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Sexually Transmitted Infections


Penetrative sexual intercourse is the most common way in which sexually transmitted infections are transmitted. Diseases occurring as a result are known as sexually transmitted infections (STI). They can also be transmitted during oral sex and skin to skin contact in the genital or anal areas. Genital ulcers and mucosal damage often associated with discharge, increase the risk of transmission of HIV. Some infections can be fatal or cause long term morbidity (e.g. hepatitis B and HIV) including infertility (e.g. gonorrhoea and chlamydia).

The risk

  • Casual sexual relationships, particularly without the use of barrier protection, are always risky. Commercial sex workers frequently have very high rates of infection.
  • In some countries commercial sex is very common and even encouraged, and exposure to propositioning and even harassment is common. The unprepared traveller may be taken unawares and end up taking risks which would not be normal behaviour at home.
  • Infections may be asymptomatic but not non-infectious so they may be transmitted, unknowingly to subsequent partners and spouses.
  • The use of recreational drugs and alcohol, can lead the traveller into risky sexual behaviour.

Some of the more common diseases

All these infections can be symptomless and no vaccines are available.
  • HIV/AIDS (Human Immunodeficiency Virus) Symptoms depend on the stage and severity of the HIV related illness. Especially prevalent in poor and developing countries, where heterosexual transmission is the main means of spread
  • Gonorrhoea (Neisseria gonorrhoea) Pain urinating, pale discharge from vagina/penis. Antibiotic resistance may be a problem
  • Chlamydia (Chlamydia trachomatis) Pain urinating, pale discharge from vagina/penis. The most common STI in developed countries
  • Lymphogranuloma venereum (Chlamydia trachomatis) Initially small granulomatous lesion that subsequently involves lymph nodes in groins. More common in areas of Africa and Asia
  • Syphilis (Treponema pallidum) Initially genital ulcer. Body, foot and hand rash at later stage. Unless treated one third of infections will result in spread to the nervous system/eyes/skin
  • Herpes (Herpes Simplex) Sores and vesicles around genitals or mouth with pain and itching with a first infection. Can be symptomless. Avoid skin to skin contact where sores might be present. Women are at greater risk of symptoms than men
  • Genital warts (Human papilloma virus) Warts develop in skin in genital or anal area. Can be symptomless. Avoid skin to skin contact where sores might be present. Small proportion may cause cancer of the cervix

Advice for travellers

Confining sexual activities to one non-infected partner is the most effective means of prevention. This is however frequently not widespread practice even in countries where this behaviour is generally seen as the social and religious norm, particularly by those who are put under peer and other social or occupational pressure to behave otherwise.

Safer sex (condoms)

Using good quality impermeable condoms with any casual or potentially infected partner is essential. Remember it is the barrier that protects against STIs, not spermicides contained within them. Remember you won't always know who is infected! Check expiry dates and only buy from a reputable source. Ensure you use condoms correctly and consistently. Donning condoms in the correct manner, before any contact is made is important, as is avoiding breaks and tears. STI transmission via skin to skin contact in particular will still occur where the condom barrier is not present (see notes on herpes and genital warts). It is important to bear in mind that while condoms will dramatically reduce the possibility of transmission of most infections they are not 100% effective. Condom use can also reduce the risk of mouth to genital transmission. back to top

Blood borne Infections

HIV is also termed a blood borne infection since it can be transmitted in the blood in addition to body fluids transferred between partners during sexual activities. Similarly, you cannot always know who is carrying blood borne infections, as they can be free of symptoms. Blood borne virus infections also include hepatitis B and hepatitis C, which can be equally or even more easily transmitted than HIV. Factors increasing the risk of spread of an infection through blood include:
  • Intravenous drug use with needle sharing carries a high risk. Also the social scene surrounding illicit drug use can lead the traveller into unprotected sex.
  • Tattooing, ear piercing, acupuncture and open razor shaving, where unsterile and possibly blood contaminated needles and other sharp equipment are used, are risks. Unless the traveller is absolutely certain that the equipment used is sterile and the environment and items within the premises are clean, these procedures should be avoided.
  • In more economically developed countries blood donated for medical purposes is normally screened for HIV and hepatitis B. This is not always the case in poorer countries for both economic and logistic reasons.

Advice for travellers

  • Blood transfusion should only be accepted when absolutely necessary.
  • If pregnant or suffering from a medical condition which may lead to heavy blood loss, travelling to countries with poor medical services may need to be reconsidered.
  • Knowing your blood group in advance may make it easier to find a blood donor in an emergency. Joining organisations, such as the Blood Care Foundation, who can help to supply safe blood is emergency situations might be considered.
  • Many developing countries re-use syringes and needles. Commercially prepared travel packs are readily available from many pharmacists, travel clinics and outdoor stores for use in an emergency. They should be supplied with a certificate showing contents and the reason for its purchase for customs clearance. Experience has shown that these packs are very rarely used and unless the traveller is going to be in very remote areas away from cities, it should normally be possible to ensure that sterile equipment is used by any local medical attendants. Observing medical staff when opening packages of sterile equipment before use is important, albeit this may not always be practically possible.
     
     
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