Travel & Sex: Are you at higher risk of STIs?

Sex and travel have been bedfellows for as long as people have been travelling. For some travellers, the freedom of being in a fun-packed tourist destination away from their daily routine – and for singles and businesspeople, away from their regular partner – creates opportunities for casual sexual encounters.
In the past, single-clinic studies of sexually transmitted infections (STIs) linked to international travel provided most of the information about the nature of the diseases and the travellers who were infected. But, hard evidence of broader trends was scant, geographically limited, or anecdotal.
Recently, Italian scientists and researchers published the first extensive, global analysis of the STIs diagnosed in travellers who visited the worldwide network of GeoSentinel travel clinics over 14 years (1996 to 2010). Their study was published recently in the British medical journal, The Lancet Infectious Diseases.
GeoSentinel clinics are scattered across the world, offering travel medicine services, as well as serving as a global surveillance and monitoring network for travel-related diseases.
Of the 112,180 travellers who visited a GeoSentinel clinic with an illness between 1996 and 2010, 974 were found to be infected with an STI, with a total of 1001 STIs diagnosed (a few infected travellers were diagnosed with more than one STI).
Headed by Dr Alberto Matteelli, the Italian team analysed the cases to identify STIs that occurred after travel, during travel, or among immigrants.

Most cases among young men
What the researchers discovered was that the type of STIs varied among different classes of travellers. Those most likely to be diagnosed with an STI were:
- Male travellers
- Younger adults
- Businesspeople
- VFRs (Visiting Friends and Relatives abroad)
- Short-stay travellers (less than 30 days)
- Immigrants
- Travellers who had not sought pre-travel medical advice
The most common STIs among travellers where non-gonococcal or other unspecified urethritis, acute HIV infection and syphilis. For men, urethritis and epididymitis were most common, while cervicitis topped the list of potential STIs for women.
Syphilis was a common diagnosis across travellers and immigrants alike — a result that's in line with the worldwide re-emergence of the disease in recent times.
The survey also found:
- Condom use was 'inconsistent' among half of the travellers who engaged in new sexual relationships abroad.
- STIs are diagnosed during travel at least as often as they are among those who returned home before seeking help.
- Travellers are at higher risk of contracting HIV and contributing to its global spread.
Dr Matteelli warned that the STI cases his team analysed represent only a fraction of the likely actual number, as most people with an STI are more likely to seek out a specialist STI clinic or a GP.
Most of the travellers (34,327, 90%) seen while still travelling visited GeoSentinel clinics in Kathmandu (24,372, 64%); Singapore (2477, 7%); Beijing (2347, 6%), Hong Kong (1959, 5%), Ho Chi Minh City (1723, 5%), and Peekshill, New York (1449, 4%).

Know the early signs of STIs
Dr Matteelli said: "In diseases such as gonorrhoea, which have a very short incubation period, symptoms probably happen before the end of the travel period."
He said travellers, especially those at higher risk for STIs, should be advised how to recognise the signs and symptoms of infection and to seek medical treatment early – even while still travelling – then have a thorough medical screening after returning home.
Ironically, the study found that those travellers who consulted a doctor for treatment of their STI during or after travel were also less likely to have seen one before they headed overseas. (Dr Matteelli suggested that this may be because these people were more likely to be 'risk-takers'.)
Not surprisingly, the study concluded that risk of STIs increase for some travellers because separation from their regular partner disrupts their usual sexual practices, while distance 'removes social taboos that might inhibit sexual freedom'.
Perhaps most worrying was the authors' observation that the true number of STIs linked to international travel is probably significantly higher, given that international travellers are more likely to seek treatment from a GP or STI clinic, rather than a travel clinic.

An STI can have long-term consequences
While the early symptoms of some STIs may seem trivial, the long-term consequences – both for you and your partner – can be serious and life-changing, according to Travelvax Australia's Medical Director, Dr Eddy Bajrovic.
"The only sure way to avoid an STI is to abstain from sex," Dr Bajrovic said.
"Using a condom may help prevent most (but not all) STIs, but product 'failures' are not uncommon.
"Antibiotics won't prevent infection and only one STI, Hepatitis B, is preventable by vaccine. Unfortunately, there is still no vaccine for HIV and it's been estimated that travellers are 200 times more likely to contract HIV abroad than at home. "
Although HIV, and Hepatitis B and C are the most serious of the STIs, others may have long-term consequences, such as infertility. In South East Asia a more resistant form of gonorrhoea is widespread, while chancroid is commonly diagnosed in Africa.
Other commonly diagnosed STIs include gonorrhoea, syphilis, herpes simplex, human papilloma virus (HPV), and chlamydia.

PREVENTING STIs
Dr Bajrovic said travellers who engage in casual sex during travel should:
- Use condoms (specifically latex) with any new sexual partner – EVERY TIME.
- Use only water-based lubricants (e.g. K-Y Jelly® or glycerine) with latex condoms. Oil-based lubricants (petroleum jelly, mineral oil, or massage oils) can weaken latex.
- To avoid blood-borne STIs, consider including needles and syringes in your first-aid kit.
And... Don't share razors and other implements; Ensure only sterile equipment is used if you or your travelling companion need a medical or dental procedure overseas; Have a dental check before leaving home.

CONDOM USE
While condoms are available in most countries, their quality may vary. If you buy condoms abroad, check their expiry date and make sure they carry a recognised quality mark.
Oil based lubricants such as baby oil, body lotions, or petroleum jelly increase the risk of the condom breaking.
Condoms WILL protect against:
 HIV
 Hepatitis B and C
 Gonorrhoea
 Chlamydia
 Syphilis
Condoms WILL NOT protect against:
 Genital herpes
 Genital warts
 Pubic lice
 Scabies
Read more about condoms and their correct use (NHS Choices website).
There's also more about preventing STIs on Travelvax Australia's website.

For additional travel health advice, including country-specific information on recommended vaccinations for the country or countries you'll be visiting, please call our travel health advisory service on 1300 360 164. We can also assist in making an appointment for you to visit a Travelvax clinic for a pre-travel consultation with doctors and nurses experienced in travel medicine.