STI Prevention – How comfortable are you talking about Sexually Transmitted Infections during your consultations?

When carrying out travel health consultations, having a conversation about sexually transmitted infections (STI’s) can be both delicate yet crucial to the client’s on-going travel journey. Talking about STI’s stands out as an essential yet often challenging dialogue between healthcare professionals and their clients. It is good practice for healthcare professionals to know that sexual health is a priority and that these conversations should be approached with sensitivity and expertise with a commitment to promote overall well-being without stigma or judgement.

For us to gain a better understanding as to why it is important for travel health professionals to discuss STI’s and sexual health prevention methods during their consultations, let’s take a look at a few details and facts surrounding sexual transmitted infections.

What are Sexually Transmitted Infection’s (STI’s)?

Sexually transmitted infections are a group of infections, which can be caused by more than 30 different types of bacteria, virus and parasite. According to the World Health Organisation (WHO), they estimate that more than one million people develop an STI every day and that around 374 million people acquire one of the four main STI’s each year – chlamydia, gonorrhoea, syphilis and trichomoniasis.   

How Are Sexually Transmitted Infections Transmitted?

The main transmission of STI’s happen during unprotected sexual intercourse. This can be either through oral, vaginal or anal penetration. Some organisms such as HIV, hepatitis B and C viruses can also be transmitted through contaminated blood or blood-based products. People who travel abroad for medical or cosmetic procedures such as dental implants, or those who have tattoos or body piercings may be exposed to these viruses if contaminated equipment, syringes or medical instruments are used.

The Journal of Travel Medicine reviewed articles from 2010-2019, of specific types of cross-border and healthcare-related infections where medical intervention was required for people within medical tourism. The research studies were based around low-income countries within Asia and the Indian sub-continent, the middle-class countries (Central and South America) and high-income countries (The United States and Europe). Wound and blood borne infections were documented in 36 (68%) and 15 (28.3%) case studies, showing that medical tourism had significant consequences. This included complications from infection and antibiotic resistance, creating public health implications when they returned to their home country.

Many STI’s such as HIV, syphilis and hepatitis B can also be transmitted from mother to child during pregnancy or through the mother’s milk while breastfeeding. With over 6 million new people being diagnosed with syphilis each year, The WHO’s article on Mother-to-Child Transmission of Syphilis, stress the importance of starting mothers on effective treatment as early as possible otherwise it can lead to severe adverse pregnancy outcomes due to congenital syphilis. They states that there has been a high burden of morbidity and mortality rates with around 109,000 infants being diagnosed with congenital syphilis. With an estimation of over 1 million pregnant women being diagnosed with syphilis in 2016, it resulted in over 350,000 adverse birth outcomes.

What Are the Common Symptoms of STI’s?

Many STI’s can be asymptomatic but lead to serious health problems. GOV.UK’s guidance on ‘Sexually transmitted infections (STI’s): Migrant health’ state that up to 50% of women and 10% of men don’t experience any symptoms of gonorrhoea and that most people don’t experience any symptoms of chlamydia.    

However, some of the main symptoms of an STI can include genital ulcers, vaginal/anal discharge, itching or pain when passing urine. Many STI’s are treatable but complications may arise, which can lead to infertility, pelvic inflammatory disease, AIDS, cervical/anal cancer and many more symptoms.

How Can we Prevent or Treat an STI?

Condoms are one of the most effective methods of protection against STI’s. However, condoms don’t protect against STI’s, which can cause extra-genital ulcers like genital herpes or syphilis so getting tested more regularly if you have regular sexual partners is important. Receiving vaccinations for two viral STI’s, hepatitis B and HPV (Human Papilloma Virus) offer great protection and will reduce secondary complications like liver cirrhosis and cervical cancer. According to the WHO’s fact sheet on Sexually Transmitted Infections, there is mounting evidence suggesting that the vaccine to prevent Meningitis B (Men B) provides some cross-protection against gonorrhoea. This is also something that is supported by the Joint Committee on Vaccination and Immunisation (JCVI) who have recently proposed recommendations for a targeted vaccination programme in the UK.

GOV.UK’s independent report into ending HIV transmissions, AIDS and HIV-related deaths in England by 2030, show that many HIV tools can be used to dramatically reduce transmissions. PrEP (Pre exposure Prophylaxis) is highly effective at stopping people from catching the virus. People who live with HIV and are on effective antiretroviral treatment, cannot pass on HIV and PEP (Post Exposure Prophylaxis) is a drug people can take within 48 hours after exposure to HIV, which can dramatically reduce the chances of acquiring the virus.

Antibiotics can be used to fight STI’s like chlamydia, gonorrhoea and syphilis however there is always a risk of resistance in any person taking antibiotics.

In 2023, the WHO introduced a framework for implementing a triple elimination of mother-to-child transmission of HIV, syphilis and hepatitis B virus cases by 2030. This is a ‘triple elimination’ consisting a framework of four pillars, which will help guide, support and co-ordinate effective services to meet the needs and rights of women, their new-borns, children and families who are affected by HIV, syphilis and hepatitis B.

Why is it Important to Talk About Sexual Health with Our Travellers?

NaTHNaC estimate that around 10-20% of travellers engage in sexual encounters with new partners while abroad, with a concerning proportion failing to consistently use condoms. The prevalence of certain STI’s, such as hepatitis B and HIV, is notably higher in low-income countries when compared to the rates in the UK. Moreover factors like alcohol consumption, can lower inhibitions, leading to more risky behaviours.

How Can Travel Health Professionals Expel Stigma When Discussing STI’s and Sexual Health Care During their Consultations?

As we have read, STI’s remain prevalent in society, affecting individuals of all ages, genders, and backgrounds. Despite advancements in medical research and education, misconceptions and stigmas still persist, hindering open dialogue and proactive prevention efforts. This is where travel health professionals can play a pivotal role.

During consultations, travel health professionals should create a safe space to discuss sexual health concerns. We should approach the topic of STIs with empathy, respect, and in a non-judgemental way.

Travel health professionals should feel confident to be able to educate clients about STIs, their symptoms, modes of transmission, and available testing and treatment options. This is vital in dispelling myths and empowering individuals to make informed decisions about their sexual health.

It is important for healthcare professionals to reassure the client that there is no shame in talking about STI’s and using preventative strategies to reduce the risk of acquiring an STI. A survey by UK Health Security Agency (UKHSA) in 2022 showed that out of 4400 people living with HIV, one in five respondents had experienced discrimination in a healthcare setting, 1 in 10 had avoided seeking healthcare services for fear of negative consequences and over one third said that they struggled to discuss HIV in the primary care setting due to fear of being stigmatised. These statistics show how important it is for healthcare professionals to show the client reassurance, support, and empathy. Normalising the experience of living with an STI and emphasising that seeking healthcare services is a positive step towards managing their own sexual health. To read further for more information on reducing HIV discriminatory practices in the healthcare setting, my colleague Aly Bunce has written an excellent blog on ‘HIV and Sharps Use in Clinical Practice. Is Your Practice Discriminatory?’

We should ensure to use clear and accessible language by avoiding the use of medical jargon or complex terminology that may confuse the client. Use clear and simple language to explain STIs, their causes, symptoms, and preventative methods.

What Information Can Travel Healthcare Professionals Give to Help Clients Access STI Testing and Sexual Health Prevention Services?

In the UK, access to STI testing and treatment is widely available through various channels, including general practices, sexual health clinics, and online services.

Travel health professionals should be able to guide clients towards these services, addressing any concerns or anxieties they may have. Additionally, travel health professionals can discuss preventative measures such as condom use, regular testing, and vaccinations against certain STIs if applicable, like human papillomavirus (HPV).

Discussing many ways of accessing treatments and support can be challenging as time can be limited in our consultations. However, it is important for the client to leave the consult with access to information and services they can use for further education and access to sexual health providers. Sending informative links of chosen websites and providing patient information will help better increase their knowledge. By conducting effective consultations with our clients, we should tailor our information to the client’s individual risk factors and lifestyle.

Providing information about STIs, their transmission routes, the risk factors, symptoms, available testing and treatment options will also allow the client to go away and research in their own time. By addressing common misconceptions about sexual health and STI’s through accurate information can empower travellers to make informed decisions about their sexual health and allow them to take control in a positive way and safeguard their health whilst abroad. When talking about STI prevention and the many tools we can use, it important to encourage the client to ask questions and actively participate in the discussion. Listening attentively to their concerns, validating their experiences and providing empathetic support throughout the consultation is vital in gaining a trustful healthcare, client relationship

How Important is Confidentiality When Addressing STI’s and Sexual Health Information?

By building confidence and trust between ourselves and the client, it is important to assure them that confidentiality and privacy will be maintained during our discussions surrounding STI prevention. By respecting their confidentiality rights and maintaining their professional boundaries, we can foster a more open, honest conversation.

Why Do We need to Educate Ourselves About STI’s and Sexual Health Care?

As it can be challenging for some travel health professionals to talk about STI prevention and sexual health, it is important to stay up to date on the latest research, guidance, and best practices related to STI prevention, diagnosis, and treatment. Continuing education and training can help travel health professionals to feel more empowered to speak more confidently during their consultations and will build trust between themselves and their clients. 

Training at Health Academy

Whether you’re a total beginner or simply wanting to update or refresh your knowledge surrounding Travel Health or Sexual Health, Health Academy have a Training course for you!

Visit our Travel Health Course page for more information on our virtual and face to face courses for both those new or experienced in Travel Health. We also offer a course for those who are working in Sexual Health services in Primary Care an Community Pharmacies. Visit our Sexual Health Course page for further details on this.

Don’t forget our Primary Care Convention 2024 is running on Saturday 15th June. We will have a panel of experienced Travel Health Professionals running a discussion on all things Travel Health! Don’t miss out on our special Buy-One-Get-One-Free offer and sign up now!