Clinical Review

Sex, sun, sea, and STIs: sexually transmitted infections acquired on holiday

BMJ 2004; 329 doi: 10.1136/bmj.329.7459.214 (Published 22 July 2004)
Cite this as: BMJ 2004;329:214

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  1. K E Rogstad (Karen.Rogstad@sth.nhs.uk), consultant1
  1. 1 Department of Genitourinary Medicine, Royal Hallamshire Hospital, Sheffield S10 2JF

    Introduction

    “The Dane in Spain was mainly on the Dane.”1 These words were spoken by the late Dr Robbie Morton, drawing on three decades' experience in venereology, about the sexual behaviour of holidaymakers and their risk of acquiring sexually transmitted infections (STIs) while abroad. Despite Morton's years of clinical expertise his opinion would not survive the rigours of evidence based guidelines and at best would be graded as level 4, if at all. So is his assumption that sexual encounters while on holiday tend to be between people of the same nationality correct? What are the implications of international mixing on the risk of acquiring sexually transmitted infections? How should we manage people at risk before and after their holiday?

    Methods

    I searched Medline in November 2003, using the key words “sexually transmitted infection”, “abroad”, “tourist”, “holiday”. I reviewed websites of the Health Protection Agency, the World Health Organization, the Department of Health, the Foreign Office, and the Association of British Travel Agents as these could be expected to provide information on travel abroad. Clinical information is from Sexually Transmitted Diseases.2

    Sexual behaviour abroad and acquisition of STIs

    More than 30 million UK residents travel abroad each year.3 Sexual activity is known to vary by season; increased sexual intercourse and unsafe sex occur around the Christmas period and the summer vacation.4 Holidays are increasingly being taken abroad and in far flung locations, and the number of UK residents travelling abroad has increased by 27% since 1997.5 Holidays provide an opportunity for increased sexual mixing whether taken at home or abroad (fig 1, fig 2). Few recent data exist on sexual behaviour while on holiday abroad, and even fewer for people holidaying in the United Kingdom. Studies in the early 1990s showed notable risk behaviour in international travellers who attended for a “tropical check.” …

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