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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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Determinants of Adherence with Malaria Chemoprophylactic Drugs Used in a Traveler's Health Clinic. J Trop Med 2015; 2015:163716. [PMID: 26379712 PMCID: PMC4561335 DOI: 10.1155/2015/163716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/20/2015] [Accepted: 05/26/2015] [Indexed: 11/17/2022] Open
Abstract
Background. The WHO recommends mefloquine, atovaquone/proguanil, and doxycycline for malaria chemoprophylaxis. Adherence to a drug is determined by many factors. Objective. To detect the determinants of travelers' adherence to malaria chemoprophylaxis. Methods. A prospective comparative study was conducted from January 2012 to July 2013 that included travelers (928 travelers) to malaria endemic countries who visited the THC. They were classified into 3 groups: the 1st is the mefloquine group (396 travelers), the 2nd is the doxycycline group (370 travelers), and finally those who did not receive any drugs (162 travelers). The participants from the 1st and 2nd groups enrolled in the study. Results. Univariate and multivariate analyses were performed. The predictors for adherence in the mefloquine group were travel to an African destination [OR = 51 (6.8–2385)], higher than a secondary school education [OR = 21 (4.1–144.2)], organized travel [OR = 4 (2.1–6.5)], traveling for leisure [OR = 2.1 (1.1–0.4)], and nationality [OR = 2 (1.11–4.00)]. In the doxycycline group, the predictors included higher than a secondary education [OR = 20.1 (4.5–125.1)], organized travel [OR = 11.4 (5.5–20.9)], travel for leisure [OR = 7 (2.3–22.9)], travel to an African destination [OR = 6.1 (0.41–417)], and nationality [OR = 4.5 (2.3–9.5)]. Conclusion. Adherence with malaria chemoprophylaxis could be affected by many factors such as nationality, education, and organized travel.
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Wilson ME, Chen LH, Han PV, Keystone JS, Cramer JP, Segurado A, Hale D, Jensenius M, Schwartz E, von Sonnenburg F, Leder K. Illness in travelers returned from Brazil: the GeoSentinel experience and implications for the 2014 FIFA World Cup and the 2016 Summer Olympics. Clin Infect Dis 2014; 58:1347-56. [PMID: 24585698 PMCID: PMC7112384 DOI: 10.1093/cid/ciu122] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Brazil will host the 2014 FIFA World Cup and the 2016 Olympic and Paralympic Games, events that are expected to attract hundreds of thousands of international travelers. Travelers to Brazil will encounter locally endemic infections as well as mass event-specific risks. METHODS We describe 1586 ill returned travelers who had visited Brazil and were seen at a GeoSentinel Clinic from July 1997 through May 2013. RESULTS The most common travel-related illnesses were dermatologic conditions (40%), diarrheal syndromes (25%), and febrile systemic illness (19%). The most common specific dermatologic diagnoses were cutaneous larva migrans, myiasis, and tungiasis. Dengue and malaria, predominantly Plasmodium vivax, were the most frequently identified specific causes of fever and the most common reasons for hospitalization after travel. Dengue fever diagnoses displayed marked seasonality, although cases were seen throughout the year. Among the 28 ill returned travelers with human immunodeficiency virus (HIV) infection, 11 had newly diagnosed asymptomatic infection and 9 had acute symptomatic HIV. CONCLUSIONS Our analysis primarily identified infectious diseases among travelers to Brazil. Knowledge of illness in travelers returning from Brazil can assist clinicians to advise prospective travelers and guide pretravel preparation, including itinerary-tailored advice, vaccines, and chemoprophylaxis; it can also help to focus posttravel evaluation of ill returned travelers. Travelers planning to attend mass events will encounter other risks that are not captured in our surveillance network.
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Affiliation(s)
- Mary E Wilson
- Global Health and Population, Harvard School of Public Health, Boston
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Croughs M, Remmen R, Van den Ende J. The effect of pre-travel advice on sexual risk behavior abroad: a systematic review. J Travel Med 2014; 21:45-51. [PMID: 24354921 DOI: 10.1111/jtm.12084] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Travelers often have casual sex abroad and the risk of acquiring a sexually transmitted infection (STI) associated with casual travel sex is considered to be threefold higher compared to the risk of casual sex in the home country. Consequently, international guidelines recommend including STI advice in the pre-travel consultation. We performed a systematic review on the effect of a pre-travel STI intervention on sexual risk behavior abroad. METHODS In September 2012, a systematic analysis and meta-analysis of peer reviewed literature were performed on the relation between pre-travel STI advice for travelers and sexual risk behavior abroad. Primary outcome measure consisted of the number of travelers with a new sexual partner abroad; secondary outcome measure entailed the proportion of consistent condom use. RESULTS Six studies were identified for inclusion in the review, of which three clinical trials on the effect of a motivational intervention compared to standard pre-travel STI advice qualified for the meta-analysis. Two of these trials were performed in US marines deployed abroad and one in visitors of a travel clinic. The extensive motivational training program of the marines led to a reduction in sexual risk behavior, while the brief motivational intervention in the travel clinic was not superior to standard advice. The meta-analysis established no overall effect on risk behavior abroad. No clinical trials on the effect of a standard pre-travel STI discussion were found, but a cohort study reported that no relation was found between the recall of a nonstructured pre-travel STI discussion and sexual risk behavior, while the recall of reading the STI information appeared to be related to more consistent condom use. CONCLUSIONS Motivational pre-travel STI intervention was not found to be superior to standard STI advice, while no clinical trials on the effect of standard pre-travel STI advice were found.
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Affiliation(s)
- Mieke Croughs
- Department of General Health, GGD Hart voor Brabant,'s-, Hertogenbosch, The Netherlands; Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Visser JT, Edwards CA. Dengue fever, tuberculosis, human immunodeficiency virus, and hepatitis C virus conversion in a group of long-term development aid workers. J Travel Med 2013; 20:361-7. [PMID: 24118595 DOI: 10.1111/jtm.12072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 08/19/2013] [Accepted: 08/22/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Development and humanitarian aid workers are a diverse group of travelers who, because of the nature of their travel, may have specific travel-related health risks. The main objective of this study was to quantify the risk of dengue fever virus (DFV), tuberculosis (TB), human immunodeficiency virus (HIV), and hepatitis C virus (HCV) infections in a group of long-term development aid volunteers. METHODS Medical files of Volunteer Service Abroad (VSA) volunteers and their accompanying family/partner/spouse serving over 17 years (1995-2011) were reviewed. Demographics, destination, months spent in-country, and, where available, results of pre- and post-assignment testing for DFV, TB, HCV and HIV infections were extracted. RESULTS Results from 652 assignments were audited. Conversion rates were calculated when both pre- and post-assignment results were available. Evidence of dengue fever seroconversion was found in 6.3% of 205 volunteers [at a rate of 3.4 per 1,000 person months (pm) on assignment], with assignments in Southeast Asia having the highest risk. Evidence of TB during assignment was found in 2.9% of 336 volunteers converting at a rate of 1.4 per 1,000 pm. There were no HIV or HCV infections detected. On post-assignment questioning, 6.7% of volunteers reported unprotected sex with someone other than their regular partner and 9.8% reported a potential exposure to blood and/or blood products. CONCLUSIONS Infection with DFV and TB occurred in this group at rates similar to that seen in other groups of long-term travelers, and screening would appear to be warranted. While none contracted HIV or HCV infection, reported behavior did put them at risk of blood- and body fluid-borne diseases. It is important that pre-assignment travel health preparation in this group focuses on strategies to minimize these risks.
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Affiliation(s)
- Jenny T Visser
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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Matteelli A, Schlagenhauf P, Carvalho ACC, Weld L, Davis XM, Wilder-Smith A, Barnett ED, Parola P, Pandey P, Han P, Castelli F. Travel-associated sexually transmitted infections: an observational cross-sectional study of the GeoSentinel surveillance database. THE LANCET. INFECTIOUS DISEASES 2013. [DOI: 10.1016/s1473-3099(12)70291-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Senn N, de Valliere S, Berdoz D, Genton B. Motivational brief intervention for the prevention of sexually transmitted infections in travelers: a randomized controlled trial. BMC Infect Dis 2011; 11:300. [PMID: 22044609 PMCID: PMC3214884 DOI: 10.1186/1471-2334-11-300] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 11/01/2011] [Indexed: 11/29/2022] Open
Abstract
Background Sexually transmitted infections (STIs) are among the frequent risks encountered by travelers. Efficient interventions are needed to improve the understanding of the risks of STIs. We investigated the potential benefits of a motivational brief intervention (BI) and the provision of condoms on the engagement in unprotected casual sex. Methods 3-arm randomized controlled trial performed among single travelers aged 18-44 years visiting a travel clinic in Switzerland. The main outcomes were the prevalence of casual unprotected sexual intercourse and their predictors. Results 5148 eligible travelers were seen from 2006 to 2008. 1681 agreed to participate and 1115 subjects (66%) completed the study. 184/1115 (17%) had a casual sexual relationship abroad and overall 46/1115 (4.1%) had inconsistently protected sexual relations. Women (adjusted OR 2.7 [95%CI 1.4-5.6]) and travelers with a history of past STI (adjusted OR 2.8 [95%CI 1.1-7.4]) had more frequent casual sexual relationships without consistent protection. Regarding the effect of our intervention, the prevalence of subjects using condoms inconsistently was 28% (95%CI16-40) in the motivational BI group, 24% (95%CI10-37) in the condoms group and 24% (95%CI14-33) in the control group (p = 0.7). Conclusion This study showed that a motivational brief intervention and/or the provision of free condoms did not modify risky sexual behavior of young travelers. The rate of inconsistently protected sexual relationships during travel was however lower than expected Trial Registration Number ClinicalTrials.gov: NCT01056536
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Affiliation(s)
- Nicolas Senn
- Travel Clinic, Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland.
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Goesch JN, Simons de Fanti A, Béchet S, Consigny PH. Comparison of knowledge on travel related health risks and their prevention among humanitarian aid workers and other travellers consulting at the Institut Pasteur travel clinic in Paris, France. Travel Med Infect Dis 2010; 8:364-72. [DOI: 10.1016/j.tmaid.2010.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Revised: 09/19/2010] [Accepted: 09/21/2010] [Indexed: 10/18/2022]
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Vivancos R, Abubakar I, Hunter P. Foreign travel, casual sex, and sexually transmitted infections: systematic review and meta-analysis. Int J Infect Dis 2010; 14:e842-51. [DOI: 10.1016/j.ijid.2010.02.2251] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 10/31/2008] [Accepted: 02/15/2010] [Indexed: 10/19/2022] Open
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Bauer IL. Sex education for local tourism/hospitality employees: addressing a local health need. Travel Med Infect Dis 2009; 7:371-4. [PMID: 19945015 DOI: 10.1016/j.tmaid.2009.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 10/22/2009] [Accepted: 10/26/2009] [Indexed: 10/20/2022]
Abstract
Health concerns arising from sexual relationships between tourists and locals usually focus on the travelling public. The local sex partners' health, and their impact on their communities' health, seem far less acknowledged. This paper describes a local health education session which implemented recommendations based on a study in Cuzco/Peru on tourists' and locals' views, knowledge, attitudes and experiences relating to sexual relationships between them. On location, fifteen discotheque employees received a health education session at the establishment's owner's request. Concluding from the positive experience, it is argued that researchers should, where possible, respond to requests to deliver ad hoc health education sessions while on location to address an identified local health need.
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Affiliation(s)
- Irmgard L Bauer
- Faculty of Medicine, Health, and Molecular Sciences, James Cook University, Townsville QLD 4811, Australia.
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Relationships between female tourists and male locals in Cuzco/Peru: implications for travel health education. Travel Med Infect Dis 2009; 7:350-8. [PMID: 19945012 DOI: 10.1016/j.tmaid.2009.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 08/31/2009] [Accepted: 09/02/2009] [Indexed: 11/22/2022]
Abstract
BACKGROUND Health concerns regarding casual sexual encounters during travel have been recognized for some time. The perception that female travellers' motivations are more romantic rather than sexual when entering a relationship with local men may exclude them from receiving appropriate travel health advice. This may pose even greater health risks, not only to themselves but also to their local partners. METHOD This paper presents 11 Western female tourists' perceptions of their relationships with local men in Cuzco/Peru, based on in-depth interviews, observations, and informal discussions. RESULTS Relationships with local men were often triggered by their physical appearance. Other themes identified were: methods and location of first contact, benefits for the local men, safe sex/condom use, and travel health advice received. CONCLUSIONS The findings support calls for more emphasis on sexual health in travel health education. Three aspects should be included: 1) an awareness that unfamiliar environment can cause 'out of character' behaviour, 2) an emphasis on not only to use but to not stop using condoms, and 3) the need to acquire negotiation skills.
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Ansart S, Hochedez P, Perez L, Bricaire F, Caumes E. Sexually transmitted diseases diagnosed among travelers returning from the tropics. J Travel Med 2009; 16:79-83. [PMID: 19335805 DOI: 10.1111/j.1708-8305.2008.00279.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Data are lacking on the spectrum of sexually transmitted diseases (STDs) diagnosed in returning travelers. STUDY DESIGN All consecutive travelers consulting our tropical unit between November 1, 2002 and October 31, 2003 were included if they presented within 1 month after their return from the tropics, with mucocutaneous signs suggesting STDs. RESULTS Forty-nine patients (12 women and 37 men; median age 36.4 y, 35 heterosexuals) were included. Four patients had traveled with their usual sexual partner and 45 patients had casual sex while abroad (31 with locals and 14 with other tourists). The main diagnoses were gonococcal urethritis (n = 18), herpes simplex virus 2 infection (n = 12), urethritis of undetermined origin (n = 9), Chlamydia trachomatis infection (n = 4), primary syphilis (n = 4), and primary human immunodeficiency virus infection (n = 2). CONCLUSIONS These results illustrate the broad spectrum of STDs contracted by travelers to the tropics. They suggest the need to also inform travelers of the risks of STD and to promote the use of condoms in case of casual sex while abroad.
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Affiliation(s)
- Séverine Ansart
- Maladies Infectieuses, CHU Cavale Blanche, bld Tanguy Prigent, Brest cedex, France
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Smith DR, Wei N. Traveling to China for the Beijing Olympic Games: internal migration of the commercial sex workforce may be an important HIV risk factor for travelers. Travel Med Infect Dis 2008; 6:160; author reply 161. [PMID: 18486075 DOI: 10.1016/j.tmaid.2008.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 01/22/2008] [Indexed: 11/25/2022]
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Croughs M, Van Gompel A, de Boer E, Van Den Ende J. Sexual risk behavior of travelers who consulted a pretravel clinic. J Travel Med 2008; 15:6-12. [PMID: 18217863 DOI: 10.1111/j.1708-8305.2007.00160.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to determine to which degree travelers who received pretravel advice at a travel clinic have protected or unprotected sexual contact with a new partner and what factors influence this behavior. METHOD An anonymous questionnaire was sent to travelers who came to a pretravel clinic between June 1 and August 31, 2005. Risk factors for casual travel sex and predictors of protected sex were studied in a multivariate model. RESULTS A total of 1,907 travelers were included (response rate 55%) in the study. Only 4.7% of the respondents had sexual contact with a new partner, and 63.1% of these new partners were from the country of destination. Of those who had casual travel sex, 52.4% did not expect this (women 75%), 30.9% did not always use condoms, and 41% were not protected against hepatitis B. Independent risk factors for casual travel sex were traveling without steady partner (OR 14.4), expecting casual travel sex (OR 9.2), having casual sexual contacts in the home country (OR 2.4), non-tourist journeys (OR 2.2), being male (OR 2.1), the fact that the information on sexually transmitted infections (STI) had been read (OR 2.0), and traveling to South and Central America (OR 2.0). Taking condoms along (OR 5.4) and reading the information on STI (OR 3.3) were identified as independent predictors of protected sex. CONCLUSIONS Travelers have substantial sexual risk behavior. Casual sex is usually not expected, and the most important predictor is traveling without a steady partner. We would advice every client of a travel clinic who will travel without a steady partner to read the STI information, to take condoms along, and to be vaccinated against hepatitis B.
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Affiliation(s)
- Mieke Croughs
- Department of General Health Care, STI Clinic and Travel Clinic, GGD Hart voor Brabant, 's-Hertogenbosch, The Netherlands.
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Shaw MT, Leggat PA, Borwein S. Travelling to China for the Beijing 2008 Olympic and Paralympic Games. Travel Med Infect Dis 2007; 5:365-73. [DOI: 10.1016/j.tmaid.2007.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Accepted: 09/06/2007] [Indexed: 10/22/2022]
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Bauer I. Understanding sexual relationships between tourists and locals in Cuzco/Peru. Travel Med Infect Dis 2007; 5:287-94. [PMID: 17870633 DOI: 10.1016/j.tmaid.2007.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 06/25/2007] [Accepted: 06/28/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Casual sexual encounters between tourists and locals have been increasingly discussed. The city of Cuzco/Peru is well known for an increased availability of such sexual opportunities. The objective of this study was to explore tourists' and locals' knowledge, attitudes, and reasoning for engaging in casual sexual relationships. METHOD In this qualitative study, 10 locals and 13 tourists were in-depth interviewed (15 women, 8 men, aged 19-50+). Participant and non-participant observations, and informal discussions provided supporting evidence. RESULTS For tourists, the relationships with locals ranged from one-night-stands as part of the travel experience and having fun, to commitment for the term of a longer stay, to marriage. From the locals' point of view, these encounters ranged from sexual adventures to increase self-esteem and high standing in their circle of friends, to serious long-term commitments. In both cases, the difference in the physical appearance played a main part in the perceived attraction that had triggered the encounter. Lack of consistent condom use remains a concern along with the locals' profound lack of knowledge of STIs. CONCLUSIONS Travel health advisors should place more emphasis on sexual health in pre-travel consultations. The use of condoms cannot be stressed enough. Local health professionals should aggressively increase safe sex health promotion, specifically targeting people related to the tourism industry.
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Affiliation(s)
- Irmgard Bauer
- School of Nursing, Midwifery and Nutrition, James Cook University, Townsville QLD 4811, Australia.
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Abstract
Travellers engaging in sexual contact with a new partner abroad may be at high risk of acquiring a sexually transmitted infection. This review examines the impact of travel on sexual health and provides prevention, management and treatment recommendations to practising occupational health physicians.
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Abstract
Increasing population mobility and increasing frequency and variety of sexually transmitted infections (STI) are closely linked around the globe. Although all mobile populations are at increased risk for acquiring STIs, international travelers are the focus of this review. Several aspects of travel such as opportunity, isolation, and the desire for unique experiences all enhance the likelihood of casual sexual experiences while abroad. The situational loss of inhibition of travel can be markedly enhanced by alcohol and drugs. Several of the most important elements of the complex interaction between travel and STIs are discussed.
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Affiliation(s)
- Brian J Ward
- McGill University Tropical Diseases Centre, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada.
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Richens J. Sexually transmitted infections and HIV among travellers: A review. Travel Med Infect Dis 2006; 4:184-95. [PMID: 16887740 DOI: 10.1016/j.tmaid.2005.06.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2005] [Accepted: 06/21/2005] [Indexed: 11/20/2022]
Abstract
Sexually transmitted infections are often acquired during travel. Infections are most often seen in young adults, travelling without a regular partner and among those who have higher numbers of partners while at home. Alcohol and recreational drug use may increase risk. The risks are highest from having unprotected sex with local partners in developing countries where the prevalence of infection can be many times higher than at home. The risks of acquiring HIV are highest in Africa, followed by South Asia. Special precautions are required by those going to work in health-care settings in high HIV prevalence countries. Travellers may benefit from advice about safer sex, condom use, emergency contraception and vaccination against hepatitis B. In special circumstances a starter pack for HIV post-exposure prophylaxis should be considered. Following return travellers should consider attending specialist services for a screen for sexually transmitted infections and HIV if they are concerned about exposure whilst travelling. A number of reports suggest that travel clinics need to pay more attention to the sexual health of travellers.
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Affiliation(s)
- John Richens
- Department of Genito-Urinary Medicine, Mortimer Market Centre, Camden Primary Care Trust NHS, London, UK.
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Keystone JS. Travel-related hepatitis B: risk factors and prevention using an accelerated vaccination schedule. Am J Med 2005; 118 Suppl 10A:63S-68S. [PMID: 16271544 DOI: 10.1016/j.amjmed.2005.07.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Rates of global travel and tourism are increasing dramatically, especially to regions with medium or high endemicity for hepatitis A and B, such as Asia, Africa, Latin America, and the Middle East. International travelers to these areas should be protected against both hepatitis A and B, regardless of their anticipated length of stay. However, many travelers depart within weeks of planning their trip (too late to complete the accelerated 0-, 1-, 2-month regimen for hepatitis B), and a majority of those traveling depart without being vaccinated. Although extended-stay travelers are at high risk for hepatitis B, short-stay travelers also are at risk. The most commonly encountered risk factors for travel-related hepatitis B are casual sexual activity with a new partner, medical and dental care abroad, and in the expatriate community, adoption of children who are hepatitis B carriers. Although efficacy studies of accelerated schedules for hepatitis B immunization have not been conducted, the results of immunogenicity studies in healthy volunteers who received an accelerated, 3-dose regimen on a 0-,7-, and 21-day schedule suggest that excellent, rapid, and long-term protection will be conferred. More data are needed to assess the efficacy of accelerated schedules in persons aged >40 years and to determine whether a fourth dose of hepatitis B vaccine is needed in all age groups.
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Affiliation(s)
- Jay S Keystone
- Centre for Travel and Tropical Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada.
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22
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Abstract
International travelers engaging in casual sex are at risk for acquiring sexually transmitted diseases (STDs), including HIV. The frequency of international travel emphasizes the need for a travel sexual activity history to be included in the clinical assessment of any returned traveler. When formulating a differential diagnosis, the STD prevalence rates at the travel destination and the risk profile of the traveler and the sexual partner need to be considered. Casual sex with host country nationals residing in tropical and subtropical areas of the developing world increases the traveler's risk for acquiring STDs rarely seen in industrialized countries, particularly bacterial genital ulcer diseases. Pretravel counseling needs to include education on STD prevention. A post-travel STD diagnostic evaluation is indicated when casual sexual activity has occurred during travel, regardless of whether symptoms are present.
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Affiliation(s)
- Noreen A Hynes
- Johns Hopkins University, School of Medicine, Division of Infectious Diseases, 1830 East Monument Street, 4th Floor, Baltimore, MD 21205, USA.
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23
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D'Acremont V, Ambresin AE, Burnand B, Genton B. Practice guidelines for evaluation of Fever in returning travelers and migrants. J Travel Med 2003; 10 Suppl 2:S25-52. [PMID: 12740187 DOI: 10.2310/7060.2003.35132] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Fever upon return from tropical or subtropical regions can be caused by diseases that are rapidly fatal if left untreated. The differential diagnosis is wide. Physicians often lack the necessary knowledge to appropriately take care of such patients. OBJECTIVE To develop practice guidelines for the initial evaluation of patients presenting with fever upon return from a tropical or subtropical country in order to reduce delays and potential fatal outcomes and to improve knowledge of physicians. TARGET AUDIENCE Medical personnel, usually physicians, who see the returning patients, primarily in an ambulatory setting or in an emergency department of a hospital and specialists in internal medicine, infectious diseases, and travel medicine. METHOD A systematic review of the literature--mainly extracted from the National Library of Medicine database--was performed between May 2000 and April 2001, using the keywords fever and/or travel and/or migrant and/or guidelines. Eventually, 250 articles were reviewed. The relevant elements of evidence were used in combination with expert knowledge to construct an algorithm with arborescence flagging the level of specialization required to deal with each situation. The proposed diagnoses and treatment plans are restricted to tropical or subtropical diseases (nonautochthonous diseases). The decision chart is accompanied with a detailed document that provides for each level of the tree the degree of evidence and the grade of recommendation as well as the key points of debate. PARTICIPANTS AND CONSENSUS PROCESS: Besides the 4 authors (2 specialists in travel/tropical medicine, 1 clinical epidemiologist, and 1 resident physician), a panel of 11 European physicians with different levels of expertise on travel medicine reviewed the guidelines. Thereafter, each point of the proposed recommendations was discussed with 15 experts in travel/tropical medicine from various continents. A final version was produced and submitted for evaluation to all participants. CONCLUSION Although the quality of evidence was limited by the paucity of clinical studies, these guidelines established with the support of a large and highly experienced panel should help physicians to deal with patients coming back from the Tropics with fever.
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Affiliation(s)
- Valérie D'Acremont
- Travel Clinic, Medical Outpatient Clinic, University of Lausanne, Rue Bugnon 44, 1011 Lausanne, Switzerland
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24
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Abstract
Every year, millions of people travel abroad, exposing themselves to various diseases. Advice on risk avoidance and on self-medication is not always successful; sometimes travellers return home ill or become unwell soon afterwards. There are many possible causes for such illnesses, and physicians should try to establish whether the disease is specifically associated with the recent journey. The approach to assessment of the ill traveller should make use not only of signs and symptoms, but also of geography and epidemiology. Travellers with fever need immediate attention to rule out serious and potentially life-threatening conditions. Faced with a difficult diagnosis, physicians should consult with experts in tropical and travel medicine.
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Abstract
The four steps for giving travellers the foundation for healthy journeys are to assess their health, analyse their itineraries, select vaccines, and provide education about prevention and self-treatment of travel-related diseases. This process takes time. Since there is a risk of information overload, travellers should leave the clinic with some written advice for reinforcement. The order of these steps can be tailored to what best suits the travel clinic, but vaccinating early in the process allows monitoring for adverse reactions. Face-to-face discussion is vital for explaining the use and side-effects of medications. Those who provide a travel medicine service should be seeing many travellers and should seek specialist training. In 2003, the International Society of Travel Medicine introduced a certificate of knowledge examination in travel medicine. We cannot make travellers bullet-proof but it is possible to make them bullet-resistant. The pre-travel visit should minimise health risks specific to the journey, give travellers the capability to handle most minor medical problems, and allow them to identify when to seek local care during the trip or on return.
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Cabada MM, Echevarria JI, Seas CR, Narvarte G, Samalvides F, Freedman DO, Gotuzzo E. Sexual behavior of international travelers visiting Peru. Sex Transm Dis 2002; 29:510-3. [PMID: 12218841 DOI: 10.1097/00007435-200209000-00003] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexual behavior of travelers to Latin America and the sexual behavior of US travelers in general are poorly characterized. GOAL The goal of the study was to evaluate sexual risk factors of travelers to Peru. STUDY DESIGN Anonymous written questionnaires were administered to 442/507 (87%) of the individuals approached in the international departures area of the Lima airport. RESULTS Of the 442 respondents, 54 (12.2%) had new sex partners during their stay. Sex with a local partner (35/52; 67.3%) was more frequent than sex with other travelers (18/52; 34.6%) or with sex workers (4/52; 7.7%). Risk factors for a new sex partner included male sex (relative risk, 1.94), single marital status (relative risk, 2.59), duration of stay longer than 30 days (relative risk, 5.05), traveling alone or with friends (relative risk, 2.88), and bisexual orientation (relative risk, 4.94). Frequency of sexual activity among US travelers was greater than that among travelers from other countries (15.2% [22/145] versus 10.6% [30/282]; NS). Condoms were consistently used by 12/50 (24%) and sometimes used by 10/50 (20%), including 8/20 United States travelers and 13/29 travelers from other countries. CONCLUSION Behaviors and risk factors are similar to those described for travelers to Africa, Asia, and Eastern Europe. Behavior of US travelers did not differ from that of other travelers.
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Affiliation(s)
- Miguel M Cabada
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
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Matteelli A, Carosi G. Sexually transmitted diseases in travelers. Clin Infect Dis 2001; 32:1063-7. [PMID: 11264035 DOI: 10.1086/319607] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2000] [Revised: 10/20/2000] [Indexed: 11/03/2022] Open
Abstract
Prevention of sexually transmitted diseases (STDs) is a low priority among travel clinic services, despite increasing evidence that travelers have an increased risk of acquiring such infections. A proportion of 5%-50% of short-term travelers engage in casual sex while abroad, and this rate is even higher among long-term travelers. Few publications are available on STD preventive interventions among travelers. Education and counseling are recognized as key components of risk reduction. New efforts should be put forth with regard to identifying effective tools to promote safer sexual behaviors and to reduce the spread of infection by promoting condom use. Travelers at increased risk should be identified for targeted interventions; research to validate proposed markers of increased risk is prospectively needed. Hepatitis B infection is the only STD that is preventable by vaccination. The feasibility and cost-effectiveness of STD screening in travelers after exposure is a virtually unexplored field, though it may represent an important component of STD control strategies in developed countries.
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Affiliation(s)
- A Matteelli
- Clinic of Infectious and Tropical Diseases, Brescia, Italy.
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Abraham C, Clift S, Grabowski P. Cognitive predictors of adherence to malaria prophylaxis regimens on return from a malarious region: a prospective study. Soc Sci Med 1999; 48:1641-54. [PMID: 10400263 DOI: 10.1016/s0277-9536(98)00455-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cases of 'imported malaria' into countries where malaria is not endemic are increasing and evidence suggests that non-use of malaria prophylaxis and lack of adherence are contributing to this increase. Non-adherence may be especially likely because chemoprophylaxis regimens require travellers to continue to take medication for 4 weeks after their return from a malarious region. This study investigated the extent to which cognition measures specified by the theory of planned behaviour and the health belief model could distinguish between those who reported greater or lesser adherence after their return. Cognitions were measured using a brief questionnaire on the day of departure from the malarious region and reports of adherence were collected between 5 and 7 weeks later. Data from two longitudinal samples of UK tourists returning from The Gambia were analysed; 106 mefloquine users and 61 chloroquine and proguanil users. Results suggested that malaria prophylaxis adherence could be improved. 22.5% of mefloquine users and 31% of chloroquine and proguanil users reported adherence for 3 weeks or less. A model based on the theory of planned behaviour explained approximately 50% of the variance in reported adherence amongst mefloquine users and 40% amongst chloroquine and proguanil users, comparing favorably with other published applications of the theory. Findings suggest that targeting key cognitions could enhance adherence on return from malarious regions. Enhancing perceived control over adherence may be important as well as emphasising susceptibility to malaria infection. Reassuring mefloquine users concerning potential side effects of the drug may also encourage adherence on return. Implications for future research are discussed.
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Affiliation(s)
- C Abraham
- School of Social Sciences, University of Sussex, Falmer, Brighton, UK.
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