FRIDAY, February 23, 2024
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Let’s keep it real: Navigating the rise in sexually transmitted infections
By Opass Putcharoen MD, MSc

Sexually transmitted infections (STIs) are infections people can get from certain types of sexual activities. There are many such varieties of infections out there,

with names like HIV, chlamydia, gonorrhea, syphilis, herpes viruses, human papillomavirus (HPV), and now monkeypox (more recently renamed as MPOX).

A series of reports have shown a concerning rise in STIs across the world including in Thailand. Mortality from STIs is relatively rare in the modern world but the infections may contribute to significant morbidities. For example, the herpes virus is not typically life-threatening; however, it could cause recurrent painful outbreaks and contribute to an increased risk of HIV transmission.

Syphilis can contribute to permanent visual impairment when infection disseminates to the eye. As well, gonorrhea has been experiencing increasing antimicrobial resistance over the past years. Many health agencies are deeply concerned about the increasing threat of drug-resistant gonorrhea.

STIs are more prevalent, especially among youth, and it is time to have a real discussion about why and how we can curtail the growth.
The dating scene has evolved with an increase in casual flings and less emphasis on safe practices. Apps like Tinder may be fun, but they have also brought an increase in diverse encounters, sometimes without much thought about playing it safe. 

The lack of comprehensive sex education is playing a big role in this rise. We need more than just the birds and the bees – we need the lowdown on staying safe and healthy. People are also scared to get tested due to the stigma surrounding STIs. Let’s be real; it is time to erase that stigma and encourage everyone to take charge of their sexual health without judgement.

“Chemsex” is another serious factor in the rise of STIs. It is a term used to describe a specific pattern of drug use in the context of sexual activity, primarily among some members of the LGBTQ+ community. This practice involves the intentional use of drugs, including certain substances like crystal methamphetamine (crystal meth), mephedrone, GHB (gamma-hydroxybutyrate), to enhance or facilitate sexual experiences.

“Ice” is an interchangeable term often used to refer to crystal methamphetamine, a powerful and highly addictive stimulant.

The use of crystal meth is very common among people with STIs. Crystal meth is known for its stimulant effects, which can lead to increased libido and sexual arousal. However, it affects cognitive functions and can impair judgment. 

Individuals using Ice may be more likely to engage in risky sexual behaviours, such as unprotected sex, multiple sexual partners, or sex with unfamiliar partners. So, addressing substance abuse is a key part of tackling the STI surge.

There are now many interventions to prevent STIs. Some sexually transmitted infections are vaccine-preventable, such as HPV, and Hepatitis A and B. There are now many ongoing studies in search of a vaccine to prevent gonococcal (gonorrhea) infection. Pre-exposure prophylaxis (PrEP) for HIV infection is a game-changer, especially for those with a high risk of acquiring HIV. It is a pill that, when taken consistently, significantly reduces the risk of contracting HIV.

However, it is crucial to note that PrEP does not protect against other STIs. Condoms are still essential for a comprehensive approach to overall sexual health. Interestingly, doxycycline, an oral antibiotic, has been shown in clinical studies to prevent some bacterial STIs.

Managing substance abuse involves making conscious efforts to reduce or quit using drugs. It begins with acknowledging the problem and seeking support from friends, family, or professionals. Setting achievable goals, changing the environment to avoid triggers, and learning healthier ways to cope with stress are essential steps. It's a step-by-step journey that requires commitment, but with support and positive choices, it is possible to make meaningful changes and achieve recovery.

So, how do we tackle this? The “Swiss cheese model” can be applied to reduce the spread of STIs. It is a concept used in risk management and healthcare to describe how multiple layers of defense can reduce the risk of a negative outcome. Each layer of defense, represented as a slice of Swiss cheese, has its own weaknesses (the holes), but when combined with other layers, the overall system can effectively prevent or mitigate risks.

First up, let’s push for better sex education in schools and communities. Practical sex education in schools is about involving students in an honest conversation about relationships, bodies, and how to navigate the whole puberty thing. It covers everything from the basics of anatomy and puberty to more complex matters including contraception, STIs, and how to build healthy relationships.

Practical sex education often involves interactive activities, role-playing, and discussions to engage students in a comfortable and supportive environment. Plus, it is important to involve parents, keep things age-appropriate, and regularly update information to keep up with the times. Ultimately, the goal is to empower students to make informed choices about their sexual health and relationships.

Furthermore, we need to ensure everyone has easy access to healthcare, including affordable tests, treatment, and information about vaccines and PrEP. Condoms need to be the norm, and public campaigns should make it cool and responsible to use protection.

It is time to break down the barriers, ditch the STI shame, talk openly about sexual health, address substance abuse, and consider additional preventive measures like PrEP.

Finally, managing substance abuse involves making conscious efforts to reduce or quit using drugs. It begins with acknowledging the problem and seeking support from friends, family, or professionals. Management is a step-by-step journey that requires commitment along with support and positive choices.

In conclusion, the resurgence of STIs is a pressing issue, especially among the youth. To combat this problem, we must promote safe sex practices, eliminate the stigma surrounding STIs, enhance accessibility to healthcare, address substance abuse, and explore preventive options like PrEP. It is incumbent upon all of us to take charge of our sexual health and actively support initiatives that prioritise safety and awareness. Let's work together to make it happen!


Biography

Dr Opass Putcharoen is chief of the Emerging Infectious Diseases Clinical Center at Thai Red Cross, and a senior lecturer in the division of infectious diseases, department of medicine, at King Chulalongkorn Memorial Hospital in Bangkok. He holds the position of Associate Professor at the Faculty of Medicine, Chulalongkorn University.

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