risk of STDs is high in some parts of the world. Some level of STD prevention counseling must be part of every pre-travel consultation. It must be highly stressed in high risk groups including males and females not traveling with a mate of the opposite sex, long term travelers, business travelers, overseas workers, single males, those  traveling to countries known for it’s sex tourism        ( S.E.A.- Africa)

Drug Resistance:

A growing concern are  the antibiotic-resistant STD agents, particularly penicillin-, tetracycline-, and quinolone-resistant strains of Neisseria gonorrhoeae. Prevalence of Penicillin Resistant Gonorrhea (PPMG) in Africa and Asia found in 50% of isolates ( 8.7% in Canada)

Sequelae:

• Pelvic inflammatory disease,
• Infertility,
• Stillbirths – Ectopic pregnancy- Neonatal infections,
• Genital ulcers –cancers ( papilloma)
• Chronic liver disease ( Hepatitis B-C)
• Premature death (HIV)

Preventive Measures

• Abstinence Travelers who wish to absolutely protect themselves from acquiring an STD should be advised to refrain from sexual contact.
• Monogamous relationship
• Avoidance of high risk contacts ( sex workers-drug addicts)
• Vaccine
• Hepatitis B is the only STD for which a vaccine is available .
• Barrier devices

Travelers should be advised that they can reduce their risk of acquiring infection by consistently and correctly using a latex condom during sexual contact, whether vaginal, oral, or anal, as well as using a vaginal spermicide. If lubricants are used during sex, only water-based lubricants (for example, K-Y Jelly^® or glycerine) should be used with latex condoms, because oil-based lubricants (for example, petroleum jelly, shortening, mineral oil, or massage oils) can weaken latex condoms.

Post exposure management  and Infection therapy

• Any traveler who might have been exposed to an STD and who develops either a vaginal or urethral discharge, an unexplained rash or genital lesion, or genital or pelvic pain should seek competent medical care. Because STDs are often asymptomatic, especially in women, travelers who believe that they might have been exposed to an STD should be advised to consult a physician regarding the advisability of screening for STDs.
• Female victims of involuntary sexual encounters ( assault) should seek ( or carry) post coital contraception and post exposure prophylaxis against STD.
• Syphilis –  B Penincillin  2.4 MU IM - doxy 100mg bid po x 14  days   or ceftriaxone125mg  IM X 10 days
• Gonorrhea – ceftriaxone125mg  IM x1- or Cipro 500mg x1 PO
• Chlamydia treatment: doxy 100mg bid po x 7 days  or azithromycin 1gram single dose
• HIV post exposure PEP kit:

 Travelers at higher risk of HIV exposure such as relief/ health workers, woman travelers, missionaries, business/laborers, sex tourism participants  may want carry PEP kits. These are expensive even for the 5 day kit. HIV testing may not be available or reliable. For those who want to purchase a kit the following

Basic  5 day regimen ;

·        Stavudine: 40mg BID

·        Lamivudine: 150mg BID

·        Nelfinavir 1250mg BID

Dr Paul Assad