Sex, sun, sea, and STIs: sexually transmitted infections acquired on holiday
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7459.214 (Published 22 July 2004) Cite this as: BMJ 2004;329:214All rapid responses
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This articles summarises excellently the consequences of unprotected
sexual relationships on holiday and gives realistic plans for the
generalist to follow in cases of possible STI exposure on holiday.
It reccomends that if patients are symptomatic a polymerase chain reaction
test should performed if an HIV seroconversion illness is suspected.
I think that it should be added that this is currenlty only practically
possible in the UK for sucspected HIV 1 seroconversion. There is not a
readilly available test in the clinical setting for HIV 2 in the UK. This
is usually not an issue as the vast majority of HIV in the world is HIV 1
other than in West Africa. In patients returning from holiday there the
usually available PCR is not a useful test as it is a test for HIV 1.
The only European country where this is a consistent issue is Portugal.
The HIV 2 rate of infection has been given as 13% of all HIV positive STD
patients and 29%of all HIV positive TB patients.( www.
Eurosurveillance.org: "Prevalence of HIV 2 infection in Europe"; Volume 1
March 1966 p 21-23)
This was an issue for English football fans returning from the Eorpean
Football Cup in Portugal who believed that they were unwell with an HIV
related infection.
As the frequency of HIV 2 increases in Europe (although there are many
reasons why this may not be so( www. aidsmap.com) this will be an
increasing problem unless clinicians have access to a readily available
PCR for HIV 2.
Competing interests:
Malcolm VandenBurg is a Physician whose practice includes sexual health.
Competing interests: No competing interests
Sex happens....(especially away from home)
The article by Krogstad (24 July, 2004), was timely. Despite the
fact that it is difficult to compare sexual behaviour and disease in
travellers with non-travelling controls, a decade or more of studies
strongly suggests a link, providing the rationale for health promotion
campaigns specifically addressed to travellers.
In Australia, "Travel-Safe" began in 1991, and (as elsewhere) has
consisted mainly of the provision of information to an indiscriminate
group of travellers. However, many travellers are fully informed, but do
not personalise risk. (1,2). The challenge is therefore to deliver the
idea that many behave differently whilst away from home, and to confront
the individual with the notion that they might also, whether they intend
to or not.(3) For example, in 1997, a new campaign introduced the simple
slogan, "Sex happens…." (4).
The last major health promotion in Sydney was in 1999, the year before the
Olympics.(5) Four principal strap messages were presented, together with
take-away information about sexual health clinics in English, Chinese,
Thai, Japanese, and Spanish. The messages:"When in Rome….., or Sydney, New
York…";"Travel insurance from $1….";"As seen in Sydney's hotspots…";"Fly
the Flag…", were variously designed around a condom image. This material
was installed using convenience advertising methodology (narrowcast
messages delivered in public conveniences- toilet and washing areas).
There were 241 display points in key sites such as the domestic and
international airports, Central railway station, youth hostels, and gay
venues. These display points had an approximate audience reach of
1,141,971 patron visits to venues per week. Overall, using intercept
methodology, there was high unprompted (66%) recall of a "condom message"
, and high acceptability by the public.
Sexual health promotion for travellers needs to be sustained, and due to
expense, its efficacy may have to be inferred from an assembly of
evidence.
References
1. Mulhall BP, Hu M, Thompson M, Lin F, et al. Planned sexual
behaviour of Australian travellers to Thailand. Med J Aust 1993;158:530-
535.
2. Mulhall BP. Sex and travel: studies of sexual behaviour, disease and
health promotion in international travellers- a global review. Int J STD
& AIDS 1996;7:455-65
3. Mulhall BP. Sexual behaviour in travellers (letter). Lancet 1999;
(i):595-6
4. Family Planning New South Wales. The backpacker campaign report. NSW
Health 1998. Unpublished
5. Mulhall BP. The NSW Travellers Program . NSW Health Department, 2000.
Unpublished.
Competing interests:
None declared
Competing interests: No competing interests