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The traveler and sexually transmitted diseases
by Dr. Rajiv Narula

Not every aspect of the travel boom, is good news. Probably one of the most worrisome is the ease by which diseases can be spread. Airlines are transporting more than people, they can and are indirectly helping diseases like Malaria, Dengue Fever, Typhoid and also some sexually transmitted diseases to spread. Reports state that the incidence of STDs worldwide is around 200 million per year, out of this 80% occur in ‘developing countries’. Amazingly 1/3 of the world’s population is infected by an STD or carry a transmissible STD pathogen.

Examples of some STDs that a traveler may be exposed to include : HIV, Syphilis, Chlymadia,Gonorrhea, Herpes, Hepatitis A and B. HIV is probably the most feared one of these. The chances of picking up HIV is 1 in 5000, compare this to hepatitis B, where there is a chance of 1 in 1000 to pick it up sexually. Risk of HIV infection is higher in travelers with other STDs.

Transmission occurs when a susceptible person is exposed to an infected person. Usually this occurs during sexual contact – this includes intercourse, kissing and mouth to genital contact. The risk of acquiring STDs increases with number of sexual encounters, number of partners and the use or nonuse of condoms .STD infections can also be transmitted by contaminated medical instruments, sharing of items like toothbrushes and razors.

According to Travel Association of America in 1999 approximately one in five (22%) adults traveled for business, this represents a 14% increase since 1994. Average business trips included 3.3 nights away from home. The issues of the business traveler were dealt with in a previous column, one of the issues was the loneliness that is experienced by them. The need for companionship may lead them to activities that will put them at risk of acquiring diseases. For some being in a foreign land, gives them opportunities that would most likely not have been available at home.

Despite all the warnings there is an increase in casual sexual activity by travelers. 2-18% of short-term travelers report casual sex with a new partner often without using a condom. “We like casual sex on travels” was the headline in a Montreal newspaper in 1998. This study was done by researchers at St Luc and Toronto General Hospitals. It was done to determine the potential exposure of travelers to blood and body fluids – a risk factor in catching sexually transmitted diseases and other infections. According to the study 18% of Quebec respondents admitted to engaging in sexual activity while on their trip. The study revealed that 28% had been exposed to blood or body fluids. Condom were used, but not always.

So how do we minimize our odds of picking up these unfriendly companions? Abstinence makes sense but may not work for some. Male travelers who are planning to engage in sexual activity, should take condoms along with them, these are a part of a well planned travel medical Pac. Availability and reliability of condoms at the destination, maybe an issue. Unfortunately condom breakage rates are at around 2-3 % making them not perfect , however they do reduce the odds significantly. Female travelers should insist that their partners use condoms, diaphragm use has also been reported to reduce transmission of disease .

For the traveler who goes to less developed countries having their own syringes/ suture kits, which, could be used in case of medical necessity. This would reduce the odds of body fluid exposure from contaminated needles. In a lot of these countries needles are sterilized and reused, this maybe done inadequately. Make sure these syringes are in the original packaging and have a letter stating why you have them. Finally vaccines can prevent Hepatitis A, B, both of these can be acquired sexually.