Today is World AIDS Day. Dr Jane Wilson-Howarth looks at travellers’ sexual health – and what we can all do to guard against bringing home unwanted souvenirs
Travellers often take risks with their sexual health. Perhaps we’re liberated by the fact that no one will know what we’re getting up to; maybe alcohol or illicit drugs disinhibit. Either way, our passion for travel enhances the spread of infection.
There are around 400 million new cases of sexually transmitted infection globally each year. As an example of how travel plays a part in this, around three-quarters of gonorrhoea cases diagnosed in London are unwanted foreign souvenirs.
Here are some hard truths about sexual health – and advice for protecting your own.
Human immunodeficiency virus (HIV) is the most feared of sexually transmitted infections (STIs) for the very good reason that, if left untreated, it inevitably progresses to acquired immunodeficiency syndrome (AIDS) and death through inability to fight off infection.
Globally, most people with HIV are heterosexual. In 2010 there were 6,658 new HIV cases diagnosed in the UK; more than half were acquired heterosexually. About two-thirds of these heterosexual HIV cases were infected overseas. Travellers beware.
Although there have been huge medical advances in the past 15 years, there isn’t yet
a vaccine, and a cure for HIV is elusive. The mainstay of treatment is to suppress the virus in order to slow progression to AIDS. In this area there have been significant advances: there are 86,500 people currently living with HIV in the UK.
There are many countries that place restrictions on HIV-positive people travelling, especially if they’re applying for a long visa or work permit, so the consequences don’t only impact your health.
While most are unlikely to kill you, STIs caught overseas can have serious consequences and costs. You may discover that your insurance doesn’t cover treatment of an STI, resulting in expensive bills. Also, sometimes it can be a challenge to find a sympathetic doctor who can speak your language and advise on treatment and management of the symptoms. Note, skin doctors often double as genitourinary physicians.
STIs are more than unpleasant. A first attack of herpes, for example, can be excruciating, and would be especially nasty to cope with in the absence of a few home comforts. In addition some STIs come with long-term downsides that can be devastating, including persisting pelvic pain or infertility.
There is, of course, the issue of conceiving an unwanted pregnancy – something else that usually isn’t covered by insurance.
Travellers often voice concerns about the risks of contracting infections during medical treatment. The risk from infected needles is considerably lower than from unsafe sex, but it can be difficult to know whether medical equipment and hypodermic needles are sterile. And how can you know whether transfusion blood is safe?
The solution is to pack a first aid kit containing syringes and needles. To ensure border officials don’t get the wrong idea, make sure your needles look like part of a kit; if you have medical reasons for travelling with hypodermics, ask your doctor for an official-looking letter confirming this.
Your insurance provider should be able to give details of local competent clinics via its 24-hour helpline. If you are still worried, consider a subscription to the Blood Care Foundation, which administers safe, screened blood in an emergency anywhere.
Note, hepatitis B and HIV can be spread during tattooing, acupuncture and piercing if the needles are contaminated, and also during shaving – beware the barber’s razor.
Using condoms greatly reduces the risk of at least 25 STIs. Condoms are available in most countries, but standards and sizes vary. If buying abroad, check the expiry date and ensure they carry a recognised quality mark such as the European BSI kitemark
(BS EN 600) or the International Standards Organisation (ISO) mark.
However, condoms are by no means fail-safe: insect repellents, body lotions, Vaseline and other oil-based potions can cause microscopic holes that allow both sperm and viruses through.
Contraception can be compromised by travel. For example, if you contract gastroenteritis (as many travellers do), the oral contraceptive pill may not be absorbed. Also, the distractions of travel make taking the pill easier to forget.
Your NHS GP shouldn’t give you large supplies of the pill to take on a long trip, so
it is important to research what kind you are taking and see if equivalent brands will be available en route.
Women planning long-term, frequent, tropical travel might explore using a long-acting method of contraception as well – an intra-uterine system (aka Mirena) or sub-dermal implant.
It is best to organise the fitting of these devices several months before travel to ensure they suit, and that any irregular bleeding or side-effects settle; implants in particular can cause increased bleeding in some. These long-acting methods carry minimal risk of deep vein thrombosis unlike the combined pill so would be good choices for frequent or long-haul travellers as well as female mountaineers ascending to extreme altitudes (over 5,500m).
Emergency contraception isn’t available everywhere; there are even countries within the European Union where it is unavailable (eg Malta). It can also be difficult to find out how to acquire it when you’re travelling as each country has its own system.
Delay in taking the ‘morning after pill’ considerably reduces its efficacy so take proper precautions in the first place. If condoms or caps are to be your travelling contraceptive method, buy some in the UK before travel.
Although it isn’t currently possible to immunise against many STIs, there is a highly effective hepatitis B vaccine, recommended for long-haul or frequent travellers, especially those going to resource-poor destinations. It reduces the chance of picking up the infection both sexually and via contaminated medical equipment.
Hepatitis A can be acquired sexually, but contaminated food is the commonest route so many travellers should be immunised.
It is also worth thinking about protection against the genital wart virus (human papillomavirus) as, in women, this is associated with cervical cancer. One of the two available vaccines (Cervarix) is offered to all schoolgirls; the second, Gardasil, is licenced for girls aged nine to 26.
Women who have missed the school immunisation programme, and some gay men, opt to be immunised, usually through a private clinic.
Remember, it’s never too late to discuss vaccinations, but you achieve the best protection if you have them early.
Dr Jane Wilson-Howarth fits implants and Mirenas in her surgery; for more on sexual health see The Essential Guide to Travel Health