Although most HIV and STD patients acquire their infections in Australia there is an increase in the numbers diagnosed with these infections after international travel. Risks to the sexual health of the travellers and their subsequent partners are discussed and suggestions made for minimising risks.
PIP: Modern international travel contributed greatly to the global AIDS pandemic. About 500,000 Australians have sexual intercourse in the Philippines and Thailand annually. Many do not practice safer sex. A significant potential means of HIV entering the Australian heterosexual population is unprotected intercourse with prostitutes in Southeast Asia. The median HIV prevalence rate in female prostitutes in Thailand is 15%. Other sexually transmitted diseases (STDs) also pose a risk to Australian travelers. In 1991, in Victoria, 44% of gonorrhea cases were heterosexual males who had acquired gonorrhea abroad. Sex workers transmitted gonorrhea to 68% of these cases. A history of gonorrhea or chancroid increases the risk of HIV transmission. Other cofactors of HIV transmission are genital warts and genital herpes, both of which are common in Australia. Various types of men have taken great risks overseas, which places their partners at risk when they return. Since it is not easy to identify the type of persons who places himself at risk when abroad, physicians should discuss sexual risks with any patient who plans to travel overseas or who has returned. Women experience more severe consequences of STDs (e.g., pelvic inflammatory disease) than men because they are more likely to be asymptomatic in the early stages. Women should know that the risk of HIV transmission is high in Africa, Southeast Asia, and some areas in the US. Physicians should know behavioral risk factors (e.g., heavy drinking or drug use). They should remind homosexual men to practice safer sexual practices abroad, even though they may be better informed than heterosexual men. Physicians need to tell travelers that a prostitute is having a health certificate does not guarantee that she does not have STDs or HIV. Further, a healthy appearance does not equate STD-free status. Travelers should carry condoms with them. Physicians should refrain from prescribing prophylactic antibiotics to minimize antibiotic resistance.