Consider postexposure STD screening
By Carol Kemper, MD
Clinical Associate Professor of Medicine
Stanford University
Stanford, CA
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Travelers are an important risk group for sexually transmitted diseases (STDs). Various surveys suggest that anywhere from 5% to 50% of travelers engage in sexual activity when traveling, the majority of which is unprotected. A recent survey of blood and body fluid exposures in international travelers found that sexual activity with a new partner was the most frequent form of risk behavior in travelers (9%), followed by sharing hygienic items (toothbrushes, razors, etc.) (5%), percutaneously administered traditional medical therapy (injections, IVs) (3.2%), acupuncture (1%), body piercing and tattooing (0.5%), and abrasive injuries (0.5%).1 Clinicians should be aware of those factors that increase the likelihood of sexual activity abroad, including male sex, unmarried status, younger age, traveling alone, a history of unprotected/casual sex at home, travel to a recurrent destination, and alcohol use.
While education and counseling are important components of prevention, written materials (which can be read at a later time) appear to have the greatest effect. The distribution of free condoms and fun lubricants in travel clinics (similar to what we offer in our HIV/AIDS clinic) may also help promote the idea of safer sex.
These studies have also wisely suggested that physicians should schedule travelers at higher risk for sexual behavior for follow-up STD screening when they return, even if they are asymptomatic or admit to condom use. This would include urine LCR/PCR for gonorrhea and chlamydia and serologic studies for HIV, HBV, and syphilis. Given the frequency of blood and body fluid exposures, vaccination for hepatitis B should be more broadly encouraged in travelers, especially homosexuals, frequent travelers, sex tourists, and people who plan to be abroad for more than 3 months.
Reference
1. Matteelli A, Carosi G. Clin Infect Dis 2001;32:1063-1067; Correia JJ, et al. J Travel Med 2001; 8:263-266.
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