Safe travels

Sexually transmitted infections (STIs) and blood-borne viruses (BBVs) are often overlooked during routine travel health consultations, despite posing a risk to travellers. In WA, a substantial proportion of new HIV diagnoses are linked to overseas exposure. Additionally, growing antimicrobial resistance is making gonorrhoea increasingly difficult to treat.

As trusted healthcare providers, GPs play a vital role in addressing sexual health proactively during pre-travel consultations. To help patients stay safe and healthy abroad, conversations about STIs and BBVs must be an integral part of that care. Below are some key considerations for your next travel health consultation.

Vaccines: 6-12 weeks before travel

Vaccinations are a common and timely health-seeking behaviour for travellers – and an ideal opportunity to also discuss sexual health. When assessing vaccination needs, check if the patient is up to date with hepatitis A and B immunisation.

While not travel-specific, offering HPV and Mpox are an opportunistic way to protect patients against preventable infections. Vaccination may be appropriate for eligible patients, including:

• gay, bisexual or other men who have sex with men (GBMSM) – including transgender and gender-diverse people;
• sex workers, particularly those whose clients may be at risk of Mpox exposure;
• people living with HIV; and anyone under 26 (HPV-specific).

As some vaccines require multiple doses or time to build effective immunity, doctors should encourage patients to book their travel health consultations early to ensure complete protection before departure.

PrEP: 2 to 3 weeks before travel

HIV pre-exposure prophylaxis (PrEP) is 99% effective at preventing HIV acquisition. It is a key tool for people travelling internationally who may be at risk. Daily co-formulated tenofovir and emtricitabine (TD*/FTC) is recommended for anyone weighing more than 35kg who may be at risk of HIV. On-demand PrEP is another option for cis-gender MSM. Given the need for STI and renal function testing, and lead-in times to achieve efficacy, PrEP consultations should take place at least two to three weeks prior to departure. Recommended lead-in times are:

• cis-gender MSM: two tablets on day of departure, or double dose 2-24 hours before sex (on-demand regimen);
• cis- and transgender heterosexual men and women: 7 days before departure.

PrEP as PEP

Post-exposure prophylaxis (PEP) reduces the risk of HIV transmission by up to 80%, if started within 72 hours of exposure. The first-line regimen – co-formulated TD*/FTC (200mg) for 28 days – is the same as daily PrEP and is a Section 85 medication, meaning it can be prescribed by any GP. For patients not on PrEP but at potential risk during travel, consider providing a PrEP script in advance for use as PEP if needed. This supports timely access to HIV prevention when overseas, as PrEP/PEP may not be readily available overseas.

Doxy-PEP

Doxycycline post-exposure prophylaxis (doxy-PEP) involves taking 200mg of doxycycline up to 72 hours after unprotected sex to reduce the risk of bacterial STIs. Evidence shows it significantly reduces the risk of syphilis and chlamydia in MSM. Consider prescribing doxy-PEP to GBMSM at high risk for a limited period, with regular review to assess ongoing need.

Kit for testing

Recommend STI testing for patients after returning from overseas. To improve follow-through, consider offering a ‘take-home’ testing kit during the pre-travel consultation – including pathology referral, urine cup and swabs. This enables patients to test post-travel or before their next PrEP appointment without the need for an extra visit.