STDs and HIV

Travellers who engage in unprotected sex abroad run a high risk of acquiring a sexually transmitted disease (STD) such as gonorrhoea, chlamydia and herpes as well as HIV and Hepatitis B or Hepatitis C. Because travellers sometimes feel less inhibited when away from home, they are more likely to engage in risky sexual practices. Risk increases with the number of contacts and with the number of sexual partners. Travellers who are sexually active should limit the number of new partners. Some groups have an increased likelihood of acquiring STDs - young men, long-term travellers, men who have sex with men, individuals travelling alone or with partners other than their families, and business travellers. Additionally, international travellers are more likely to have contact with commercial sex workers who have high rates of STDs.

HIV/AIDS

HIV infection, which can lead to AIDS, is now a worldwide problem. The ease of international travel has undoubtedly been a major contributor to the rapid spread of HIV. In 2015 the World Health Organisation estimated that over 36 million adults are living with HIV/AIDS. They also estimate that 40% of people living with HIV infection are unaware that they have it. Sub-Saharan African countries have the highest prevalence currently. In Africa screening for HIV is limited but the problem is enormous. In 2016 the World Health Organisation estimated that 1 in 25 adults in Africa are living with HIV. More than 20% of the general population are infected in a few African countries. Cases have been reported from over 160 countries. The majority of these cases have occurred in developing countries where the main route of transmission is now heterosexual contact, and 50% of cases now occur in females. Sex workers are also at particular risk. For example:

  • Over 10% of male sex workers and 2% of female sex workers in Thailand are HIV+.
  • 2% of Indian sex workers are HIV+, and this can increase to 18% in regions of India.

Travellers are estimated to be over 200 times more likely to contract HIV whilst abroad, than at home.

What is the difference between HIV and AIDS?

HIV (human immunodeficiency virus) is the name of the virus that people catch. HIV can be transmitted sexually, from mother to baby, and from contaminated blood and sharing injection equipment.

AIDS, or Acquired Immune Deficiency Syndrome, is caused by HIV. The virus attacks the body's immune system making it unable to fight some diseases. It can take many years from the time of infection until development of symptoms of AIDS if the virus is undetected and untreated - consequently just because someone looks healthy does not mean they are not infected with HIV.

HIV Cannot Be Transmitted By:

Sitting on toilet seats or Mosquitoes or Coughing and Sneezing or Swimming or Shaking Hands

The following list are of the most common STDs:

Disease

Incubation

Symptoms

Diagnosis

Chlamydia

5-7 days

Males: discharge, usually thin & clear and painful urination

Females: often none. May have vaginal discharge

Swab or Urine Test

Gonorrhoea

2-7 days

Males: creamy discharge from penis and painful urination

Females: often no symptoms. May have a vaginal discharge.

Swab or Urine Test

Hepatitis B or Hepatitis C

2-6 months

Often none or can fulminate in acute hepatitis which may be fatal.

Blood Test

Herpes virus

2-12 days

Painful blisters/ulcers on penis or vagina. Can be transmitted when no ulcers visible.

Swab or Blood Test

HIV/AIDS

3 months

Asymptomatic but may lead to full blown AIDS

Blood Test

Syphilis

10-90 days

Primary; chancre (painless ulcer) on penis or vagina.

Secondary: flu like illness with rash. If untreated both can lead to Tertiary syphilis which is fatal.

Blood Test or Swab

Wart Virus

1-20 months

Visible warts or vaginal irritation.

Examination

Prevention

HIV, Hepatitis B or C and other STDs are preventable. Abstinence is the only absolute protection from sexually transmitted diseases. Other protective methods include:

  • If you choose to be sexually active, limit the number of contacts with a potentially high risk partner and limit the number of new sexual partners. Travellers should also avoid sex in situations of high risk, such as those that involve sex for drugs or money in areas with high rates of STDs.
  • Use a new, high quality condom for each act of intercourse and be aware that condoms do not entirely eliminate the risk of HIV transmission or of other STDs. Latex condoms provide higher protective efficacy. Pack an adequate supply (as well as lubricant) as quality and availability in some areas is unpredictable. Protect condoms from sun or temperature extremes. The Oral Contraceptive Pill does not provide any protection against STDs.
  • Limit consumption of alcohol. Alcohol is a significant factor in many sexual encounters, so limit your intake of alcohol when travelling, especially when in a situation that might lead to a sexual encounter. Failure to do so may result in infection with an STD.
  • Consider vaccination against Hepatitis B virus. This vaccine is recommended for non-immune long-term travellers. It is now part of the routine Australian childhood immunisation schedule. For those who have not had the vaccine, it is available at our clinic.
  • Consider vaccination against Human Papillomavirus (HPV) This vaccination is also now part of the routine childhood schedule. It can also be given to people under the age of 45 years who feel they are at risk, and is available at our clinic.
  • Do not use or allow the use of contaminated, unsterilised syringes or needles for any injections or other skin-piercing procedures, including acupuncture, use of illicit drugs, steroid or vitamin injections, medical or dental procedures, ear or body piercing or tattooing. If travelling to high risk areas consider taking your own emergency needle and syringe kit. Insulin dependent diabetics, haemophiliacs and people who require routine injections should carry a supply of syringes, needles and alcohol swabs sufficient to last their entire stay abroad, with an accompanying letter of authorisation.
  • Ensure that you have comprehensive travel insurance that provides worldwide 24 hour access. Many countries do not have mandatory screening of donated blood for HIV, Hepatitis B or Hepatitis C. If you are injured try to avoid a blood transfusion, blood components or clotting factors unless necessary. In an emergency, sterile plasma expanding fluids can be substituted for blood in the short term. If a transfusion must be given, make sure the blood is screened.

International travellers should be aware that some countries serologically screen incoming travellers (primarily those planning extended visits, such as for work or study) and deny entry to people with AIDS and those whose test results indicate infection with HIV. People intending to visit a country for a substantial period or to work or study abroad should be informed of the policies and requirements of that particular country. Information is available from consular officials or on the Internet, try http://hivtravel.org/.

On Your Return Home

If you have had sexual contacts (even if you have no symptoms) whilst travelling please get a complete check up on your return. These are confidential. Your own G.P., Travel Medicine Centre Perth or a specialised STD clinic can perform this. If you feel you may have been exposed make sure you abstain or practice safe sex on your return to Australia. Remember that HIV, Hepatitis B or Hepatitis C and other STDs have long incubation periods and it is possible to spread the disease before a diagnosis is made. Discussing this problem with your partner at home and then taking precautions can be difficult, but is absolutely necessary to prevent spread of disease to them. Persons with negative lab results will need to be rechecked 12 weeks later for Hepatitis B and HIV, and even longer for hepatitis C.

Refs and useful links:

https://www.avert.org/

http://hivtravel.org/

http://www.waaids.com/living-well-with-hiv/key-information/plhiv-travel.html

http://www.who.int/gho/hiv/en/

© 2017, DRSK Travel Medicine Centre Perth