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Gareau E, Phillips KP. Sexual behaviors at home and abroad: an online survey of Canadian young adult travelers. BMC Public Health 2022; 22:967. [PMID: 35562691 PMCID: PMC9106270 DOI: 10.1186/s12889-022-13383-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For young adults, travel- an accessible and aspirational experience- may be accompanied by high-risk lifestyle behaviors abroad, which in turn, increases the risk of sexually transmitted and blood-borne infections (STBBI). This study aimed to examine sexual and risk behaviors of young Canadian adults both at-home and during international travel. METHODS Sexually-active Canadians, aged 18-25 years (N = 646) who travelled abroad in 2016, completed an online, cross-sectional survey analyzed by descriptive statistics. Outcome measures included young Canadian adults' lifestyle risk and sexual behaviors at-home and abroad. RESULTS Sexual behaviors, both penetrative and non-penetrative activities, decreased significantly (p < 0.001; McNemar test) abroad compared to at-home. International travel elicited a statistically significant increase in alcohol consumption compared to at-home (Wilcoxon, z = - 11.341, p < 0.001). Partner type (new trip-acquired partner) abroad was associated with a greater number of travel-acquired sexual partners (Mann-Whitney, U = 4901, p < 0.001), inconsistent condom use during penetrative sex (U = 7215, p = 0.009), and sex under the influence of alcohol (Test of Two Proportions, p < 0.001). CONCLUSIONS Although many young Canadian respondents practiced abstinence in their 2016 travel, for sexually-active travelers, new partner-type was related to high risk sexual behaviors. Young Canadians exhibited sexual risk behaviors both at-home and while travelling; suggesting the need for both domestic and pre-travel sexual health interventions.
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Affiliation(s)
- Emmanuelle Gareau
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 University Private, Ottawa, Ontario, K1N 6N5, Canada
| | - Karen P Phillips
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 University Private, Ottawa, Ontario, K1N 6N5, Canada.
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2
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Jacups SP, Potter C, Yarwood T, Doyle-Adams S, Russell D. How accurate is presumptive Chlamydia trachomatis treatment? A 6-month clinical audit of a walk-in sexual health service. Sex Health 2021; 18:413-420. [PMID: 34742364 DOI: 10.1071/sh21078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/16/2021] [Indexed: 01/23/2023]
Abstract
Background Chlamydia trachomatis (chlamydia) is highly prevalent and is an important sexually transmitted infection as it can lead to increased risk of HIV seroconversion; and if left untreated, can cause infertility in women. Clinical guidelines recommend treating chlamydia presumptively when presenting symptomatically; however, clinicians are now questioning this due to increasing prevalence of antimicrobial resistance. Methods To determine the accuracy of presumptive chlamydia treatment practices at a walk-in sexual health service in regional Australia, we audited all same-day screen and treat presentations prescribed azithromycin over a 6-month period in 2018. Results A total of 325 cases were included in the analysis. Over half (54%) the presentations returned negative pathology for all pathogens investigated. One quarter (25%) of presentations were positive for chlamydia, and (4%) reported a dual infection. A further one fifth (20%) were negative for chlamydia but positive for another pathogen. More symptomatic males than females returned positive pathology for chlamydia (8% vs 4%). Conclusions While presumptive treatment is recommended in the current guidelines, our findings indicate this resulted in over-treatment. Considering the increasing resistance patterns for Mycoplasma genitalium, which include azithromycin, presumptive treatments need to balance immediate client care needs against long-term community antimicrobial resistance outcomes. This internal audit provided a feedback mechanism to the walk-in sexual service, enabling modification of practices to provide more precise, individual clinical care within the bounds of current STI guidelines, while balancing wider the objectives of antimicrobial stewardship.
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Affiliation(s)
- Susan P Jacups
- School of Public Health, The University of Queensland, St Lucia, Qld 4067, Australia; and The Cairns Institute, James Cook University, McGregor Road, Smithfield, Qld 4878, Australia
| | - Caroline Potter
- Cairns Sexual Health Service, Cairns and Hinterland Hospital and Health Service, Cairns, Qld 4870, Australia
| | - Trent Yarwood
- Cairns Sexual Health Service, Cairns and Hinterland Hospital and Health Service, Cairns, Qld 4870, Australia; and Infectious Diseases, Cairns Hospital, Cairns and Hinterland Hospital and Health Service, Cairns, Qld 4870, Australia; and School of Clinical Medicine, University of Queensland, Herston, Qld 4006, Australia; and College of Medicine and Dentistry, James Cook University, Cairns, Qld 4870, Australia
| | - Simon Doyle-Adams
- Cairns Sexual Health Service, Cairns and Hinterland Hospital and Health Service, Cairns, Qld 4870, Australia
| | - Darren Russell
- Cairns Sexual Health Service, Cairns and Hinterland Hospital and Health Service, Cairns, Qld 4870, Australia; and College of Medicine and Dentistry, James Cook University, Cairns, Qld 4870, Australia
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Aung ET, Chow EP, Fairley CK, Hocking JS, Bradshaw CS, Williamson DA, Chen MY. International travel as risk factor for Chlamydia trachomatis infections among young heterosexuals attending a sexual health clinic in Melbourne, Australia, 2007 to 2017. ACTA ACUST UNITED AC 2020; 24. [PMID: 31690365 PMCID: PMC6836681 DOI: 10.2807/1560-7917.es.2019.24.44.1900219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BackgroundInternational travel is considered a risk factor for acquiring Chlamydia trachomatis; however, there are little empirical data to support this.AimTo examine the prevalence and risk factors for Chlamydia trachomatis infections among heterosexual international travellers (n = 28,786) attending the Melbourne Sexual Health Centre (MSHC), Australia, compared to Australian residents (n = 20,614).MethodsWe conducted a repeated cross-sectional study and analysed sexual behaviours and chlamydia positivity among heterosexual males and females aged ≤ 30 attending MSHC for the first time between January 2007 and February 2017. 'Travellers' were defined as individuals born outside of Australia who had resided in the country < 2 years. Associations between patient characteristics and chlamydia positivity were examined.ResultsChlamydia positivity was higher among travellers (11.2%) compared with Australian residents (8.5%; p < 0.001). Male travellers had higher chlamydia positivity (12.1%) than Australian males (9.3%; p < 0.001), as did female travellers (10.4%) compared with Australian females (7.7%; p < 0.001). Travellers had a higher mean number of sexual partners than Australian residents among males (5.7 vs 4.7; p < 0.001) and females (3.6 vs 3.2; p < 0.001). Travellers from the United Kingdom, Europe, Ireland and New Zealand accounted for 29.6%, 21%, 8.5% and 5.8% of C. trachomatis infections, respectively. Chlamydia in males and females was associated with younger age (≤ 25), inconsistent condom use, a higher number of sexual partners (≥ 4 partners) and being a traveller (p < 0.001).ConclusionsWe found that international travel is an independent risk factor for chlamydia among young heterosexual travellers in Australia, who should therefore be a target group for chlamydia prevention.
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Affiliation(s)
- Ei T Aung
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Eric Pf Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Christopher K Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Jane S Hocking
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Catriona S Bradshaw
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Marcus Y Chen
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
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Charleson FJ, Fairley CK, Hocking JS, Vodstrcil LA, Bradshaw CS, Chow EPF. Age, ethnic and travel-related disparities in kissing and sexual practices among heterosexual men in Melbourne, Australia. Sex Health 2020; 17:279-287. [DOI: 10.1071/sh19230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/06/2020] [Indexed: 11/23/2022]
Abstract
Background The kissing practices of heterosexual men are not well understood, despite the potential of kissing to be a significant risk factor for gonorrhoea transmission. This study aimed to explore kissing and sex practices among heterosexual men. Methods: A cross-sectional survey among heterosexual men attending the Melbourne Sexual Health Centre in 2016–2017 was conducted. Men were asked to report their number of kissing-only (in the absence of sex), sex-only (in the absence of kissing) and kissing-with-sex partners in the last 3 months. The mean number of each partner type was calculated, and multivariable negative binomial regression was used to investigate associations between the number of different types of partners and demographic characteristics. Results: Of the 2351 heterosexual men, men reported a mean of 2.98 kissing-only, 0.54 sex-only and 2.64 kissing-with-sex partners in the last 3 months. Younger men had a mean higher number of kissing-only partners than older men (4.52 partners among men aged ≤24 years compared with 1.75 partners among men ≥35 years, P < 0.001). Men born in Europe had the most kissing-only partners (mean: 5.16 partners) and men born in Asia had the fewest kissing-only partners (mean: 1.61 partners). Men recently arrived in Australia, including travellers from overseas, had significantly more kissing-only partners (adjusted incidence rate ratio (aIRR): 1.53; 95% CI: 1.31–1.80) than local men. Conclusions: This study provides novel data about kissing practices of heterosexual men. Studies assessing oropharyngeal gonorrhoea should include measurements of kissing until studies can clarify its contribution to transmission risk.
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Sundbeck M, Agardh A, Östergren PO. Travel abroad increases sexual health risk-taking among Swedish youth: a population-based study using a case-crossover strategy. Glob Health Action 2018; 10:1330511. [PMID: 28598729 PMCID: PMC5496094 DOI: 10.1080/16549716.2017.1330511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: The fact that youth take sexual risks when they are abroad have been shown in previous studies. However, it is not known if they increased their sexual risk-taking when travelling abroad, compared to the stay in their homeland. Objective: To assess whether Swedish youth increased their individual sexual risk behaviour, defined as having a casual sex partner, when travelling abroad and to examine possible factors that may be associated with increased risk-taking abroad. Design: In 2013, a population-based sample of 2189 Swedes, 18-29 years, was assessed by a questionnaire (45% response rate). Sexuality, duration of travel, parents’ country of origin, mental health, heavy episodic drinking (HED), use of illicit drugs, and socio-demographic background were assessed. Increased risk of casual sex in relation to time spent abroad vs. time spent in Sweden was analysed by a variant of case-crossover design. Factors that could be associated with increased risk of casual sex in Sweden and abroad, separately, were analysed by logistic regression.
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Affiliation(s)
- Mats Sundbeck
- a Social Medicine and Global Health , Lund University , Malmö , Sweden
| | - Anette Agardh
- a Social Medicine and Global Health , Lund University , Malmö , Sweden
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Trevis T, Gossé M, Santarossa N, Tabrizi S, Russell D, McBride WJ. Mycoplasma genitalium in the Far North Queensland backpacker population: An observational study of prevalence and azithromycin resistance. PLoS One 2018; 13:e0202428. [PMID: 30153259 PMCID: PMC6112622 DOI: 10.1371/journal.pone.0202428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/02/2018] [Indexed: 11/18/2022] Open
Abstract
Background Mycoplasma genitalium is a sexually transmitted infection (STI), and a common cause of non-gonococcal urethritis (NGU). There is concern regarding the rise in prevalence of M. genitalium and rates of resistance to macrolide antibiotics. International backpackers represent a unique population that may be at an increased risk of STIs. The purpose of this study was to determine the prevalence of M. genitalium and antibiotic resistance in international backpackers. Methods First void urine samples were obtained utilising opportunistic sampling from 294 non-treatment-seeking international backpackers at a variety of hostels in Cairns, Queensland Australia. Participants also answered a fixed-answer survey regarding sociodemographic characteristics and sexual risk behaviours. Samples were tested for M. genitalium, Chlamydia trachomatis and Neisseria gonorrhoeae using polymerase chain reaction (PCR). Samples positive for M. genitalium were investigated for macrolide resistance-associated mutations in the 23S rRNA genome at positions A2058G, A2058C, A2058T, A2059G and A2059C (Escherichia coli numbering). Results Of the 294 samples, 23 failed the internal control. The prevalence of M. genitalium was 1.8% (5/271, 95% confidence interval [CI] ± 1.58), C. trachomatis was 4.1% (11/271, 95% CI ± 2.36) and N. gonorrhoeae was not detected. Macrolide resistance-associated mutations were identified in 40% (2/5) of M. genitalium-positive samples. M. genitalium infection was associated with reporting symptoms (odds ratio [OR] 14.36, 95% CI 2.17–94.94, p < 0.05). Conclusions M. genitalium and C. trachomatis are relatively common amongst non-treatment seeking international backpackers, but may not differ from Australian population prevalence. This article provides evidence to further support the increased utilisation of M. genitalium PCR in the diagnosis of NGU, and for macrolide resistance testing for all identified M. genitalium infections.
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Affiliation(s)
- Thomas Trevis
- James Cook University Clinical School, Cairns Hospital, Cairns, Queensland, Australia
- * E-mail:
| | - Marianne Gossé
- Norwegian University of Science and Technology, Faculty of Medicine, Trondheim, Norway
| | - Nicola Santarossa
- James Cook University Clinical School, Cairns Hospital, Cairns, Queensland, Australia
| | - Sepehr Tabrizi
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - Darren Russell
- Cairns Sexual Health Service, Cairns North, Queensland, Australia
| | - William John McBride
- James Cook University Clinical School, Cairns Hospital, Cairns, Queensland, Australia
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Svensson P, Sundbeck M, Persson KI, Stafström M, Östergren PO, Mannheimer L, Agardh A. A meta-analysis and systematic literature review of factors associated with sexual risk-taking during international travel. Travel Med Infect Dis 2018; 24:65-88. [PMID: 29567294 DOI: 10.1016/j.tmaid.2018.03.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/23/2018] [Accepted: 03/12/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND International travel facilitates global spread of sexually transmitted infections (STI). Travellers could contribute to onward transmission of pathogens rarely encountered at home and export new strains to the destination. The aim was to systematically examine evidence regarding determinants of travel-related sexual risk-taking and identify knowledge gaps and areas for targeted interventions. METHOD Articles published in peer-reviewed journals from 2000 to 2017 were screened in 6 databases and assessed for relevance against criteria. Data was extracted for factors associated with travel-related STI or proxies. Meta-analyses estimated pooled prevalence of casual sex and non-condom use. Adjusted odds ratios of predictors were pooled to generate a combined estimate. RESULT Forty-nine articles qualified for inclusion. A heterogeneity test indicated variation across studies. The pooled prevalence of casual travel sex was 35% and prevalence of non-condom use 17%. Expectations of casual sex strongly predicted sex with a new partner when travelling abroad. Planning to have sex indicated condom use. CONCLUSION The studies largely represented sub-groups of risk-taking populations from a European context, indicating substantial knowledge gaps. Studies investigating migrants travelling to visit friends and relatives, older travellers, and female travelers are needed. Post-travel harm reduction activities may serve as a focus for future interventions.
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Affiliation(s)
- Pia Svensson
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden.
| | - Mats Sundbeck
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Kristina Ingemarsdotter Persson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Public Health Agency, Health and Sexuality, Stockholm, Sweden
| | - Martin Stafström
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Per-Olof Östergren
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Louise Mannheimer
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Public Health Agency, Health and Sexuality, Stockholm, Sweden
| | - Anette Agardh
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Croughs M, de Gouw A, Remmen R, Van den Ende J. Do travel clinic visitors read information on sexual risk abroad in travel health brochures? J Infect Prev 2016; 18:18-22. [PMID: 28989499 DOI: 10.1177/1757177416661405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 06/26/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A substantial proportion of travel clinic visitors have sexual encounters while abroad. Hence, guidelines on travel health recommend discussing sexual risk in a pre-travel consultation. However, previous studies showed that it often is not discussed. Although travel clinic visitors usually do receive written information on sexual risk abroad, few data are available on whether this information is read. Therefore, this prospective cohort study in travel clinic visitors was performed. METHODS Travel clinic visitors were invited to complete a questionnaire after return from their journey. RESULTS A total of 130 travellers (55%) responded. Half of them recorded they read the information on sexual risk. Male gender (OR 9.94 95% CI 3.12 - 31.63) and 'travelling with others' (OR 2.7 95% CI 1.29 - 5.78) were significant independent predictors of reading the information on sexual risk. High risk travellers, i.e. those travelling without a steady partner, were less likely to have read it. Although websites and apps were mentioned as better methods of providing information, none of the participants visited the websites on sexual behaviour and sexually transmitted infections recommended in the travel health brochure. CONCLUSION Only half of travel clinic visitors read information on sexual risk in the health brochure received in the clinic and none of them visited the related websites mentioned in the brochure. Further research to identify the most effective way to inform travellers about sexual risk is needed.
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Affiliation(s)
- Mieke Croughs
- Department of Environment, GGD Hart voor Brabant, 's-Hertogenbosch, The Netherlands.,Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Annemarie de Gouw
- Department of Environment, GGD Hart voor Brabant, 's-Hertogenbosch, The Netherlands
| | - Roy Remmen
- Department of Primary and Interdisciplinary Care, University of Antwerp, Belgium
| | - Jef Van den Ende
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Sexual risk-taking during travel abroad - a cross-sectional survey among youth in Sweden. Travel Med Infect Dis 2016; 14:233-41. [PMID: 27083687 DOI: 10.1016/j.tmaid.2016.03.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 03/09/2016] [Accepted: 03/23/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim was to assess sexual risk-taking behaviour in a sample of Swedish youth who were sexually active while travelling abroad and to examine possible associations with sexual risk-taking behaviour during such travel. METHODS From a population-based sample of 2189 Swedes 18-29 years, 768 who were sexually active while abroad, were assessed by a questionnaire concerning socio-demographic background, life-style, travel duration, sexuality, mental health, heavy episodic drinking (HED) and drug-use. RESULTS Approximately 1/4 reported intercourse with a casual partner abroad. Casual sex was associated with HED, 18-24 years, and drug use in both sexes, and for women, also with ≥one month of travel. Among youth with casual partners, 48% reported non-condom use. Non-condom use with a casual partner was associated with 18-24 years, ≥one month of travel for women, and poor self-rated mental health for men. About 10% had ≥2 partners abroad. Having ≥2 partners abroad was associated with ≥one month of travel, and for men also with HED. CONCLUSION Male sex, 18-24 years of age, ≥1 month of travel, HED, and drug use were significantly associated with sexual risk-taking during travel abroad. Poor self-rated mental health and foreign-born parentage might also constitute risk factors for men.
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Abstract
The control of sexually transmitted infections relies on case-finding and treatment of sexual contacts to prevent further transmission. Screening for infections should be tailored to the demographic and sexual risk of the individual. For most sexually transmitted infections, screening is performed on self-collected, non-invasive samples using highly sensitive molecular assays. These are quick and inexpensive. Shorter courses of antivirals for genital herpes are now recommended. New chemoprophylactic strategies for preventing HIV transmission have emerged, including treatment to prevent transmission and the use of antiretrovirals for pre-exposure prophylaxis.
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Vajta B, Holberg M, Mills J, McBride WJH. Weighing up the costs of seeking health care for dengue symptoms: a grounded theory study of backpackers' decision-making processes. Aust J Prim Health 2015; 21:245-8. [PMID: 26509208 DOI: 10.1071/py13107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Dengue fever, a mosquito-borne virus, is an ongoing public health issue in North Queensland. Importation of dengue fever by travellers visiting or returning to Australia can lead to epidemics. The mosquito can acquire the virus in the symptomatic viraemic phase, so timely recognition of cases is important to prevent epidemics. There is a gap in the literature about backpackers' knowledge of dengue fever and the decision-making process they use when considering utilising the Australian health-care system. This study uses grounded theory methods to construct a theory that explains the process backpackers use when seeking health care. Fifty semi-structured interviews with backpackers, hostel receptionists, travel agents and pharmacists were analysed, resulting in identification of a core category: 'weighing up the costs of seeking health care'. This core category has three subcategories: 'self-assessment of health status', 'wait-and-see' and 'seek direction'. Findings from this study identified key areas where health promotion material and increased access to health-care professionals could reduce the risk of backpackers spreading dengue fever.
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Alcedo S, Kossuth-Cabrejos S, Piscoya A, Mayta-Tristán P. Factors associated with non-use of condoms in an online community of frequent travellers. Travel Med Infect Dis 2015; 12:750-6. [PMID: 25457304 DOI: 10.1016/j.tmaid.2014.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 08/01/2014] [Accepted: 10/06/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Millions of travellers around the world have gathered together into online communities. The objective is to analyse the factors associated with risky sexual behaviour among travellers. METHODS Cross-sectional study was conducted within an online community of travellers using an online survey; we included travellers who had engaged in sexual activity while on their last trip. Risky sexual behaviour was defined as inconsistent condom use (<100%), and the factors associated were evaluated using the prevalence ratio (PR). RESULTS Of the 468 participants, 245 had sex during their last trip. 59.7% did not consistently use condoms, and one out of every four participants reported never using condoms. Having a travel destination of Latin America or the Caribbean was significantly associated with inconsistent condom use. This association was maintained (PR 1.37, CI 95% 1.06–1.77) after adjusting for gender, age, migration, the presence of travel partners, and the use of drugs and alcohol prior to sexual activity. CONCLUSION An association was observed between travel destination (specifically Latin America or the Caribbean) and risky sexual behaviour. For this reason, tourists should be educated in STI transmission and regional STI and HIV incidences both before and during their travels; public health systems ought to work together with travel agencies, international airports, etc., in order to distribute this information and ensure a responsible travel experience.
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Levy-Shraga Y, Hamiel U, Yaron M, Pinhas-Hamiel O. Health risks of young adult travelers with type 1 diabetes. J Travel Med 2014; 21:391-6. [PMID: 24909100 DOI: 10.1111/jtm.12136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 02/01/2014] [Accepted: 04/04/2014] [Indexed: 02/05/2023]
Abstract
AIM International travel has become popular among young adults. This study evaluated the rate and characteristics of travel-associated health risks among young adults with type 1 diabetes mellitus (T1DM) compared with healthy same-aged individuals. METHODS A retrospective study was conducted of 47 young adults with T1DM and 48 without (controls). Structured questionnaires accessed information regarding 154 international trips during the preceding 5 years and lasted 7 days and longer. RESULTS Mean ± SD ages of the diabetic and control groups were 26.6 ± 5.0 and 26.9 ± 2.6 years, respectively. Mean trip durations were 80.0 (range 7.0-390.0) and 87.6 days (range 7.0-395.0), respectively. The number of trips per person was 1.5 ± 0.6 and 1.7 ± 0.8, and the proportion of trips to developing countries 64 and 61%, respectively. There were no differences between the groups in rates of travel-related diseases that required medical consultation (11% vs 15% for all trips). No patient sought medical attention for acute problems related to diabetes management. Prior to 71% of their trips to developing countries, respondents with diabetes consulted their diabetes physician; prior to 26% of their trips they switched from an insulin pump to injections; during 41% of the trips they increased glucose monitoring; and for the period of 11% of the trips they defined their metabolic control as poor. Self-reported mean hemoglobin A1c (HbA1c) levels before and after trips were 7.65 ± 1.45 and 7.81 ± 1.23%, respectively (p = 0.42, paired t-test). CONCLUSIONS Young adults with type 1 diabetes did not report more travel-related diseases than did healthy individuals. Most reported reasonable to good glycemic control during the trip without severe consequences.
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Affiliation(s)
- Yael Levy-Shraga
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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14
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Davies SC, Shepherd B, Wiig R, Kaan I. Unsupervised screening for chlamydia and gonorrhoea in backpacker hostels in Manly, Sydney. Sex Health 2014; 10:185-7. [PMID: 23158843 DOI: 10.1071/sh12136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 08/24/2012] [Indexed: 11/23/2022]
Abstract
Young international backpackers frequently have new sexual partners. We conducted a pilot project of unsupervised screening for chlamydia (Chlamydia trachomatis) and gonorrhoea (Neisseria gonorrhoeae) by self-collected specimens at two backpacker hostels in Manly, Sydney. The median age was 24 years for men and 23 years for women. A new sexual partner during travel was reported by 94%, of whom only 20% always using condoms. The prevalence of chlamydia was 11.9% (14.3% of 35 men and 10.2% of 49 women). No cases of gonorrhoea were detected. Half of the dispensed testing kits went missing or were tampered with, and there was spoilage of the receptacle bins, which persisted despite a redesign to a more secure and locked box. While populations such as young backpackers may be a priority group for sexually transmissible infection screening, we advise caution for projects contemplating an unsupervised model.
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Affiliation(s)
- Stephen C Davies
- North Shore Sexual Health Service, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
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15
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Dahlman D, Stafström M. Female Swedish backpackers in Vietnam: A hypotheses generating study on sexual health risks while travelling. Travel Med Infect Dis 2013; 11:243-9. [DOI: 10.1016/j.tmaid.2013.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 03/06/2013] [Accepted: 04/27/2013] [Indexed: 10/26/2022]
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Chlamydia trends in men who have sex with men attending sexual health services in Australia, 2004-2008. Sex Transm Dis 2013; 38:339-46. [PMID: 21217421 DOI: 10.1097/olq.0b013e318202719d] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In most Australian settings, chlamydia notifications do not contain information on the gender of sexual partners. We assessed trends and predictors of chlamydia testing and positivity among men who have sex with men (MSM), attending sexual health services in Australia. METHODS The Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) program was established in 2008 to collate demographic and chlamydia testing information from 25 sexual health services. We calculated the proportion tested and chlamydia positivity among MSM and assessed trends from 2004 to 2008 using a χ2 test and predictors using logistic regression. RESULTS In the 5-year period, 11,777 MSM attended as new patients (first visit ever to the service) and the proportion tested for chlamydia increased significantly from 71% in 2004 to 79% in 2008 (P < 0.01). Independent predictors of chlamydia testing were younger age, residing in a metropolitan area (adjusted prevalence ratio [APR] = 1.23; 95% confidence interval [CI]: 1.19, 1.27), being Australian-born (APR = 1.03; 95% CI: 1.01, 1.06), being a traveler or migrant (APR = 1.09; 95% CI: 1.06, 1.12), and sex overseas in the past year (APR = 1.05; 95% CI: 1.03, 1.07). Overall chlamydia positivity was 8.6% (95% CI: 8.0%-9.2%). There was no significant trend in chlamydia positivity between 2004 and 2008. Independent predictors of chlamydia positivity were younger age, being a traveler or migrant (APR = 1.52; 95% CI: 1.26-1.84), and exclusive same-sex contact (APR = 1.28; 95% CI: 1.05-1.55). CONCLUSIONS This new national surveillance program demonstrates that the majority of MSM attending sexual health services was offered chlamydia testing and testing has increased over time. The MSM at highest risk of chlamydia were more likely to be tested. Chlamydia transmission was frequent but stable among MSM accessing clinical services.
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Fischer JA, Debattista J, Rostami S, Peet AR, Dean JA, Allen KE, Stewart M. Sexual risk taking in a community sample of international backpackers visiting Brisbane, Australia. Asia Pac J Public Health 2013; 27:NP2400-9. [PMID: 23572374 DOI: 10.1177/1010539513483822] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We sought to examine correlations between international backpackers' alcohol consumption and sexual behaviors and determine the prevalence of Chlamydia trachomatis and Neisseria gonorrhoea in this population. A cross-sectional study design consisting of a convenience sample (N = 168) of non-treatment-seeking international backpackers visiting Brisbane, Australia was recruited. Participants were asked to self-complete a questionnaire on sexual behavior and to undertake a urine-based polymerase chain reaction test for C trachomatis and N gonorrhoea. Since arriving in Australia, 73.2% reported having had sex, with a median number of 2 different sex partners (range = 0-21). Most participants had consumed alcohol (53.7%) and used condoms (46.3%) the last time they had sex. In our sample, there was a 4.3% prevalence of C trachomatis and a 0% prevalence of N gonorrhoea. This study identified a variable pattern of risk among backpackers, with those spending longer periods in the country more likely to have sex with Australians.
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Affiliation(s)
- Jane A Fischer
- Centre for Drug and Alcohol Studies, Queensland Health, Brisbane, Queensland, Australia
| | - Joseph Debattista
- Sexual Health and HIV Service, Queensland Health, Brisbane, Queensland, Australia
| | - Soulmaz Rostami
- Ethnic Communities Council of Queensland, Brisbane, Queensland, Australia
| | - Anthony R Peet
- Metro South Health Service District, Queensland Health, Brisbane, Queensland, Australia
| | - Judith A Dean
- Sexual Health and HIV Service, Queensland Health, Brisbane, Queensland, Australia Griffith University, Brisbane, Queensland, Australia
| | - Kate E Allen
- Sexual Health and HIV Service, Queensland Health, Brisbane, Queensland, Australia
| | - Mary Stewart
- Centre for Drug and Alcohol Studies, Queensland Health, Brisbane, Queensland, Australia
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Zimmermann R, Hattendorf J, Blum J, Nüesch R, Hatz C. Risk perception of travelers to tropical and subtropical countries visiting a swiss travel health center. J Travel Med 2013; 20:3-10. [PMID: 23279224 DOI: 10.1111/j.1708-8305.2012.00671.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 07/15/2012] [Accepted: 07/16/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study assessed the risk perception ratings of travelers pre- and post-travel and in comparison to the ratings by travel health experts. While most surveys on travel health knowledge, attitudes, and practices focus on malaria and vaccine-preventable diseases, noninfectious travel risks were included in this study. METHODS Pre- and post-travel perception of nine travel-associated health risks was recorded among 314 travelers to tropical and subtropical destinations. All travelers sought pre-travel health advice at the Travel Clinic of the Swiss Tropical and Public Health Institute in 2008 and 2009. In addition, 18 Swiss travel health experts provided an assessment of the respective risks. A validated visual psychometric measuring instrument was used [pictorial representation of illness and self measure (PRISM)]. RESULTS Travelers and experts rated most risks similarly, except for accidents and sexually transmitted infections (STIs) which experts rated higher. Compared to other risks, accidents ranked highly in both groups and were the only risk perceived higher after travel. Pre- and post-travel perceptions of all other risks were similar with a tendency to be lower after travel. Travelers perceived mosquitoes to be the highest risk before travel and accidents after travel. CONCLUSION Travelers' risk perception appears to be accurate for most risks stated in this study. However, travel health professionals should be aware that some perception patterns among travelers regarding travel-related health risks may be different from professional risk assessment. Important but insufficiently perceived health risks, such as sexual behavior/STIs and accidents, should be considered to be part of any pre-travel health advice package.
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Affiliation(s)
- Rosalie Zimmermann
- Departments of Medicine and Diagnostics, Swiss Tropical and Public Health Institute, Basel, Switzerland.
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Wyler N, Green S, Boddington N, Davies C, Friedli K, Lankester T. Travel related illness in short-term volunteers from the UK to developing countries. Travel Med Infect Dis 2012; 10:172-8. [DOI: 10.1016/j.tmaid.2012.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Revised: 02/25/2012] [Accepted: 04/25/2012] [Indexed: 11/25/2022]
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Lim MSC, Goller JL, Guy R, Gold J, Stoove M, Hocking JS, Fairley CK, Henning D, McNamee K, Owen L, Sheehan P, Hellard ME. Correlates of Chlamydia trachomatis infection in a primary care sentinel surveillance network. Sex Health 2012; 9:247-53. [DOI: 10.1071/sh11019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 07/28/2011] [Indexed: 11/23/2022]
Abstract
Background
Chlamydia is the most commonly notified infection in Australia. Prevention strategies should be informed by routine data on at-risk populations. Methods: We calculated chlamydia positivity and correlates of infection using multivariable logistic regression for data collected between April 2006 and June 2009. Results: Chlamydia positivity was 5.6% in 12 233 females, 7.7% in 10 316 heterosexual males and 6.2% in 7872 men who have sex with men (MSM). Correlates of chlamydia positivity among females included younger age (odds ratio (OR) 2.27, 95% confidence interval (CI) 1.92–2.69), being born overseas (OR 1.50, 95% CI 1.25–1.82), multiple sex partners in the past year (OR 1.72, 95% CI 1.40–2.11) and inconsistent condom use with regular sex partners (OR 3.44 ,95% CI 1.65–7.20). Sex work was protective for females (OR 0.68, 95% CI 0.53–0.86). Among heterosexual males, correlates of positivity were younger age (OR 1.87, 95% CI 1.62–2.17), being born overseas (OR 1.35, 95% CI 1.16–1.58), symptoms at the time of testing (OR 1.64, 95% CI 1.40–1.92) and multiple sex partners in the past year (OR 1.83, 95% CI 1.46–2.30). Correlates of positivity among MSM were being born overseas (OR 1.23, 95% CI 1.00–1.51), being HIV-positive (OR 1.80, 95%CI 1.32–2.47), and reporting six or more anal sex partners in the past 6 months (OR 4.45, 95% CI 1.37–14.5). Conclusions: Our analysis identified subgroups at the highest risk of chlamydia in Victoria. These estimates will provide important baseline information to measure the impact of chlamydia control strategies.
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Davies SC, Karagiannis T, Headon V, Wiig R, Duffy J. Prevalence of genital chlamydial infection among a community sample of young international backpackers in Sydney, Australia. Int J STD AIDS 2011; 22:160-4. [PMID: 21464454 DOI: 10.1258/ijsa.2010.010354] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We conducted a chlamydia prevalence study from January to June 2009 among a community sample of young international backpackers by recruiting at hostels in Sydney, Australia. Participants completed a questionnaire; men provided a urine sample and women provided a self-collected vaginal swab, which were tested for Chlamydia trachomatis DNA by strand displacement amplification. We recruited 225 men (median age 24 years) and 207 women (median age 23 years). Most (87%) of the travellers came from Europe. A new sexual partner during travel was reported by 67%, and 51% had more than one new sexual partner. Of those reporting a new sexual partner, 40% always used condoms. Prevalence of chlamydia was 3.5% (3.1% in men, 3.9% in women). Previous testing for chlamydia was reported by 40%. Drinking alcohol at hazardous levels was reported by 58% of men and 29% of women. Despite the reporting of new sexual partners and inconsistent condom use, the prevalence of chlamydia in these backpackers was not higher than that found in more general populations, and may relate to good health-care seeking behaviour. Young travellers need education about sexual risks and promotion of condom use prior to travel, and access to public sexual health services.
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Affiliation(s)
- S C Davies
- Northern Sydney Sexual Health Service, Royal North Shore Hospital, St Leonards, Australia.
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