STI: An unwanted travel memento

By Laurie Sullivan

Travellers heading abroad through Sydney Airport are getting a double whammy of messages – one as they leave, the other when they return – warning them of the increased risk of picking up a sexually transmitted infections (STIs) or blood-borne viruses (BBVs) during overseas travel.
The warnings follow news that 1-in-5 of NSW’s new HIV infections is acquired overseas. Around half of the 26,800 Australians living with HIV in Australia reside in NSW.
NSW Health data revealed that of the 354 people newly diagnosed with HIV in 2013, 21% were likely to have been infected overseas, 64% within Australia and 15% unknown.
The high proportion of heterosexual and older people among the infected returning travellers has health experts concerned. Heterosexual contact accounted for 17% of the soaring number of HIV cases – more than half of them acquired abroad.

‘When you were travelling did you...’

With the theme, ‘When you were travelling did you...’, the six-month long campaign developed by the South Eastern Sydney Local Health District, reminds passengers that HIV, STIs and BBVs – such as hepatitis B and C – are more common overseas, and urges them to play safe when having sex, injecting or tattooing. 
Because the prompt treatment of HIV and other STIs generally leads to better outcomes, returning travellers will see posters prompting them to get tested if they engaged in practices that may have put them at risk of sexually transmitted or blood-borne diseases.
Posters and take-away cards have been placed in the toilets in the departures and arrivals terminals at Sydney International Airport, and direct travellers to the Sexual Health Info Link and the PlaySafe website. 

STIs more common overseas

Infections such as syphilis, gonorrhoea, chlamydia, and hepatitis B and C are more prevalent overseas. Getting chlamydia or gonorrhoea increases the risk of contracting HIV.
Chlamydia is the most prevalent notifiable disease in Australia, with 86,049 cases reported last year – more than double the number a decade ago – and over 16,000 already in 2015. It is more common among females, older teenagers, and young adults.
Rates of other STIs are soaring, too: Gonorrhoea cases increased sharply in 2014 with 15,712 infections nationwide, while 3860 cases of infectious syphilis were recorded across Australia last year, according to national disease surveillance figures.
Travellers should never be complacent – even in countries with relatively low rates of STIs, Travelvax Australia’s Medical Director, Dr Eddy Bajrovic warned.

Symptoms may not be apparent

Unlike measles, flu and other diseases with obvious symptoms of illness, people infected with sexually transmitted diseases may have no obvious symptoms. STIs can spread rapidly to create disease hotspots in destinations popular with tourists.
“Travel and sex have been bedfellows for as long as people have been travelling,” Dr Bajrovic said.
“Unfortunately, a doctor’s warning about the risks of STIs during overseas travel can be quickly forgotten.
“Being in a tourist destination away from your daily routine brings a sense of freedom that creates opportunities for casual sexual encounters with other travellers and locals.”

STIs – who’s at highest risk?

In 2013, a 14-year study of STI patterns and rates among 112,180 travellers from across the globe found that the type of infections 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 (including chlamydia), acute HIV infection and syphilis. For men, urethritis and epididymitis were most common, while cervicitis topped the list of potential STIs for women. 

Re-emergence and spread of STIs

Syphilis was a common diagnosis in travellers and immigrants alike - not surprising given the global re-emergence of the disease. 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 (meaning that travellers are forced to access expensive treatment abroad). 
Another disturbing finding was that travellers are not only at higher risk of contracting HIV, but are contributing to its spread across the globe.

Long-term consequences of an STI

While the early symptoms of some STIs may seem trivial, the long-term consequences – both for you and your partner – can be severe and life-changing.
“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 hepatitis B and Human Papillomavirus are the only STIs that can be prevented by vaccination.”

Use a condom – every time

Travellers who engage in casual sex during travel should always use a condom with any new sexual partner. 
While condoms are widely available overseas, their quality may vary. Check the expiry date and make sure the pack carries a recognised quality assurance mark.
Condoms WILL provide good protection against: HIV, hepatitis B and C, gonorrhoea, chlamydia, and syphilis. However, they WILL NOT prevent: Genital herpes, genital warts, pubic lice, or scabies.
Read more about condoms and their correct use (NHS Choices website). 

Come kitted out for emergencies

To avoid the risk of blood-borne infections such as HIV, hepatitis B or C, Travelvax Australia recommends travellers carry a first-aid kit containing sharps, needles, syringes, and sutures. Then, if a medical or dental procedure is required, your own sterile equipment can be used.
But, the needles used for tattoos and body piercings, manicure and pedicure tools, and the razors and scissors used by unlicensed barbers hold the same potential for a blood-borne infection.
Dr Bajrovic said a market or street stall is the worst place for these procedures. Instead, look for a licensed service provider who uses sterilised equipment for each new client.
“A lone operator offering a cut-price service would find it virtually impossible to keep equipment sterile,” he added.
The golden rules are:
ALWAYS insist sterile equipment be used in any procedure.
DON’T share razors, needles or other implements.
DO have a dental check-up before leaving home.

Travelvax Australia’s website has more about preventing STIs.

For no-obligation travel health advice, please call Travelvax Australia’s advisory service on 1300 360 164 (toll-free from landlines). We can also make an appointment for you to visit a Travelvax clinic for a pre-travel consultation with doctors and nurses experienced in travel medicine.