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Sex slang glossary: 20 naughty terms from rail to Netflix and Chill

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To quote Salt-N-Pepa, let’s talk about sex , baby. Or, rather, let’s talk about how we talk about sex.

Whether it’s a euphemism used to shy away from talking about a topic that’s too taboo from some, or the complete opposite and a visceral, visual slang term that penetrates the mind, we’ve invented a lot of ways to start discourse around intercourse.   

There’s a popular tidbit about the Inuit people having over 50 words for snow, but we might have them beat for the different terms for sex.

Here, we take a look at some of the favourite phrases used to discuss doing the deed…

What does getting railed mean?

Let’s start off with one of the more uncouth phrases – since Google search results indicate a lot of people are curious as to what this particular saying means.

Getting railed, quite literally, means having sex – or, if you prefer to take the cue from Urban Dictionary, it means the act of having wild, wild sex.

So, making romantic, meaningful love, this is not.

Netflix and Chill

Netflix and chill has become the most common mating call for a modern day audience.

To Netflix and Chill implies putting on Netflix as background noise – or a convincing alibi – as you and your partner(s) engage in a bit of consensual fun.

Some of these terms get their names from the implication that a penis is involved in the act.

Boning is such a term – entering the lexicon most likely as an after-effect to boner becoming a popular term for an erect penis.

D***ing down

If you have been d***ed down, you have had vigorous sex – this one is fairly self-explanatory.

Clapping cheeks

Getting one’s cheeks clapped is a newer term which is rising in popularity.

The name comes from the idea that, when you are in the throes of very intense sex, bum cheeks could make a clapping sound.

Porking is another term people use forhaving sex.

We wouldn’t suggest Googling the term, but there are some who think the term came about because squealing, the sound associated with pigs, is sometimes the sign that sexual partners are having a good time.

The origins of this term should be fairly obvious for anyone with, or who has sex with people with, a penis, sometimes colloquially called a shaft.

Nothing to do with the crime fighting cop.

This is a term most often associated with sexual acts between people who identify as men.

Breeding, or to be bred, generally means having unprotected anal sex.

There are too many to name, but other phrases for having sex that deserve a shoutout include:

• Laying pipe
• Taking the skin boat to tuna town
• Getting drilled
• Nutting/Busting a nut

Euphemisms for having sex   

In Human Nature, Queen of Pop and queen of never shying away from the subject, Madonna proclaimed ‘oops, I didn’t know I couldn’t talk about sex’ – and she was on to something.

Some people are more comfortable using gentler language to avoid any blushes.

Some euphemisms that actually mean having sex include:

• Making love
• Knocking boots
• Hitting the sheets
• Going all the way
• Getting lucky

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A-Z of sex lingo

From Anus to Areola and Boner to Balls there are a lot of words when it comes to sex, sexual health, and your body. Luckily, we’re here to help.

The termination of a pregnancy before birth.

Age of consent

The age at which the law considers a person old enough to decide to have sex with another person. "Depending on what state or territory you're in, you can only give consent to engage in certain sexual acts once you've reached a certain age. Until you've reached that age -  ' the age of consent ' - the law says you cannot give your permission to have sex. So even though you might have agreed to have sex with someone, that person can still be charged with sexual assault if you haven't reached the age of consent."

Sexual activity involving penetration of the anus.

A gender identity or appearance that is isn't clearly male or female.

The opening from the rectum located in-between the buttocks.

The dark area surrounding the nipples of women and men.

Having a lack of (or very low level of) sexual attraction to others and/or a lack of interest or desire for sex or sexual partners. Another term used within the asexual community is “ace,” meaning someone who is asexual.

Slang for testicles.

Curious about exploring same-sex sexual attraction and behaviour.

A person who has two gender identities either simultaneously or at different times.

Biological Sex

Medical term used to refer to the chromosomal, hormonal and anatomical characteristics that are used to classify an individual as female or male or intersex. Often referred to as simply "sex", "physical sex," "anatomical sex", or specifically as "sex assigned [or designated] at birth."

Birth control

Behaviours, devices, or medications used to avoid unintended pregnancy (see also: contraception).

Bisexual Person

A person who identifies as or who has romantic and/or sexual relationships with, and/or attractions toward people of multiple genders.

The organ that collects and stores urine produced by the kidney. The bladder is emptied through the urethra.

Slang term for an uncomfortable feeling in the genitals that may occur when men do not have an ejaculation following sexual excitation. Women may experience similar aches if they do not reach orgasm.

Bondage & Discipline (B&D)

Consensual sexual role-play that includes performance of power and submission. It often involves physical restraint and/or pain.

Slang for an erect penis.

Glandular tissue and fat on the chests of women. Breasts are secondary sex characteristics in women. They are also considered sex organs because they are often sexually sensitive and may inspire sexual desire. Like mammary glands in other mammals, they produce milk during and after pregnancy. Men also have breast tissue.

A toy for anal sex designed to stay in place in the anus and rectum. Some are designed to stimulate a man’s prostate gland.

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17 Sex Terms You Were Too Embarrassed to Ask About, Defined

Especially with the rise of social media, new terms are coined all the time, including in the arena of sexuality. For instance, while the word "cuck" has become an insult hurled by the right-wing trolls, it's related to cuckolding, which can (and should) be a hot and consensual sexual activity that all involved parties enjoy. If you weren't quite sure of what that particular word's definition is — or you're unclear on terms like felching, docking, or queening, for that matter — I've written a near-comprehensive guide.

Additionally, if you're wondering if any given sex act is really a thing, keep in mind the wise words of sex educator Jimanekia Eborn : " Everything is a thing, is basically what I have learned working in sex education." In other words, if you can dream it, you can do it — or at least rest assured that someone else has probably tried to. With that being said, here are 17 sex terms you probably didn't learn in sex ed, explained.

1. Pearl Necklace

As Samantha explained to Charlotte on a memorable episode of Sex and the City , a pearl necklace is what results when someone ejaculates on or around their partner's neck or chest (yes, so that the semen is roughly where a pearl necklace is when worn). If you're not someone who enjoys wearing this kind of pearl necklace, feel free to stick to Charlotte's preferred version, which you can find at Bloomingdale's.

2. Impact Play

Impact play refers to any impact on the body done for sexual gratification, from spanking to whips and crops . When engaging in impact play, remember to pick a safe word and continually check in with one another to ensure the level of pain is desirable. It's also important to stick to areas on the body which are safe to spank or tap on with a crop, which means fleshy, meaty areas away from the organs, such as the butt and thighs. If this sounds appealing to you, be sure to check out my guide to first-timer BDSM tips .

Dungeon Dwellers And Domination Enthusiasts Descend On DomconLA

3. squirting.

Squirting is when a person with a vagina ejaculates fluid during sex. Eborn says she is frequently asked if squirting is a myth, and she's only too happy to share that it is not, nor is it "just peeing." Research suggests that the fluid involved comes partly from Skene's glands, also known as the "female prostate" — but as with many subjects that don't focus on a penis, more research is required. Not everyone squirts, and among those who do, some squirt from clitoral stimulation and some squirt from G-spot stimulation (that is, stimulation of the sensitive front wall of the vagina).

You may be familiar with cognitive behavioral therapy , a helpful form of talk therapy. However, within the world of kink, CBT refers to "cock and ball torture." This form of CBT can be therapeutic for people with penises interested in having a dominatrix inflict pain on their genitals, through the use of ropes, whips, or even chastity devices.

Pegging refers to when a woman penetrates a man anally with a strap-on dildo . There's a now-infamous pegging scene in a Broad City episode that recently repopularized the term.

6. Queening

Queening is just a glamorous name for sitting on someone's face. There's nothing more to it than that.

7. Scissoring

Scissoring, also called tribadism or tribbing, is most often thought of as the territory of same-sex, female-identified couples. It's usually considered to be two partners rubbing their vulvas against each other's, but can also be defined as one partner rubbing their vulva against other body parts of their partner's (including the thighs and butt), as Autostraddle pointed out . In so-called "classic" scissor position, partners' legs intersect so that they look like — you guessed it — scissors. Porn (especially porn made for the male gaze) has probably hyped up scissoring as a more popular act among women who have sex with women than it actually is in real life, but plenty of people love it.

Women in lingerie touching each other

8. edge play.

When you first hear the term "edge play," it's easy to assume it refers to extreme sex acts that literally involve an edge of some sort, such as knives or needles (and yes, some people consensually incorporate those things into sex). But no sharp objects need to be involved in this type of edge play. The term means kinky sexual acts that push your boundaries (consensually) to the edge, which can be exhilarating for some. What is considered edge play differs from person to person, as we all have our own boundaries and limits. For some, psychological play such as name-calling may be edge play. If you are going to try pushing your boundaries , please do so with a partner you trust and use a safe word.

Figging is one of those sexual acts that are so interesting it's fun to know what it means, but you have to wonder if anyone actually does it. Figging is the act of inserting a piece of peeled ginger into someone's butthole, which would burn, sting, and be quite painful. Figging allegedly originated as a (non-sexual) form of corporal punishment on female prisoners by the Greek and the Roman empires. These days, the term also can refer to the general infliction of consensual pain on the anus.

10. Aftercare

Aftercare is a sexual practice that everyone should be doing, whether you're having kinky sex or vanilla sex. It's a term created by the kink community and simply means checking in with your partner(s) after sex to make sure all parties felt good and safe about what just went down and taking care of one another emotionally and physically. This can mean cuddling, bringing ice to the submissive partners if there are any spanking bruises, and talking about what you liked or what you didn't like. It really just means checking in post-sex, and if anything did happen that one or all parties felt weird about, making sure it doesn't happen the next time.

11. Felching

To felch is to suck up semen out of an orifice (using a straw is optional). For instance, someone may ejaculate inside their partner's anus and then suck their own semen out of the anus with their mouth; they then may or may not swallow. (Keep in mind that exchanging fluids in this way is associated with the risk of STIs , including HIV.)

12. Bukkake

Bukkake is both a sex act and popular genre of porn in which multiple men, typically three or more, ejaculate all over a woman.

13. Docking

"Docking is when two uncircumcised [people with penises] get together," Eborn explains. "[The first] pulls his foreskin back and holds it while [the second] stretches [theirs] open and outward as far as possible over the head and shaft of [the first partner's] penis." She says she is frequently asked if this act is real and possible, and her response is that with enough imagination and determination, most things are. (That said, remember that comfort and safety should take priority in all sexual encounters, no matter how creative.)

14. Cuckolding

Cuckolding is when a person in a relationship stands by as their partner has sex with someone else. There are many ways to cuck: The "cuckold" may look on while tied up in a corner, or the cuckold's partner may go out on their own, have sex, and report back. There is usually an element of humiliation involved: For instance, a wife may tell her husband all about how her other partner has a massive penis and can satisfy her in ways her husband cannot. Yes, some men are turned on by being told they suck in bed. (Important note: It's totally possible to share sexy fantasies about cuckolding with your partner without actually doing it.)

Professional dominatrixes often get requests to do cuckolding sessions in which they may have their submissive watch as they have sex with a different partner or tell the submissive to buy them lingerie for them to wear on a date with someone else. While cuckolding is primarily associated with married, opposite-sex couples, people can enjoy cuckolding play regardless of gender, orientation, or relationship status.

Me, My Boyfriend And My Slave

15. water sports.

According to safe-for-work Google searches, water sports are aquatic activities such as jet-skiing. In the bedroom, however, the term refers to the incorporation of urine in erotic play. A golden shower, for example, is when one partner pees on the other. If you want to try this kind of play for the first time but are a little nervous, peeing on your partner (or being peed on) in the shower is a good way to dip your toe in the water, metaphorically speaking.

16. Fisting

Fisting is when one partner inserts their entire hand or fist into the other partner's vagina (or anus, for the highly talented). If you enjoy intense penetration but are dating someone with a small penis, remember that they have an entire fist to use on you. (And no, a penchant for fisting won't make your vagina loose ( nor will sex in general , so put that myth out of your head).

If you'd like to try it, go slow and use plenty of lube ; the fister can also wear a latex glove to keep things extra sanitary and help the hand slide into the orifice. And as with any sex act, enthusiastic consent and in-the-moment communication are key to enjoyment by all parties.

Medicine. Medical staff putting on latex gloves. Germany, Europe

17. queefing.

OK, so this one may not be a sex act, exactly, but it frequently happens during sex. Queefing is when air escapes from the vagina, often during or after penetration, and makes a farting sound. It's a form of flatulence, and it's totally normal. "At one point in time, it happens to all of us. We laugh [about it] to keep from being embarrassed," Eborn says.

Read more stories about sexuality and exploration:

11 of the Most Common Sexual Fetishes

What You Need to Know Before Having a Threesome

BDSM Sex Tips to Try If You're a Total Beginner

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Don't forget to follow Allure on Instagram and Twitter .

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Article Contents

The history of sex and travel, stis—global overview, sti prevalence “gradients” between the developed and developing worlds, emerging drug resistance among stis, sexual behavior of travelers, travelers who may be at particular risk for acquiring stis, the profile of the traveler who will have sex overseas, sexual tourism, sexual tourism by another name, risk of acquiring an sti during international travel, the consequences of acquiring an sti while traveling, public health implications of stis acquired while traveling, general comments regarding the prevention and treatment of stis, prevention of stis, the “morning‐after” sti pill, postexposure prophylaxis for sexual assault victims, special traveling groups, barriers to the promotion of sexual health in travelers, advocacy for sexual health in travelers, conclusions, declaration of interests.

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Travel and Sexually Transmitted Infections

• Article contents
• Figures & tables
• Supplementary Data

Brian J. Ward, Pierre Plourde, Travel and Sexually Transmitted Infections, Journal of Travel Medicine , Volume 13, Issue 5, 1 September 2006, Pages 300–317, https://doi.org/10.1111/j.1708-8305.2006.00061.x

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Increasing population mobility and increasing frequency and variety of sexually transmitted infections (STI) are closely linked around the globe. Although all mobile populations are at increased risk for acquiring STIs, international travelers are the focus of this review. Several aspects of travel such as opportunity, isolation, and the desire for unique experiences all enhance the likelihood of casual sexual experiences while abroad. The situational loss of inhibition of travel can be markedly enhanced by alcohol and drugs. Several of the most important elements of the complex interaction between travel and STIs are discussed.

Sex and travel have a long and occasionally inglorious shared history. From the Huns and Vikings to the current day, unscrupulous military and paramilitary commanders have used sex to motivate men to march across deserts, row open boats across oceans, and face all manner of other perils. 1 Old sailors’ ballads make it clear that the promise of exotic sex in distant lands contributed to the willingness of young men to sign up for the navy or to serve on whaling vessels. 2 When Captain Cook’s crew discovered that Tahitian women would trade sex for iron nails, guards had to be posted to prevent the boats from being dismantled, plank by rapturous plank. 3 The less humorous consequence of this 17th century meeting of cultures is the subject of this review. Within months of their arrival in Tahiti, half of Cook’s crew had venereal diseases leading him to write that “we will be forever damned by the fact that we brought these diseases to these islands.” Since Cook’s time, there has been a remarkable democratization of travel: exotic itineraries are now accessible to a large majority of those living in the developed world including both genders and the extremes of age. Sex is still sex, however, and many will still do remarkably silly things in its pursuit. As a result, the population at risk of acquiring “exotic” sexually transmitted infections (STI) is steadily increasing. The purpose of the current review is to provide travel medicine practitioners with an up‐to‐date understanding of the complex relationship between sex and travel.

In the past 20 to 30 years, there has been a remarkable growth in population mobility both within and across national boundaries. The World Travel Organization estimates that ∼700 million people crossed international borders in 2002 for work, study, or pleasure and that traffic in 2003 to 2004 exceeded 1 billion such trips. 4 All mobile populations including business travelers, expatriates, soldiers, and tourists are at increased risk for acquiring STIs. 5–8 The anonymity of travel, the sense of isolation brought on by unfamiliar surroundings, and the desire for unique experiences all encourage travelers to shed social and sexual inhibitions. The risk of acquiring an STI may be enhanced in mobile populations by poor understanding of the global epidemiology of these infections 9 and the means available to mitigate risk. Rates of STIs may also be elevated among migrant and marginalized populations (eg, refugees, internally displaced, street youth), and these populations may be overrepresented among commercial sex workers (CSW) in many countries. 6,9–14 Many of the risk factors for disease acquisition in these vulnerable populations are distinct, however, and will not be addressed in this review.

STIs are among the most common notifiable infections worldwide, and rates are particularly high in many developing countries. In 1990, the WHO estimated the global burden of curable STIs at >250 million cases [syphilis, gonorrhea (GC), chlamydia, and trichomoniasis]. 15 Estimates rose to 333 and 340 million new cases of these infections in 1995 and 1999. 8 The 1999 estimate includes 151 million cases in South/Southeast Asia, 38 million in Latin America, and 69 million in Africa. 16,17 In many developing world countries, these increasing numbers have been fueled by the economic and societal disruption of the human immunodeficiency virus (HIV) pandemic. In sub‐Saharan Africa in particular, there has been an explosive growth in the number of children who have lost one or both parents (∼14–20 million in 2000). 18 In the mid‐1990s, >40,000 street children were thought to live in Nairobi alone where many had been driven to trade sex for food to survive. 19,20 Although HIV, syphilis, and GC are usually in the STI spotlight, more than 20 different infectious agents can be acquired and/or spread by various types of sexual contact 9,21 (eg, vaginal sex, anal sex, oral–genital/oral–anal contact; Table 1 ). Although the prevalence rates for many of these infectious agents still vary widely by geographic region [eg, human lymphotropic virus (HTLV)‐1, chancroid], changes in migration, immigration, and travel patterns during the past 50 years have ensured that almost any STI can be acquired anywhere in the world. As a result, the risk of acquiring a given STI in any particular setting is best considered in quantitative rather than qualitative terms.

Sexually transmitted infections

Note that any “list” of diseases transmissible by sexual activity is somewhat arbitrary. The actual agents and risks are determined by what types of sexual activities are under consideration. HAV = hepatitis A virus; HBV = hepatitis B virus; HCV = hepatitis C virus; HSV = herpes simplex virus; HIV = human immunodeficiency virus; HTLV = human lymphotropic virus; NGU = nongonococcal urethritis; LGV = lymphogranuloma venereum.

Although STIs can be encountered anywhere, many are hyperendemic in developing world countries. 9 Prevalence data for most developing world countries are derived largely from ad hoc surveys. Such surveys provide useful estimates but must be interpreted with caution because they may not be representative of the total population 22 ( Table 2 ). On the other hand, surveys that focus on CSW may actually be a good reflection of risk to travelers since individuals in this group are the most likely to engage in sex acts with foreigners. For example, prevalence rates for chlamydia infection in antenatal and family planning clinics range from 1.9% to 12.2% in Latin America, 6% to 13% in African countries, and 5.7% to 26% in South/Southeast Asia. 9 These rates overlap with those reported in many developed countries (2.7%–8%). Estimated prevalence rates for GC range from 5.7% to 17% in sub‐Saharan Africa and 0.1% to 3.5% in Asia and Western Pacific countries. 9 Although the number of reported GC cases actually increased in some European countries during the 1990s, the overall incidence of GC urethritis in the developed world remains quite low (2.5–125 per 100,000). 9 In most developed countries, syphilis incidence rates remained well below 5 per 100,000 through the 1990s. In contrast, there have been striking increases in the reported rates of new syphilis cases during this period in Eastern Europe and the independent states of the former Soviet Union (120–170 per 100,000). The reported seroprevalence of syphilis is generally higher in developing world countries ranging from 3.5% to 8% in South/Southeast Asia and the Western Pacific, 5% to 6% in Latin America, and 2.5% to 17% in sub‐Saharan Africa. 9 Not surprisingly, surveys of CSW in the developing world reveal much higher rates of STIs: 13% to 32% for chlamydia, 11% to 45% for GC, and 5% to 55% for syphilis. 9,32,33 The rates for any curable STI among CSW vary from 5% to 65% in Africa, 20.9% in Brazil, and 0% to 13.6% in Southeast Asia. 32,33 When prevalence rates for the major noncurable viral infections that can be sexually transmitted are included ( Table 3 ), it is obvious that there is no such thing as a “safe” sexual encounter with a CSW [eg, HIV, 5 hepatitis B virus (HBV), 48 hepatitis C virus (HCV), 49,50 HTLV‐I 51 ]. It is certainly worth noting that the presence of one of more STIs can increase the risk of HIV transmission by a factor of 3 to 10 or more. 9

Examples of STI prevalence rates in healthy populations in the developing world (% of clinic visits)

STI = sexually transmitted infections; GC = gonorrhea; HIV = human immunodeficiency virus; HBV = hepatitis B virus; HSV = herpes simplex virus.

Literature review.

Population‐based study.

Examples of STI prevalence rates in CSWs in the developing world (% of clinic visits)

CSW = commercial sex workers; STI = sexually transmitted infections; GC = gonorrhea; HIV = human immunodeficiency virus; HBV = hepatitis B virus; HSV = herpes simplex virus.

Clinical evidence of cervicitis (either GC or chlamydia).

In addition to the higher prevalence rates of STIs in the developing world, a steadily increasing proportion of the infections acquired abroad are resistant to standard antibiotics. 52 Beta lactamase–producing strains of Neisseria gonorrheae (NG) are prevalent in Africa, the Caribbean, and Asia. 53–57 Several studies from Africa and Southeast Asia show that penicillin‐resistant N gonorrheae (PRNG) can occur in ≥50% of isolates. 58–60 In Canada, the rate of PRNG was only 8.7% in 1992, but the isolation of resistant organisms has increased substantially since then (15%–22%). 61 Similar findings have been reported for antibiotic‐resistant NG in many other countries of the industrialized world. 61–65 Low‐level, chromosomally mediated tetracycline resistance is also common among NG isolates in developing world settings, 66 and spectinomycin resistance has begun to appear in some industrialized regions as well. 61,67,68 Fluoroquinolone‐resistant NG, which first appeared in 1992 is most prevalent in the Far East but now occurs around the world including Europe, the United States, and Canada. 69 Antibiotic resistance in Haemophilus ducreyi , the causative agent of chancroid, continues to spread globally: 57 resistance to trimethoprim/sulphonamide combination drugs is now widespread in Southeast Asia (eg, Thailand, Vietnam, Laos, Cambodia). 52,70 Some believe that implementation of antiretroviral programs in the developing world will lead to the development of highly resistant HIV strains. 71–73

The sexual attitudes and behaviors of developed world travelers have been extensively studied in the past 10 to 15 years 5,58,59,74–83 and have been recently reviewed. 84 Rates of reported casual sexual experiences (CSE) during travel vary between 5 and 51% (summarized in tabular form by Matteelli and Carosi 81 ). Virtually all these studies have been conducted using questionnaires, and no study achieved a 100% response rate (some as low as 30% 85 ). As a result, the reported figures, high as they may appear, are likely to be underestimates. In an “intention‐to‐have‐sex” study of young Australian males traveling to Thailand, only 34% reported a definite intention not to have sex. 76 As many as 47.5% of unmarried UK residents on vacation in Spain reported a CSE during a 2‐week holiday. 83 The rate of new partner acquisition during this 2‐week period was roughly 12‐fold higher than rates observed in the UK. A study of medical students reported that 32% had CSE while on holiday with a mean of three new partners. 86

Although early studies demonstrated that men were far more likely than women to have CSE while traveling, 85 more recent studies suggest that male and female travelers are quite similar in their willingness to acquire new partners while abroad. 80,82,86–90 However, both quantitative and qualitative behavioral differences persist between the sexes (eg, number of partners, willingness to pay for sex, consistent condom use, and partner choice). 83 For example, young women tend to choose fellow travelers or expatriates as new sexual partners, while older female travelers and men of all ages tend to seek out local partners. 91,92 While logical to some extent, the young women’s strategy may not fully mitigate the risk since STI prevalence rates in expatriate communities are likely to be intermediate between those of the home and the local indigenous populations. 93,94 As a second example of differences between the sexes, men tend to seek out “unencumbered” sex with CSW during travel while women are more likely to become romantically involved and assist their sex partners to emigrate. 95

Factors that increase the chances that a given individual will engage in sex while traveling include youth, male sex, traveling alone or with a same‐sex group, a history of casual sex or multiple partners at home, repeated visits to the same region, previous STIs, and higher social status. 91,96,97 As with other high‐risk behaviors, there is also considerable evidence that alcohol and drugs contribute to CSE in both men and women. 12,83,87,91,97–102 Even without actually ingesting intoxicants, travel itself seems to be sufficiently intoxicating to encourage CSE in many people. This syndrome of sun, stimulants, and sex has been described as “situational disinhibition.” 103,104

Expatriates

Long‐term overseas workers or expatriates are more likely than other types of travelers to engage in sexual activity while abroad. Among 1,080 US Peace Corps volunteers, 60% had at least one CSE (40% of these contacts were with local residents) and only 33% used condoms. 105 Among Belgian men working in Central Africa, 51 and 31% reported extramarital sex with a local woman and with a CSW, respectively. 93 In a study of 1,968 Dutch expatriates working in sub‐Saharan Africa, 31% of males and 13% of females had casual sex with African partners; regular condom use was reported by less than 25% of the participants. 106 A more recent survey of 634 male and 230 female Dutch expatriates revealed that differences between the sexes are narrowing. 107 In this study 41% of men and 31% of women had either casual or regular sex with local residents. Of the men who had CSE, 59% had paid for sex at least once. These figures help to explain why expatriates tend to have STI prevalence “profiles” that are intermediate between those of their countries of origin and their host countries. 93,94,96,107

VFR Travelers

Travelers returning to their countries of origin to visit family and relatives (so‐called VFR travelers) are at high risk for acquiring a number of travel‐related illnesses. 108,109 Although few studies exist that specifically address this issue, VFR travelers are likely to be at particularly high risk for acquiring STIs. Factors that may influence this risk include the choice of setting to solicit sex, 46,110 more intimate contact with the local population and a willingness to use substandard, locally purchased condoms. 111 A recent study of 756 UK residents of African origin found that 43% of the men and 46% of the women had visited their country of origin in the preceding 5 years. New sexual partners were reported by 40% of the men and 21% of the women. 80 A similar study in 408 VFR travelers from the Netherlands returning to either Surinam or the Antilles revealed that 47% of the men and 11% of the women acquired a new sexual partner while overseas. 112

Military Personnel and Seamen

Seamen and military personnel are reported to have high rates of sexual contact with overseas nationals during postings ranging from 45% to 56%. 113–120 Among 1,744 US Navy and Marine corps personnel deployed abroad for 6 months, 49% reported having had sexual contact and 70% of these reported having had multiple partners. 121 In a Dutch study of 2,289 UN peacekeepers in Cambodia between 1992 and 1993, 45% reported CSE with local partners including CSWs. UK troops posted in the tropics report similar rates of CSE with local partners (56.5%) with only 30% reporting consistent condom use. 113 In a “spot check” of 1,028 US male military personnel in 2002, 7.4% reported either a current or recent (3 month) STI. 114 As additional evidence of the equalization of risk between the sexes, a recent survey of 105 US female military recruits suggested that 66% of them were at risk for the acquisition of STIs. 118,122

Men Who Have Sex With Men

Male homosexual travelers are less well studied than their heterosexual peers. However, the available data suggest that men who have sex with men (MSM) are at least as likely to engage in CSE while traveling as heterosexual men. 89,97,123–126 In a Norwegian study, homosexual/bisexual travelers were twice as likely to have paid for sex while overseas as heterosexuals (64% vs 32%, respectively). 97 A UK survey of 395 MSM travelers in 1995 revealed that 48% reported at least one CSE while abroad. 124 The internationalization of STI risk in MSM was recently made very clear with the virtual simultaneous outbreaks of syphilis and lymphogranuloma venereum (LGV) in both Europe and the United States. 126

Limited and/or inconsistent condom use in travelers appears to be independent of country of origin, travel “style” (eg, business, back‐packer), and country of destination. 86,88,89,91,97,98,105,106,123,127–129 Overall, at least 33% to 50% of travelers do not consistently use condoms. Although many travelers carry condoms, they often “forget” to use them in the heat of the moment. 98,130 Even when condoms are used by travelers, there may be greater risks of failure due to poor quality of locally purchased products, 111 improper storage (ie, the bottom of the knapsack for 2 months at 40°C), improper application, or anal sex. 115,131,132

It should be obvious from the above that there is no single “profile” of the traveler likely to have CSE while traveling. 91,96 With few exceptions, questions related to anticipated or actual sexual activity are appropriate for almost every pretravel interview and every post‐travel review of systems. In this context, it is worth pointing out that the peak in new sexual partner acquisition in the teenage years is followed by a “second peak” among men and women 35 to 55 years of age (the “just‐divorced” group). 133 Finally, an ever‐greater number of elderly individuals are traveling to exotic locations, 134 and STIs among the elderly are easily overlooked. 135 Based upon their studies in Dutch travelers, de Graaf and colleagues divide travelers into four groups, with regard to CSE overseas: 92

The “unprepared” (who are surprised when sex happens).

The “fanatical” (who must have sex to have a successful vacation).

The “unaffected” (who feel that sex abroad is the same as sex at home).

The “slightly accessible” (who feel that sex abroad is different and come prepared).

Although high levels of sexual activity have been documented in a wide range of travelers, “sexual tourism” is defined as travel expressly for the purpose of engaging in sexual activity. 5,136 Such travel is highly risky with respect to STIs, and prevention/harm reduction measures should be encouraged (eg, consistent condom use, reduction in the number of partners). In many instances, sexual tourism is exploitative and illegal (eg, seeking sex with a minor) and should be strongly discouraged (reviewed in Marrazzo 137 ). As noted above, the prevalence rates for STIs among CSW throughout the world can be very high ( Table 3 ). However, relative risk gradients exist even in environments of overall elevated risk: street CSW generally have higher rates of STIs than their “higher class” competitors working in bars and hotels. 46,110 However, in 2006, there is probably no community in the world so isolated that its CSW can be considered to be even “relatively safe.” Risk mitigation strategies used by sexual tourists (eg, seeking virgins or ever‐younger CSW, insisting upon health certificates) are routinely thwarted. Some of these behaviors can also place travelers in serious jeopardy regarding both local and international laws.

The subtlety of sexual predation in the developing world must be explained to travelers. Many people in developing countries engage in sexual acts simply to survive: sex for a sandwich can be a fair trade in the eyes of a street child. 19,20,137 In many settings, the fact that a traveler is not paying money for sex does not mean that he/she is not buying sex. Effective “currencies” in many regions of the developing world include food, gifts, and even hope (ie, the chance to emigrate). The commercial nature of such transactions is often not appreciated or acknowledged by the Western traveler. Although legitimate “barmaids” and “pool boys” certainly exist in resort areas and lasting relationships are occasionally forged in such environments, both male and female travelers more often delude themselves or rationalize their behavior by falling “in love.” 130 As noted above, more female than male travelers follow through with their vacation trysts by longer term commitments such as assistance to emigrate. 95

The risk of acquiring one or more STIs while traveling depends entirely on the behavior of the traveler. There is no such thing as the “standardized sexual act.” As a result, accurate estimates for rates of STI transmission per exposure are very hard to generate. However, the following general rules apply to all situations:

Most STIs are more readily transmitted from males to females than the reverse.

Individuals with obvious lesions (eg, sores, ulcers, vesicles) are more likely to transmit the agents that caused the lesions as well as copathogens (eg, HIV, HBV) than individuals without any evident genital pathology.

Decisions about sexual partners and/or sex activities made under the influence of alcohol or drugs will increase the risk of acquiring STIs.

Sex acts that result in bleeding or that occur during menses significantly enhance the risk of transmitting and/or acquiring sexually transmitted, blood‐borne viruses (eg, HIV, hepatitis B and C viruses).

Because so many factors can influence risk, there have been relatively few attempts to quantify the risk of transmitting any given STI by individual sex acts. However, the risk of acquiring HIV, HBV, or HCV from a percutaneous injury are relatively well defined (0.5%, 4%–30%, and 3%–10%, respectively). 138 The risks following a single, unprotected, heterosexual, and consensual sex act are thought to be much lower: ∼.001% for HIV 139 and 0%–0.6% for HCV. 140 The presence of genital lesions can dramatically increase the risk of acquiring HIV and possibly other sexually transmitted viruses. A study of Kenyan men who acquired chancroid from HIV+ CSW suggested a 43% risk of HIV transmission following a single CSE. 141 The efficiency of purely sexual HBV transmission is currently unknown but is likely to be at least as high as HCV. 142 The transmission of gonorrhea and chlamydia is highly efficient during both hetero‐ and homosexual sex. A single episode of vaginal intercourse incurs a 20 and 50% risk of acquiring gonorrhea in uninfected men and women, respectively. 143 The transmission efficiencies for open syphilis and chancroid lesions are probably at least as high. Chlamydia trachomatis is transmitted heterosexually with only slightly lower efficiency (0.8%–8% per episode). 144 In a large study of Swiss travelers, Steffen estimated that hepatitis B, GC, and syphilis were acquired at rates of 4, 3, and ∼1 per 1,000 traveler months, respectively. 85 Reported rates of hepatitis B acquisition by unvaccinated, long‐term travelers have been as high as 4%–7% per year. 145,146

Acquisition of one or more STI can result in both short‐term problems (eg, genital ulcers, urethritis, cervicitis) and long‐term or chronic complications (eg, infertility and ectopic pregnancy, pelvic inflammatory disease, liver disease secondary to hepatitis B or C, cervical dysplasia secondary to human papillomavirus (HPV), immunodeficiency due to HIV). Several of these chronic infections can significantly shorten life [eg, cancer, liver cirrhosis, acquired immunodeficiency syndrome (AIDS)]. Both short‐ and long‐term consequences of acquiring any particular STI while traveling can vary substantially. Infections that manifest while traveling can expose travelers to products that are not used in the developed world (eg, chloramphenicol, serum‐based HBV vaccines) and to suboptimal medical practices and environments (eg, unsterilized needles/instruments). Some drugs and products such as hepatitis B immune globulin (HBIG) and antiretrovirals may not be readily available in some areas of the world or may be of unpredictable or unacceptably low potency. Infections that only manifest upon return of the traveler can also be problematic. Several of the STIs that can be acquired while traveling remain rare in North America and may go undiagnosed or be treated inappropriately by physicians who are unfamiliar with them (eg, chancroid, LGV). Finally, travelers who bring one or more STIs “home” to prior partners must also consider the emotional price including lost trust, broken relationships, and divorce.

The potential impact of travel on STIs has significant public health implications in both departure and destination countries: the introduction of a new or more resistant organism can occur on either the outbound or the return voyage. Travelers who have CSEs overseas may also be more likely to engage in CSE back in their home country and vice versa. As a result, there are both small and large public health issues with CSE among travelers. At the “micro” level in the departure country, transmission of rare and/or resistant STIs to the nontraveling partner(s) must always be considered by treating physicians when confronted by a confusing clinical presentation. At the “macro” level, the potential to introduce exotic and/or resistant STIs into departure countries is very real. 7,62,63,147,148 Because so many people are currently traveling, the risk‐taking behavior of individuals can “add up” to epidemic spread rather quickly. For example, it has been estimated that >500,000 Australians have at least one CSE in the Philippines or Thailand every year. 75 Tourism and travel by truck and airline were major factors in the spread of HIV across Africa and then around the globe. 79 A recent survey among 1,325 male travelers in Hong Kong revealed that 453 (34.2%) had had at least one sexual contact with a CSW in the preceding 6‐month period. 149 The proportion of subjects presenting to some STI clinics with foreign sexual contact as their only risk factor can be impressive (10%–50%). 58,123,128,150 In 1993, Rowbottom estimated that at least 44% of GC cases in Victoria, Australia, had been acquired abroad. 75 Many of these imported STIs exhibit unusual or broad‐spectrum antibiotic resistance. 58

The treatment of STIs has recently been reviewed in both the general population 151–153 and specifically in travelers. 33,78 Of course, the only way to reduce the risk of STIs to zero is abstinence or monogamous sex with a stable, uninfected partner. The following general statements apply to all STIs:

Condoms reduce the risk of most, but not all, STIs.

Prevention of STIs is preferred over treatment.

Partner notification is essential to prevent STI spread.

Prompt diagnosis and therapy can reduce both complications and spread.

Therapy should be guided by cultures and sensitivity tests when possible.

The presence of one STI should trigger a search for others.

Global resistance patterns should be considered when choosing antimicrobials.

Despite several new therapeutic strategies, 153 it is also worth pointing out that the treatment options for some of the most serious STIs remain very limited (eg, HBV, HCV). HIV can be controlled in most people for prolonged periods but at enormous financial and personal cost. For general treatment recommendations of the most common STIs, see Table 4 . These recommendations have been abstracted largely from the Public Health Agency of Canada 151 and CDC guidelines. 152 The reader is encouraged to visit these sites to obtain more complete information.

Overview of STI screening, diagnosis, and treatments

This table is designed as a quick reference and is not meant to replace more comprehensive guidelines (eg, Health Canada, 151 CDC 152 ). STI = sexually transmitted infections; NAAT = nucleic acid amplification test; IDU = intravenous drug use; RFLP = restriction fragment length polymorphism; PEP = postexposure prophylaxis; HIV = human immunodeficiency virus; LGV = lymphogranuloma venereum; GC = gonorrhea; HAV = hepatitis A virus; HBV = hepatitis B virus; HCV = hepatitis C virus; CSE = casual sex experience; TPPA = Treponema pallidum particle agglutination; WBC = white blood cell count; ELISA = enzyme‐linked immunosorbent assay; RPR = rapid plasmin reagin; VDRL = venereal diseases research laboratory.

Treat until lesions have healed completely. An aminoglycoside can be added to regimens above if no improvement seen in first week of therapy (eg, gentamicin 1mg/kg IV every 8 hours—monitor levels).

Health care professionals who see international travelers should make advice about STIs and avoidance strategies a routine part of the pretravel visit. Among the microbial risks of travel, the STIs are probably second only to malaria in terms of their potential for serious morbidity and mortality. Safer sex and harm reduction counseling should be emphasized. Barrier contraceptive devices, specifically male and female condoms, provide the best alternative to abstinence by preventing direct contact with infective genital lesions. Although male and female condoms are likely to have similar efficacy for many STIs when used appropriately, almost all of the available data come from studies of male condom use. Condoms made from latex provide a more effective barrier than “natural” condoms made from animal membranes. In experimental models, the latter are not impervious to viruses such as hepatitis B, hepatitis C, and HIV. 152 In the event that a latex condom is not available, natural condoms do provide some degree of protection against a range of pathogens and are certainly better than nothing. If possible, latex condoms should be purchased in a developed world country since the quality of condoms produced in many regions of the world is inconsistent. 111 Only water‐base lubricants should be used with condoms since oil‐based products (eg, petroleum jelly, mineral oil, massage oil) can significantly weaken latex condoms and lead to breakage. 152 High‐quality polyurethane condoms are available in most developed world countries for travelers with latex allergies. 154

The reported efficacy of latex condoms against STIs ranges from 40% to 70%, 155 but the contraceptive literature suggests that consistent and correct use can reduce the risk of heterosexual HIV transmission by 80%. They are generally more effective against viral pathogens spread by semen, vaginal secretions, and blood than bacterial agents associated with lesions around the genitalia. The most serious limitation of condoms is their inability to spontaneously migrate from pocket to penis (see above). The most common factors involved in condom breakage include inappropriate application, repeated or prolonged use, and anal intercourse. Although not as widely available as standard male condoms, the so‐called female condom can also be a relatively effective barrier against STIs. 156,157 Spermicides, such as nonoxynol‐9, interfere with sperm viability, and early studies suggested a protective effect against a range of sexually transmitted viruses and bacteria. 158 However, a recent Cochrane Database review suggests that nonoxynol‐9 has no protective effect against a range of pathogens. 159,160 In fact, with too frequent vaginal use or use in anal receptive intercourse, nonoxynol‐9 can disrupt epithelial integrity and lead to increased transmission of HIV and other STIs. 159,160

Screening for STIs is appropriate for many travelers who report CSE while abroad. 161,162 Such screening should be guided by the nature of the sexual contact and current or past symptoms and could include an examination of the genitals, a cervical/urethral/anal/pharyngeal swab and/or urine testing as well as serologic tests for syphilis, HIV, and possibly HBV and HCV ( Table 4 ).

Although it may be tempting to “arm” travelers likely to engage in high‐risk sexual activities while abroad (eg, by stated intention or past behavior) with a morning‐after course of antibiotic therapy, this practice is not recommended. Ready access to antibiotics could lead to a false sense of security and increased exposure to STIs not targeted by the therapy provided (eg, HIV, HCV, HPV). Such behavioral effects have recently been documented among CSW. 163

The management of sexual assault victims has recently been reviewed. 164–166 Women traveling for prolonged periods of time in developing world countries should be counseled with regards to risk mitigation strategies in the event of sexual assault. In all such long‐term travelers (male and female), verification of hepatitis B vaccination status should be routine. Unvaccinated travelers who have been assaulted should begin active immunization as well as HBIG if a trustworthy product can be found locally. Individuals with incomplete immunization schedules must be reviewed on a case‐by‐case basis (ie, complete or reinitiate active immunization with or without HBIG). Although postexposure prophylaxis (PEP) for HIV using three drugs would be appropriate in many circumstances, these combinations are expensive (eg, ∼US$1,500 for 28 days of 3TC+AZT plus efavirenz) and would not be appropriate to prescribe for all travelers. However, such an expenditure might be reasonable for groups living or working overseas for prolonged periods (eg, semester abroad, large international projects). Many institutions in the developing world (eg, embassies, private schools, industries) have access to appropriate HIV PEP drugs. An alternate and lower cost strategy for individual travelers might be the purchase of a “starter kit” with 3 to 5 days of PEP drugs (US$160–$260). In some countries with high rates of sexual assault and limited availability of antiretrovirals (eg, South Africa), specific insurance policies can be purchased to ensure access to HIV PEP. It is logical to offer broad prophylaxis for other STIs if it is unsure whether or not the victim of assault will return, if the assailant has a known STI, if prophylaxis is requested or if the assault victim has signs and symptoms of an STI (see Table 4 ). However, the efficacy of prophylaxis following sexual assault has not been studied. Unintended pregnancy may also result from sexual assault, and the emergency contraceptive pill may also be considered in these circumstances. Treatment should be taken as soon as possible (0–72 hours for maximum efficacy) but may be of benefit up to 120 hours after exposure. 167

Pregnant and Lactating Women

Pregnancy is also one of the major risks of CSE in any setting. Although few data are available, pregnancy does not appear to be a major risk factor for the acquisition or evolution of most STIs, although treatment can be complicated by the presence of the fetus.

As a general rule, most children who travel do so with their parents and are relatively unlikely to be at high risk for the sexually transmitted disease. However, it is worth noting that developing world children are common targets of the sex trade. Tens, if not hundreds or thousands, of street children work in the sex trade in many cities of the developing world. 19,20,137

Adolescents and Young Adults

Adolescents and young adults are at particularly high risk for acquiring and spreading STIs. Peak acquisition of new sexual partners occurs in all cultures during the teen and early adult years. 133

Immunocompromised Hosts

A recent survey of 133 HIV+ Canadian travelers (93% male) suggest these individuals are as likely as their noninfected peers to engage in casual sex while overseas (23%) and are just as unlikely to use condoms consistently (only 58%). 125 Not only do STIs facilitate the transmission of HIV but also the diagnosis of these infections, their clinical presentation, and treatment can all be influenced by HIV (reviewed by Dallabetta 166 ). HIV+ subjects are more likely to have asymptomatic primary syphilis and to progress rapidly to neurologic and ophthalmologic complications. 168 GC is more severe and more likely to disseminate in HIV+ subjects. 166 Pelvic inflammatory disease of all etiologies is more common and severe, 169,170 and molluscum contagiosum can be profuse in HIV/AIDS patients. 171 With the exception of neurosyphilis that can be difficult to treat, STIs in HIV+ subjects can generally be expected to respond to standard therapy. 150,151,166,171 It is worth noting that HIV testing is increasingly demanded of immigrants and refugees in many countries. 172,173 There has been a parallel worldwide increase in mandatory HIV testing for long‐term, nonresident visas (eg, expatriates, students, missionaries).

The Mature or Elderly Traveler

Sexual activity with all its attendant pleasures and risks, is a central part of a healthy life at all ages. 134,135,174 As noted above, the rapid acquisition of new sexual partners is not restricted to the teenage years: a second peak between the ages of 45 to 55 has been described even among nontravelers (the restless and the divorced). 133 It is important not to make assumptions about the actual or intended sexual activity of either male or female travelers at any age.

Several obstacles to the promotion of sexual health in travelers have recently been discussed by Abdullah and colleagues 8 These include traveler diversity, the ambivalence of both the travel industry and destination governments to a frank discussion of the risks of sexual encounters while abroad and a lack of support for travel counseling and preventative services in many departure countries. As noted above, there is often a pervasive and even willful denial of both sexual risk and responsibility among developed world travelers. In this context, a forced discussion of sexual behaviors and responsibility can be intrusive and unwanted. Furthermore, as pointed out by Sanford, 175 the role of the travel advisor is not to be a killjoy but to help each traveler find a reasonable balance between risk acceptance and appropriate risk avoidance or mitigation.

The rapidity with which international travel has expanded in recent years has provided unprecedented potential for the development of global sexual networks. Holiday, business, and VFR travelers each present particular challenges to travel medicine practitioners. At the current time, travel health messages reach only a tiny proportion of the traveling community (certainly <20%). 176 Innovative approaches are needed to gain access to these diverse groups of travelers and to encourage the travel industry and both departure and destination governments to accept responsibility for ensuring that sexual health issues receive the attention that they deserve.

Individuals who acquire new sexual partners while traveling, especially those who pay for sex or have multiple CSEs overseas, are at risk for a wide range of STIs. Although the behaviors of some travelers put them at higher risk of contracting STIs, there is no single profile of the “at‐risk” traveler. Barrier contraceptives can provide some degree of protection against many STIs, but 100% protection cannot be achieved even with meticulous use. Only HBV and HPV genotypes can currently be prevented by vaccination, although vaccines for chlamydia species and HSV‐II (among others) are in development. 177 Although drug resistance is more commonly encountered in STIs acquired overseas, all the bacterial STIs can be treated successfully at the current time if appropriate antimicrobials are chosen. A series of evidence‐based recommendations for managing travelers and STIs are presented in Table 5 . 178

Evidence‐based * recommendations for managing travelers and STIs

CSW = commercial sex workers; STI = sexually transmitted infections; CSE = casual sex experience.

Strength of Recommendation scored as A Good evidence to support a recommendation for use. B Moderate evidence to support a recommendation for use. C Poor evidence to support a recommendation for or against use. D Moderate evidence to support a recommendation against use. E Good evidence to support a recommendation against use.Quality of Evidence scored as   I Evidence from at least one properly randomized, controlled trial.  II Evidence from at least one well‐designed clinical trial without randomization, from cohort or case‐controlled analytic studies, preferably from more than one centre, from multiple time series, or dramatic results in uncontrolled experiments. III Evidence from opinions of respected authorities on the basis of clinical experience, descriptive studies, or reports of expert committees.178

The authors state that they have no conflicts of interest.

Zimmerman C . Violence against women: global scope and magnitude . Lancet 2002 ; 359 : 1232 – 1237 .

Google Scholar

Rogers S . Rolling down to old Maui . Available at: http://www.ifred.ca/stanrogers/songs.html . (Accessed 2006 Aug 16)

Watt J . Lettsomian lectures. Medical perspectives of some voyages of discovery . Trans Roy Soc Lond 1979 ; 95 : 61 – 91 .

World Tourism Organization . Tourism highlight 2003 . Available at: http://www.world-tourism.org/market_research/facts/menu.html . (Accessed 2006 Aug 21)

Mulhall BP . Sex and travel: studies of sexual behaviour, disease and health promotion in international travelers—a global review . Int J STD AIDS 1996 ; 7 : 455 – 465 .

Aral SO . Sexually transmitted diseases: magnitude, determinants and consequences . Int J STD AIDS 2001 ; 12 : 211 – 215 .

Aral SO . Determinants of STI epidemics: implications for phase appropriate intervention strategies . Sex Transm Infect 2002 ; 78 ( Suppl 1 ): 3 – 13 .

Abdullah AS Ebrahim SH Fielding R Morisky DE . Sexually transmitted infections in travelers: implications for prevention and control . Clin Infect Dis 2004 ; 39 : 533 – 538 .

World Health Organization . Global prevalence and incidence of selected curable sexually transmitted infections: overview and estimates . Geneva : WHO. WHO/CDS/CSR/EDC/2001.10. 2001; 1 – 54 .

Ruiz J . Street youth in Colombia: lifestyle, attitudes and knowledge . AIDS Health Promot Exch 1994 ; 1 : 12 – 14 .

Msuya W Mayaud P Mkanje R Grosskurth H . Taking early action in emergencies to reduce the spread of STIs and HIV . Afr Health 1996 ; 18 : 24 .

Van Den Hoek A . STI control in drug users and street youth . Genitourin Med 1997 ; 73 : 240 – 244 .

Rew L . Sexual health practices of homeless youth: a model for intervention . Issues Compr Pediatr Nurs 2001 ; 24 : 1 – 18 .

Roy E Haley N Leclerc P , et al . Mortality in a cohort of street youth in Montreal . JAMA 2004 ; 292 : 569 – 574 .

World Health Organization . WHO. Office of Information. Sexually transmitted infections ncreasing—250 million new infections annually . WHO Feature 1990 ; 152 : 1 – 6 .

Gerbase AC Rowley JT Heymann DH , et al . Global prevalence and incidence estimates of selected curable STIs . Sex Transm Infect 1998 ; 74 ( Suppl 1 ): S12 – S16 .

Gerbase AC Rowley JT Mertens TE . Global epidemiology of sexually transmitted diseases . Lancet 1998 ; 351 : 2 – 4 .

Shetty AK Powell G . Children orphaned by AIDS: a global perspective . Semin Pediatr Infect Dis 2003 ; 14 : 25 – 31 .

Foster G . Africa’s children and AIDS‐a continent in crisis . The devastators of the HIV/AIDS pandemic. AIDS link 1997 May‐June; 4–5.

Anonymous. Street children turn to sex‐work to survive . AIDS Anal Afr 1995 ; 5 : 6 – 7 .

Brunham RC Plummer FA . A general model of sexually transmitted disease epidemiology and its implications for control . Med Clin North Am 1990 ; 74 : 1339 – 1352 .

Saphonn V Hor LB Ly SP , et al . How well do antenatal clinic (ANC) attendees represent the general population? A comparison of HIV prevalence from ANC sentinel surveillance sites with a population‐based survey of women aged 15‐49 in Cambodia . Int J Epidemiol 2002 ; 31 : 449 – 455 .

Aboyeji AP Nwabuisi C . Prevalence of sexually transmitted diseases among pregnant women in Ilorin, Nigeria . J Obstet Gynaecol 2003 ; 23 : 637 – 639 .

Latif AS Bvumbe J Muongerwa J , et al . Sexually transmitted diseases in pregnant women in Harare, Zimbabwe . Afr J Sex Transmi Dis 1984 ; 1 : 21 – 23 .

Duncan ME Tibaux G Kloos H , et al . STIS in women attending family planning clinics: a case study in Addis Ababa . Soc Sci Med 1997 ; 44 : 441 – 454 .

Pham‐Kanter GB Steinberg MH Ballard RC . Sexually transmitted diseases in South Africa . Genitourin Med 1996 ; 72 : 160 – 171 .

Blankhart D Muller O Gresenguet G Weis P . Sexually transmitted infections in young pregnant women in Bangui, Central African Republic . Int J STD AIDS 1999 ; 10 : 609 – 614 .

Kilmarx PH Black CM Limpakarnjanarat K , et al . Rapid assessment of sexually transmitted diseases in a sentinel population in Thailand: prevalence of chlamydial infection, gonorrhoea, and syphilis among pregnant women—1996 . Transm Infect 1998 ; 74 : 189 – 193 .

Thomas K Thyagarajan SP Jeyaseelan L , et al . Community prevalence of sexually transmitted diseases and human immunodeficiency virus infection in Tamil Nadu, India: a probability proportional to size cluster survey . Natl Med J India 2002 ; 15 : 135 – 140 .

Purevdawa E Moon TD Baigalmaa C , et al . Rise in sexually transmitted diseases during democratization and economic crisis in Mongolia . Int J STD AIDS 1997 ; 8 : 398 – 401 .

Cowan FM French RS Mayaud P , et al . Seroepidemiological study of herpes simplex virus types 1 and 2 in Brazil, Estonia, India, Morocco, and Sri Lanka . Sex Transm Infect 2003 ; 79 : 286 – 290 .

Parenti DM . Sexually transmissible diseases and travelers . Med Clin North Am 1992 ; 76 : 1449 – 1461 .

Wang CC Celum CL . Global risk of sexually transmitted diseases . Med Clin North Am 1999 ; 83 : 975 – 995 .

Ndoye I Mboup S De Schryver A , et al . Diagnosis of sexually transmitted infections in female prostitutes in Dakar, Senegal . Sex Transm Infect 1998 ; 74 ( Suppl 1 ): S112 – S117 .

Ramjee G Karim SS Sturm AW . Sexually transmitted infections among sex workers in KwaZulu‐Natal, South Africa . Sex Transm Dis 1998 ; 25 : 346 – 349 .

Van Den Hoek A Yuliang F Dukers NH , et al . High prevalence of syphilis and other sexually transmitted diseases among sex workers in China: potential for fast spread of HIV . AIDS 2001 ; 15 : 753 – 759 .

Sugihantono A Slidell M Syaifudin A , et al . Syphilis and HIV prevalence among commercial sex workers in Central Java, Indonesia: risk‐taking behavior and attitudes that may potentiate a wider epidemic . AIDS Patient Care STDS 2003 ; 17 : 595 – 600 .

Ford K Wirawan DN Reed BD , et al . AIDS and STI knowledge, condom use and HIV/STI infection among female sex workers in Bali, Indonesia . AIDS Care 2000 ; 12 : 523 – 534 .

Joesoef MR Linnan M Barakbah Y , et al . Patterns of sexually transmitted diseases in female sex workers in Surabaya, Indonesia . Int J STD AIDS 1997 ; 8 : 576 – 580 .

Sarkar S Islam N Durandin F , et al . Low HIV and high STI among commercial sex workers in a brothel in Bangladesh: scope for prevention of larger epidemic . Int J STD AIDS 1998 ; 9 : 45 – 47 .

Joesoef MR Gultom M Irana ID , et al . High rates of sexually transmitted diseases among male transvestites in Jakarta, Indonesia . Int J STD AIDS 2003 ; 14 : 609 – 613 .

Camejo MI Mata G Diaz M . Prevalence of hepatitis B, hepatitis C and syphilis in female sex workers in Venezuela . Rev Saude Publica 2003 ; 37 : 339 – 344 .

Mesquita PE Granato CF Castelo A . Risk factors associated with hepatitis C virus (HCV) infection among prostitutes and their clients in the city of Santos, Sao Paulo State, Brazil . J Med Virol 1997 ; 51 : 338 – 343 .

Hyams KC Phillips IA Tejada A , et al . Three‐year incidence study of retroviral and viral hepatitis transmission in a Peruvian prostitute population . J Acquir Immune Defic Syndr 1993 ; 6 : 1353 – 1357 .

Russi JC Serra M Vinoles J , et al . Sexual transmission of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus type 1 infections among male transvestite comercial sex workers in Montevideo, Uruguay . Am J Trop Med Hyg 2003 ; 68 : 716 – 720 .

Laurent C Henzel D Mulanga‐Kabeya C , et al . Seroepidemiological survey of hepatitis C virus among commercial sex workers and pregnant women in Kinshasa, Democratic Republic of Congo . Int J Epidemiol 2001 ; 30 : 872 – 877 .

Pando MA Berini C Bibini M , et al . Prevalence of HIV and other sexually‐transmitted infections among female commercial sex workers in Argentina . Am J Trop Med Hyg 2006 ; 74 : 233 – 238 .

Lavanchy D . Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures . J Viral Hepat 2004 ; 11 : 97 – 107 .

Ray Kim W . Global epidemiology and burden of hepatitis C . Microbes Infect 2002 ; 4 : 1219 – 1225 .

The Global Burden of Hepatitis C Working Group . Global burden of disease (GBD) for hepatitis C . J Clin Pharmacol 2004 ; 44 : 20 – 29 .

Edlich RF Arnette JA Williams FM . Global epidemic of human T‐cell lymphotropic virus type‐I (HTLV‐I) . J Emerg Med 2000 ; 18 : 109 – 119 .

Erbelding E Quinn TC . The impact of antimicrobial resistance on the treatment of sexually transmitted diseases . Infect Dis Clin North Am 1997 ; 11 : 889 – 903 .

CDC . Global distribution of penicillinase‐producing Neisseria gonorrhoeae (PPNG) . MMWR Morb Mortal Wkly Rep 1982 ; 31 : 1 – 3 .

Brown S Warnnissorn T Biddle J , et al . Antimicrobial resistance of Neisseria gonorrhoea in Bangkok: is single‐drug treatment passe . Lancet 1982 ; 2 : 1366 – 1368 .

Bodonaik NC . Decrease in the incidence of tetracycline resistance in strains of Neisseria gonorrhoeae in the nineties . West Indian Med J 2003 ; 52 : 228 – 230 .

Bogaerts J Van Dyck E Mukantabana B , et al . Auxotypes, serovars, and trends of antimicrobial resistance of Neisseria gonorrhoeae in Kigali, Rwanda (1985‐93) . Sex Transm Infect 1998 ; 74 : 205 – 209 .

Ison CA Dillon JA Tapsall JW . The epidemiology of global antibiotic resistance among Neisseria gonorrhoeae and Haemophilus ducreyi . Lancet 1998 ; 351 ( Suppl 3 ): 8 – 11 .

De Schryver A Meheus A . International travel and sexually transmitted diseases . World Health Stat Q 1989 ; 42 : 90 – 99 .

De Schryver A Meheus A . Epidemiology of sexually transmitted diseases: the global picture . Bull World Health Organ 1990 ; 68 : 639 – 654 .

Yeung KH Dillon JA . Cases of Neisseria gonorrhoeae with plasmid‐mediated resistance to penicillin increase. The National Study Group . Can Dis Wkly Rep 1990 ; 16 : 13 – 16 .

Ng LK Martin I Lau A ; The National Gonococcal Surveillance Program Members. Trends of chromosomally mediated antimicrobial resistance in Neisseria gonorrhoeae in Canada: 1994‐1999 . Sex Transm Dis 2003 ; 30 : 896 – 900 .

Sarwal S Wong T Sevigny C Ng LK . Increasing incidence of ciprofloxacin‐resistant Neisseria gonorrhoeae infection in Canada . CMAJ 2003 ; 168 : 872 – 873 .

Patrick D Shaw C Rekart ML . Neisseria gonorrhoeae with decreased susceptibility to ciprofloxacin in British Columbia: an imported phenomenon . Can Commun Dis Rep 1995 ; 21 : 137 – 139 .

Ehret JM Judson FN . Quinolone‐resistant Neisseria gonorrhoeae: the beginning of the end? Report of quinolone‐resistant isolates and surveillance in the southwestern United States, 1989 to 1997 . Sex Transm Dis 1998 ; 25 : 522 – 526 .

Herida M Sednaoui P Goulet V . Gonorrhoea surveillance system in France: 1986‐2000 . Sex Transm Dis 2004 ; 31 : 209 – 214 .

Carballo M Pauze M Dillon JR . Increase of Neisseria gonorrhoeae isolates with combined plasmid-mediated resistance to tetracycline (TRNG) and penicillin (PPNG) . Can Dis Wkly Rep 1990 ; 16 : 219 – 222 .

Rousseau D Nadeau D Lafontaine G . Emergence of spectinomycin‐resistant strains of penicillinase‐producing Neisseria gonorrhoeae (PPNG)—Quebec . Can Dis Wkly Rep 1989 ; 15 : 101 – 102 ; discussion 102–103.

Ray K Bala M Kumari S Narain JP . Antimicrobial resistance of Neisseria gonorrhoeae in selected World Health Organization Southeast Asia Region countries: an overview . Sex Transm Dis 2005 ; 32 : 178 – 184 .

Mann J Kropp R Wong T Venne S Romanowski B . Gonorrhea treatment guidelines in Canada: 2004 update . CMAJ 2004 ; 171 : 1345 – 1346 .

Rutanarugsa A Vorachit M Polnikorn N Jayanetra P . Drug resistance of Haemophilus ducreyi . Southeast Asian J Trop Med Public Health 1990 ; 21 : 185 – 193 .

Harries AD Nyangulu DS Hargreaves NJ , et al . Preventing antiretroviral anarchy in sub‐Saharan Africa . Lancet 2001 ; 358 : 410 – 414 .

Blower S Ma L Farmer P Koenig S . Predicting the impact of antiretrovirals in resource‐poor settings: preventing HIV infections whilst controlling drug resistance . Curr Drug Targets Infect Disord 2003 ; 3 : 345 – 353 .

Nkengasong JN Adje‐Toure C Weidle PJ . HIV antiretroviral drug resistance in Africa . AIDS Rev 2004 ; 6 : 4 – 12 .

Steffen R DeBernardis C Banos A . Travel epidemiology—a global perspective . Int J Antimicrob Agents 2003 ; 21 : 89 – 95 .

Rowbottom J . STIs and the overseas traveller . Aust Fam Physician 1993 ; 22 : 125 – 131 .

Mulhall BP Hu M Thompson M , et al . Planned sexual behaviour of young Australian visitors to Thailand . Med J Aust 1993 ; 158 : 530 – 535 .

Bloor M Thomas M Hood K , et al . Differences in sexual risk behaviour between young men and women travelling abroad from the UK . Lancet 1998 ; 352 : 1664 – 1668 .

Hawkes S Hart G . The sexual health of travelers . Infect Dis Clin North Am 1998 ; 12 : 413 – 430 .

Forsythe S . HIV/AIDS and tourism . AIDS Anal Afr 1999 ; 9 : 4 – 6 .

Fenton KA Chinouya M Davidson O Copas A , MAYISHA research team. HIV transmission risk among sub‐Saharan Africans in London travelling to their countries of origin . AIDS 2001 ; 15 : 1442 – 1445 .

Matteelli A Carosi G . Sexually transmitted diseases in travelers . Clin Infect Dis 2001 ; 32 : 1063 – 1067 .

Correia JD Shafer RT Patel V , et al . Blood and body fluid exposure as a health risk for international travelers . J Travel Med 2001 ; 8 : 263 – 266 .

Bellis MA Hughes K Thomson R Bennett A . Sexual behaviour of young people in international tourist resorts . Sex Transm Infect 2004 ; 80 : 43 – 47 .

Hynes NA . Sexually transmitted diseases in travelers . Curr Infect Dis Rep 2005 ; 7 : 132 – 137 .

Steffen R Rickenbach M Wilhelm U , et al . Health problems after travel to developing countries . J Infect Dis 1987 ; 156 : 84 – 91 .

Finney H . Contraceptive use by medical students whilst on holiday . Fam Pract 2003 ; 20 : 93 .

Arvidson M Hellberg D Mardh PA . Sexual risk behavior and history of sexually transmitted diseases in relation to casual travel sex during different types of journeys . Acta Obstet Gynecol Scand 1996 ; 75 : 490 – 494 .

Cabada MM Echevarria JI Seas CR , et al . Sexual behavior of international travelers visiting Peru . Sex Transm Dis 2002 ; 29 : 510 – 513 .

Cabada MM Montoya M Echevarria JI , et al . Sexual behavior in travelers visiting Cuzco . J Travel Med 2003 ; 10 : 214 – 218 .

Batalla‐Duran E Oakeshott P Hay P . Sun, sea and sex? Sexual behaviour of people on holiday in Tenerife . Fam Pract 2003 ; 20 : 493 – 494 .

Gagneux OP Blochliger CU Tanner M Hatz CF . Malaria and casual sex: what travelers know and how they behave . J Travel Med 1996 ; 3 : 14 – 21 .

De Graaf R Van Zessen G Houweling H . Underlying reasons for sexual conduct and condom use among expatriates posted in AIDS endemic areas . AIDS Care 1998 ; 10 : 651 – 665 .

Bonneaux L Van der Stuyft P Taelman H , et al . Risk factors for infection with human immunodeficiency virus among European expatriates in Africa . BMJ 1988 ; 297 : 581 – 584 .

Jones ME . HIV and the returning expatriate . J Travel Med 1999 ; 6 : 99 – 106 .

Herold ES Van Kerkwijk C . AIDS and sex tourism . AIDS Soc 1992 ; 4 : 1 , 8 .

Stricker M Steffen R Hornung R , et al . Flûchtige sexuelle Kontakte von Scheizer Touristen in den Tropen . Mûnch Med Wschr 1990 ; 132 : 175 – 177 .

Tveit KS Nilsen A Nyfors A . Casual sexual experience abroad in patients attending an STI clinic and at high risk for HIV infection . Genitourin Med 1994 ; 70 : 12 – 14 .

Gillies P Slack R Stoddart N Conway S . HIV‐related risk behaviour in UK holiday‐makers . AIDS 1992 ; 6 : 339 – 341 .

Bryant KJ . Decreasing HIV/STI risk in relation to alcohol use: a research agenda . AIDS STD Health Promot Exch 1997 ; 2 : 13 – 15 .

Fortenberry JD . Alcohol, drugs, and STI/HIV risk among adolescents . AIDS Patient Care STDS 1998 ; 12 : 783 – 786 .

Gehring TM Widmer J Kleiber D Steffen R . Are preventive HIV interventions at airports effective? J Travel Med 1998 ; 5 : 205 – 209 .

Minichiello V Marino R Khan MA Browne J . Alcohol and drug use in Australian male sex workers: its relationship to the safety outcome of the sex encounter . AIDS Care 2003 ; 15 : 549 – 561 .

Apostolopoulos Y Sonmez S Yu CH . HIV‐risk behaviours of American spring break vacationers: a case of situational disinhibition? Int J STD AIDS 2002 ; 13 : 733 – 743 .

Mewhinney DM Herold ES Maticka‐Tyndale E . Sexual scripts and risk taking of Canadian university students on spring break in Daytona beach, Florida . Can J Hum Sex 1995 ; 3 : 273 – 288 .

Moore J Beeker C Harrison JS , et al . HIV risk behavior among Peace Corps Volunteers . AIDS 1995 ; 9 : 795 – 799 .

Houweling H Coutinho RA . Risk of HIV infection among Dutch expatriates in sub‐Saharan Africa . Int J STD AIDS 1991 ; 2 : 252 – 257 .

De Graaf R Van Zessen G Houweling H , et al . Sexual risk of HIV infection among expatriates posted in AIDS endemic areas . AIDS 1997 ; 11 : 1173 – 1181 .

Bacaner N Stauffer B Boulware DR , et al . Travel medicine considerations for North American immigrants visiting friends and relatives . JAMA 2004 ; 291 : 2856 – 2864 .

Fulford M Keystone JS . Health risks associated with visiting friends and relatives in developing countries . Curr Infect Dis Rep 2005 ; 7 : 48 – 53 .

Wallace D . WESTPAC, AIDS, and the Navy . Mil Med 1994 ; 159 : 171 – 173 .

Anonymous . High condom quality essential to reduce HIV spread . Network 1988 ; 10 : 6 – 7 .

Kramer MA Van Den Hoek A Coutinho RA Prins M . Sexual risk behaviour among Surinamese and Antillean migrants travelling to their countries of origin . Sex Transm Infect 2005 ; 81 : 508 – 510 .

Adams EJ Strike PW Green AD Masterton RG . Sexually transmitted diseases in transient British forces in the tropics . Genitourin Med 1994 ; 70 : 94 – 96 .

Shafer MA Boyer CB Shaffer RA , et al . Correlates of sexually transmitted diseases in a young male deployed military population . Mil Med 2002 ; 167 : 496 – 500 .

Hopperus Buma AP Veltink RL Van Ameijden EJ , et al . Sexual behaviour and sexually transmitted diseases in Dutch marines and naval personnel on a United Nations mission in Cambodia . Genitourin Med 1995 ; 71 : 172 – 175 .

Miller N Yeager R . By virtue of their occupation, soldiers and sailors are at greater risk. Special report: the military . AIDS Anal Afr 1995 ; 5 : 8 – 9 .

Vuksanovic P Goethe WH Burchard HV , et al . Seamen and AIDS . Travel Med Int 1988 ; 6 : 18 – 19 .

Pavli P Bayliss GJ Dent OF Lunzer MR . The prevalence of serological markers for hepatitis B virus infection in Australian Naval personnel . Med J Aust 1989 ; 151 : 71 , 74 – 75 .

Tiwari VD Talwar S Panvelkar VV Tutakne MA . Wars and sexually transmitted diseases in the Indian Army . Indian J Sex Transm Dis 1992 ; 13 : 80 – 82 .

Bond MM Yates SW . Sexually transmitted disease screening and reporting practices in a military medical center . Mil Med 2000 ; 165 : 470 – 472 .

Malone JD Hyams KC Hawkins RE , et al . Risk factors for sexually‐transmitted diseases among deployed U.S. military personnel . Sex Transm Dis 1993 ; 20 : 294 – 298 .

Abel E Adams E Stevenson R . Sexual risk behaviour among female army recruits . Mil Med 1996 ; 161 : 491 – 494 .

Hawkes S Hart GJ Bletsoe E , et al . Risk behaviour and STI acquisition in genitourinary clinic attenders who have travelled . Genitourin Med 1995 ; 71 : 351 – 354 .

Clift SM Forrest SP . Factors associated with gay men’s sexual behaviours and risk on holiday . AIDS Care 1999 ; 11 : 281 – 295 .

Salit IE Sano M Boggild AK Kain KC . Travel patterns and risk behaviour of HIV‐positive people travelling internationally . CMAJ 2005 ; 172 : 884 – 888 .

Fenton KA Imrie J . Increasing rates of sexually transmitted diseases in homosexual men in Western Europe and the United States: why? Infect Dis Clin North Am 2005 ; 19 : 311 – 331 .

Hawkes S Hart GJ Johnson AM , et al . Risk behaviour and HIV prevalence in international travellers . AIDS 1994 ; 8 : 247 – 252 .

Thorpe L Ford K Fajans P Wirawan DN . Correlates of condom use among female prostitutes and tourist clients in Bali, Indonesia . AIDS Care 1997 ; 9 : 181 – 197 .

Abdullah AS Fielding R Hedley AJ Luk YK . Risk factors for sexually transmitted diseases and casual sex among Chinese patients attending sexually transmitted disease clinics in Hong Kong . Sex Transm Dis 2002 ; 29 : 360 – 365 .

Kleiber D Wilke M . Sexual behaviour of German (sex) tourists . Abstract WS‐D110‐2, 9th International Conference on AIDS, Berlin, Germany 1993.

Songkhla MN . Quality control of condoms in Thailand: a case study . J Med Assoc Thai 1993 ; 76 : 353 – 358 .

Deparis X Migliani R Merlin M . Evidence of risk factors for condom breakage among French military personnel stationed overseas . Med Trop (Mars) 1999 ; 59 : 266 – 270 .

Brisson M Boily MC Masse BR , et al . Highlights of the sexual activity of the heterosexual population in the province of Quebec . Sex Transm Infect 1999 ; 75 : 296 – 299 .

Leder K Weller PF Wilson ME . Travel vaccines and elderly persons: review of vaccines available in the United States . Clin Infect Dis 2001 ; 33 : 1553 – 1566 .

Wilson MM . Sexually transmitted diseases . Clin Geriatr Med 2003 ; 19 : 637 – 655 .

Van Kerkwijk C . Sex tourism in Thailand . AIDS Soc 1992 ; 4 : 6 – 7 .

Marrazzo JM . Sexual tourism: implications for travelers and the destination culture . Infect Dis Clin North Am 2005 ; 19 : 103 – 120 .

Puro V De Carli G Scognamiglio P , et al . Risk of HIV and other blood‐borne infections in the cardiac setting: patient‐to‐provider and provider‐to‐patient transmission . Ann N Y Acad Sci 2001 ; 946 : 291 – 309 .

Pinkerton SD Martin JN Roland ME , et al . Cost‐effectiveness of postexposure prophylaxis after sexual or injection‐drug exposure to human immunodeficiency virus . Arch Intern Med 2004 ; 164 : 46 – 54 .

Terrault NA . Sexual activity as a risk factor for hepatitis C . Hepatology 2002 ; 36 (5 Suppl 1): S99 – S105 .

O’Farrell N . Transmission of HIV: genital ulceration, sexual behaviour, and circumcision . Lancet 1989 ; 2 : 1157 .

Robinson WS . Hepatitis B virus and hepatitis D virus . In: Mandel G , Bennet JE , Dolin R , eds. Principles and practice of infectious diseases . Philadelphia, Churchill Livingstone , 2000 : 1652 – 1684 .

Sparling PF Handsfield HH . Neisseria gonorrheae . In: Mandel G , Bennet JE , Dolin R , eds. Principles and practice of infectious diseases . Philadelphia, Churchill Livingstone , 2000 : 2242 – 2258 .

Warner L Newman DR ., Austin HD , et al . Condom effectiveness for reducing transmission of gonorrhea and chlamydia: the importance of assessing partner infection status . Am J Epidemiol 2004 ; 159 : 242 – 251 .

Larouze B Gaudebout C Mercier E , et al . Infection with hepatitis A and B viruses in French volunteers working in tropical Africa . Am J Epidemiol 1987 ; 126 : 31 – 37 .

Lange WR Frame JD . High incidence of viral hepatitis among American missionaries in Africa . Am J Trop Med Hyg 1990 ; 43 : 527 – 533 .

Arvidson M Hellberg D Mardh PA . Sexually transmitted diseases in Swedish women with experience of casual sex with men of foreign nationalities within Sweden . Acta Obstet Gynecol Scand 1995 ; 74 : 794 – 798 .

Hiltunen‐Back E Haikala O Koskela P , et al . Epidemics due to imported syphilis in Finland . Sex Transm Dis 2002 ; 29 : 746 – 751 .

Abdullah AS Fielding R Hedley AJ , et al . Related reasons for not using condoms among the Hong Kong Chinese population: implications for HIV and STD prevention . Sex Transm Infect 2002 ; 78 : 180 – 184 .

Gunn RA Harper SL Borntrager DE , et al . Implementing a syphilis elimination and importation control strategy in a low‐incidence urban area: San Diego County, California, 1997‐1998 . Am J Public Health 2000 ; 90 : 1540 – 1544 .

Public Health Agency of Canada . Canadian guidelines on sexually transmitted infections 2006 (in press) Available at: http://www.phac-aspc.gc.ca/std-mts/sti_2006/sti-intro2006-e.html (2006 Aug 21).

CDC . Update: barrier protection against HIV infection and other sexually transmitted diseases . MMWR 1993 ; 42 : 589 – 591 , 597.

Donovan B . Sexually transmissible infections other than HIV . Lancet 2004 ; 363 : 545 – 556 .

Gallo MF Grimes DA Schulz KF . Non‐latex versus latex male condoms for contraception . Cochrane Database Syst Rev 2003 ; 2 :CD003550.

Holmes KK Levine R Weaver M . Effectiveness of condoms in preventing sexually transmitted infections . Bull World Health Organ 2004 ; 82 : 454 – 461 .

Latka M . Female‐initiated barrier methods for the prevention of STI/HIV: where are we now? Where should we go? J Urban Health 2001 ; 78 : 571 – 580 .

Macaluso M Lawson ML Hortin G , et al . Efficacy of the female condom as a barrier to semen during intercourse . Am J Epidemiol 2003 ; 157 : 289 – 297 .

Ask a Sex Therapist: How Do I Get Past the Pressure to Have Vacation Sex?

By Vanessa Marin

Sex should be fun, but it can also be complicated. Welcome to Sexual Resolution , a column by sex therapist Vanessa Marin that answers your most confidential questions to help you achieve the healthy, safe, and joyful sex life you deserve. In this edition, she offers advice to a reader who just doesn’t get why everyone else seems to love vacation sex.

DEAR VANESSA: I know everyone says vacation sex is the best, but for me, it's the worst. I hate the expectation that just because we're on vacation, we're supposed to be screwing like rabbits . I'd rather be sightseeing! My partner and I are about to go on vacation , and I know she wants to have a lot of sex. What can I do to take the pressure off? - Vacation Sex Hater, 29

DEAR VSH: First of all, you’re not alone. A lot of my clients express your same frustrations about vacation sex. Everybody thinks vacation sex is supposed to be magical, but for a lot of couples, it inadvertently creates a lot of pressure . When you feel expected or obligated to have sex, it can be hard to feel much actual desire.

Your first step is to have a conversation with your girlfriend before you two leave. Don’t wait until you’re already on vacation and arguing about not having sex. Let her know first that you like being intimate with her, and give her some personal reasons why. Whenever you need to have a tough conversation about your sex life, it’s always great to start with compliments. It can help make the conversation feel more comfortable, and it helps your partner recognize that there are still plenty of great things about your sex life.

Then, let your girlfriend know that you’re feeling pressured by the idea of vacation sex. Tell her you want to enjoy this special time away together, but that the pressure of needing to have hot sex is blocking the desire you usually feel. Ask your girlfriend what her specific desires are for your time away together.

It’s possible that you may be overestimating what she wants because you’re feeling anxious about the trip. Maybe “a lot of sex” to her is once or twice during the trip. Maybe it’s a quickie before your next sightseeing adventure. Maybe it’s wanting more time for cuddling and making out. Just ask her.

It would also be useful for you to be honest about what your non-vacation sex life looks like. Is your girlfriend excited about this vacation because you guys haven’t had sex in weeks or months? Have the two of you argued about how frequently you each want to be having sex? It’s possible that this upcoming trip is highlighting issues that you two have in your sex life overall. It may be a sign that the two of you have some broader work to do. You may want to talk about scheduling sex, talking to a sex therapist, or doing couples counseling.

If your sex life is generally fine, and it’s really just the specific vacation issue that’s bothering you, try asking yourself this question: “What would I need to feel open to having sex on vacation?” The beauty of travel is that you don’t have to stick to your usual routine. Your entire days are free for you to schedule. There can be time for sightseeing and for connecting intimately. So think about what specific dynamics you would like to have in place in order to feel open to being intimate.

Here are some ideas to amp up the intimacy in your relationship:

• Have a date night, so you guys are flirting all evening before being intimate later. If you’re staying at a nice hotel, you can even ask your concierge to arrange a date night for you.
• Try morning sex, so you can have the rest of the day for sightseeing adventures.
• Or try a quickie at the end of a long day of sightseeing.
• Visit a local sex shop or lingerie store to put you in the mood.
• Define “sex” in different ways. Maybe you feel more open to making more space for make-out sessions, or for masturbating with each other.
• Schedule sex on specific days of the trip, so you both know exactly what to expect and look forward to.

By Aliza Kelly

By Marci Robin

By Kara McGrath

You may also want to think about how your girlfriend can support you in feeling desire on this trip. Maybe she usually complains about the sightseeing stuff you want to do. If she were to be more enthusiastic about going along with some of your plans, would that make you feel more enthusiastic about some of hers? Maybe the two of you could even trade off planning days of the trip?

At the end of the day, it’s perfectly fine for you to not be a big vacation sex fan. You just want to make sure you put forth the same amount of effort and intention into your vacation sex life as you do into your at-home sex life.

Read more about sex and relationships:

• Ask a Sex Therapist: Why Is My Vagina Always So Dry During Sex?
• Women Reveal What They Were Thinking the Last Time They Had Sex
• 22 Sex-Positive Porn Sites You'll Want to Pay For

Now, watch Ruby Rose try 9 things she's never done before:

Vanessa Marin is a licensed sex therapist based in Los Angeles. You can find her on Twitter , Instagram , and her website .

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By Jessica Cruel

By Sophie Saint Thomas

• Open access
• Published: 27 November 2020

Sun, sea and sex: a review of the sex tourism literature

• Timothy Siliang Lu 1 ,
• Andrea Holmes 1 , 2 ,
• Chris Noone 3 &
• Gerard Thomas Flaherty   ORCID: orcid.org/0000-0002-5987-1658 1 , 4  

Tropical Diseases, Travel Medicine and Vaccines volume  6 , Article number:  24 ( 2020 ) Cite this article

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Sex tourism is defined as travel planned specifically for the purpose of sex, generally to a country where prostitution is legal. While much of the literature on sex tourism relates to the commercial sex worker industry, sex tourism also finds expression in non-transactional sexual encounters. This narrative review explores current concepts related to travel and sex, with a focus on trans-national sex tourism.

The PubMed database was accessed to source relevant literature, using combinations of pertinent search terms. Only articles published in the English language were selected. Reference lists of published articles were also examined for relevant articles.

With regard to preferred destinations, South/Central America and the Caribbean were more likely to receive tourists looking for casual sex. Longer duration of travel, travelling alone or with friends, alcohol or drug use, being younger and being single were factors associated with higher levels of casual sex overseas. The majority of literature retrieved on sex workers focused on risk behaviours, sexually transmitted infections (STI), mobility of sex workers and how these factors affected their lives. Sex tourists require better access to effective methods of preventing HIV, such as pre-exposure prophylaxis, and better education on HIV prevention. Drugs and alcohol play a major role as risk factors for and cofactors in casual sexual behaviour while abroad.

Conclusions

Travellers need to be informed of the increased risks of STI before travel. They should be aware of the local prevalence of STIs and the risks associated with their sexual practices when they travel, including engaging with commercial sex workers, having unprotected sexual intercourse and becoming victims of sexual violence.

Prior to the current pandemic of COVID-19, international travel had reached record levels of activity, with 1.4 billion traveller arrivals recorded in 2018 [ 1 ]. Sex and travel have a long association, dating from the ancient world onwards [ 2 ], and their connection is still apparent today. Sex tourism is defined by the Centre for Disease Control and Prevention (CDC) as “travel planned specifically for the purpose of sex, generally to a country where prostitution is legal” [ 3 ]. Domestic sex tourism implies travel within the same country, while trans-national sex tourism refers to travel across international boundaries.

While much of the literature on sex tourism relates to the commercial sex worker industry, which remains illegal in many jurisdictions, sex tourism also finds expression in non-transactional sexual encounters, typically involving a tourist from an economically developed country seeking sexual experiences in developing host destinations. In some cases, travellers may engage in sex tourism to validate their own sexual identity with greater freedom than would be allowed in their own, more conservative nations. The main source of opposition to sex tourism concerns the troubling phenomenon of child sex tourism, which will be explored later in this review.

The link between travelling and the spread of disease is undeniable, as demonstrated by the current COVID-19 pandemic. As the travel landscape changes in the aftermath of the pandemic, so will the behaviour of travellers. The subject of sex tourism has been neglected to date in the travel medicine literature and receives little attention in the pre-travel health consultation. This narrative review explores current concepts related to travel and sex, with a focus on trans-national sex tourism, while also giving an insight into specific risks and behaviours associated with this activity.

Literature search strategy

The PubMed database was accessed between June 2019 and June 2020 to source relevant literature using combinations of the following search terms: Sex, Tourism, Travel, Migration, Holiday, Abroad, Vacation, Sexually Transmitted Infection, Sexually Transmitted Disease, Human Immunodeficiency Virus, Prostitution, Drugs, Alcohol, Trafficking, Rape, Child, Military, Navy, Defence Forces, Business, Homosexual, Heterosexual, LGBTQ+, Transgender, Asia, North America, South America, Europe, Oceania, Africa. Only articles published in the English language were selected. Articles published within the past 5 years were prioritised. Reference lists of published articles were examined to ensure all relevant articles were included. Relevant sources of grey literature were also retrieved using Google® as a search engine. The legality of prostitution in different international jurisdictions, governmental attempts to regulate the sex tourism industry and the extraterritorial criminalisation of child sex tourism were beyond the scope of the current review.

Epidemiology of sex and travel

In the context of this review, we define casual sex as sexual relations undertaken without serious intent or emotional commitment between individuals who are not established sexual partners or do not know each other well. Men were more likely to seek out or engage in casual or risky sex behaviours (e.g., multiple partners, unprotected intercourse) while travelling [ 4 , 5 , 6 ]. As many as 1 in 10 men were recorded as having an overseas partner in a British study [ 6 ], and different categories of male sex tourist have also been proposed in the literature [ 7 ], ranging from the ‘macho lad’ asserting his dominance over foreign women to the ‘white knight’ saving women from commercial sex work. A study from the United States showed that female travellers had a greater preference for travel to European or tropical countries, and that sex was more likely to occur on group tours, sightseeing or backpacking holidays lasting fewer than 14 days [ 8 ]. Female sex tourism has also been described in Caribbean destinations such as Jamaica, with Euro-American women purchasing the services of so-called “Rent-A-Dreads”, local men who seek out relationships with tourist women for economic gain [ 9 ]. Younger women were reported to prefer expatriates and other tourists as sexual partners [ 10 ], while men of all ages and older women were reported to exercise a preference for local partners.

With regards to preferred destinations, a meta-analysis conducted in 2018 showed that South/Central America and the Caribbean were more likely to receive tourists looking for casual sex [ 5 ]. Additionally, Thailand and Cuba also have a prevalent sex tourism industry [ 7 , 11 ]. One study found that 66% of Australian tourists to Thailand were planning on having a sexual encounter while there [ 11 ], while sex tourism in Cuba has been described as “integral to the Cuban experience” [ 12 ]. Traveller subtypes who were more likely to engage in sex included backpackers, travelling businessmen, those visiting friends and relatives (VFR), and those travelling specifically to solicit commercial sex workers [ 5 ]. Factors associated with popular sex tourism destinations are described in Table  1 .

Several studies report that longer duration of travel (greater than 1 month), travelling alone or with friends, alcohol or drug use, being younger and being single were factors associated with higher levels of casual sex overseas [ 4 , 5 , 6 ]. A study conducted in Sweden reported conflicting data, showing that short term travellers (less than 5 days) were 20 times more likely to engage in casual sex [ 16 ]. While few studies offered information linking different ethnicities to sexual behaviour overseas, one British study found that non-white citizens were more likely to engage in sexual behaviour while travelling [ 6 ]. Migrants and members of the lesbian, gay, bisexual, transgender and queer (LGBTQ+) community are also discussed frequently in the sex tourism literature. A summary of the characteristics associated with sexual risk behaviour is shown in Table  2 . This will be explored further in this review. Studies of travellers engaging in sex with tourism representatives [ 11 ], sex workers and fellow travellers [ 5 ] show that choice of partner while travelling is not limited to any particular demographic.

Commercial sex work and travel

Travellers may engage in planned or opportunistic interactions with commercial sex workers (CSW). The majority of literature we retrieved on sex workers focused on risk behaviours, sexually transmitted infections (STI), mobility of sex workers and how these factors affected their lives. De et al. examined the different categories of sex worker in the region of Bangui in the Central African Republic, and found that 1 in 4 of ‘Pupulenge’, the higher class sex worker more likely to cater to foreigners, had poor regular usage of condoms in the previous 3 months, but better knowledge of their HIV/AIDS risk and status [ 24 ]. There were similar findings among male sex workers in Jamaica, who regarded themselves more as long term romantic partners of female tourists, and as such had low levels of condom usage [ 13 ]. In addition, these men had reported misuse of alcohol and drugs, and were accustomed to having multiple partners.

Safe sex behaviours were also shown to be highly dependent on the travel destination. A study in Singapore showed that 87.5% of local men used condoms when engaging a sex worker in Singapore, but when travelling the rate dropped to between 44 and 77%, depending on location [ 25 ]. This finding was supported by research from Hong Kong, which also showed that heterosexual men reported lower levels of condom usage when visiting sex workers outside of their own country [ 26 ]. Hsieh et al. [ 27 ] proposed that the clients of sex workers could facilitate the spread of STIs between different nations and networks to a larger degree than sex workers, while also contributing to STI prevalence within their own communities.

An interesting area with limited research evidence is the role sex tourism websites play, with only one paper identified on this subject [ 28 ]. This article analysed various sex tourism websites and found that most displayed sex workers as commodities, to be chosen and paid for by tourists, portraying them as exotic third world women, capable of providing a “total girlfriend experience”, enjoying the company of foreigners and being completely subservient to them. This study proposed that these websites enforce the fiction behind sex tourism and, in doing so, sustain the possible misogynistic views of the sex tourist. It was also noted that any legal or health information on these websites was centred round the tourist, rather than the sex worker.

The risks faced by non-commercial partners of sex workers have also been studied. An examination of CSW in a Mexican border town with high migratory traffic found that unprotected sex was often common in their personal relationships, too [ 29 ]. The literature relating to CSW and travel showed that multiple parties are implicated in commercial sex networks, and the behaviour of any one individual in these networks has implications for many others. Table  3 below summarises these findings.

• Sexually transmitted infections

The association of sex tourism and casual sex during travel with the spread of novel STIs has long been recognised. It has been suggested that Columbus’ sailors were responsible for the epidemic of venereal syphilis in Europe in the late fifteenth century following sexual relations with local Haitian women [ 2 ], while the link between travel and the spread of novel STIs was also established in Thailand in the 1980s [ 30 ], and Trinidad and Tobago in 2012 [ 31 ]. Travellers are also thought to be implicated in the reintroduction of syphilis and lymphogranuloma venereum to parts of North America and Europe [ 25 ]. The risk factors for traveller acquisition of STIs include longer duration of stay, travel to lower income countries, being single, substance abuse, being male, repeat visits to the same area, and a previous history of multiple partners or STIs [ 32 , 33 ]. Crawford et al. identified being female, having a history of fewer sexual partners, and having received pre-travel health advice and vaccinations as being associated with a lower risk of contracting STIs among expatriates and travellers [ 32 ].

While prevalence rates for STIs among CSW vary, rates as high as 88% in Nairobi and 44% in Bangkok have been reported [ 34 ]. In addition to this, high rates of curable STI prevail worldwide, ranging from 5 to 65% in Africa, 20.9% in Brazil and 0–13.6% in Asia [ 10 ]. These findings put sex tourists at very high risk for STIs on a global scale. A diverse range of STIs has been recorded in travellers returning from tropical countries [ 35 ], from frequent detection of genital herpes in sailors returning to China [ 36 ], to the suggested “new” STI Tinea genitalis , found in several individuals with a recent travel sex history in Southeast Asia [ 37 ]. While this type of dermatophyte infection is not primarily an STI, the sudden rise in cases associated with it over a short period highlights how vulnerable travellers are to organisms transferable through intimate contact during travel.

A study examining all cases of gonorrhoea contracted by people living in Nordic nations between 2008 and 2013 showed that 25.5% of all cases were associated with travel [ 14 ]. The rates of travel-associated gonorrhoea increased from year to year and, while the majority of cases involved men, the number of affected women increased from year to year. Among the regions visited, the majority of Nordic travel-associated cases of gonorrhoea were associated with travel to Asia (between December and July) and Europe (from August to November), a third of cases were associated with travel to Thailand, and travel to Thailand, Philippines and Spain accounted for almost half of all travel-related cases. These data imply that specific regions can be considered hotspots for contraction of STIs during travel.

Another important consideration is the acquisition and spread of antimicrobial resistant (AMR) STIs. In recent years, the rise in AMR involving Haemophilus ducreyi has been documented worldwide [ 10 ]. Similarly, beta-lactamase producing strains of Neisseria gonorrhoeae have been detected in Africa, the Caribbean and Asia. In isolates of N. gonorrhoeae from Africa and Southeast Asia, penicillin resistance has been reported in as many as 50% of isolates. Baker et al. also noted the worldwide spread of azithromycin-resistant shigellosis through sexual transmission, from high prevalence regions in Africa and Asia, to lower prevalence nations [ 38 ]. The documented increase in AMR STIs puts travellers engaging in sexual behaviour at high risk of treatment-resistant infection.

Current efforts to advise and change traveller behaviours have been shown to be of limited effectiveness. A study of different efforts to curtail travellers’ risk behaviour showed that providing brief interventions on sexual health during consults for travellers proved minimally more effective than just distributing condoms or not providing additional advice [ 39 ]. This trial showed that the methods employed still resulted in low levels of condom usage. In a study by Croughs et al., extensive motivational training was shown to reduce sexual risk behaviour, and it was also found that written materials on STIs were more effective than having travel health practitioners discuss STI prevention with travellers [ 40 ]. A change in strategy appears necessary to combat the risk-taking behaviours of travellers, especially given the reported difficulty of reaching target audiences [ 41 ].

This is an important area that warrants further research, given poor recorded levels of condom usage in travellers. A meta-analysis of literature on this subject found that the pooled prevalence of unprotected intercourse among travellers who had sex overseas was 49.4% [ 42 ]. Similar results have been shown among sexually active backpackers visiting Ko Tao and Ko Phangan in Thailand, with a third of subjects reporting inconsistent condom use. An online cross-sectional study of travellers was conducted in 2014 [ 15 ], and among the sexually active population 59.7% reported inconsistent condom use. A study of condom usage among Swedish travellers revealed flawed reasoning for decisions around condom usage, such as length of familiarity with partner, the country visited, and asking if their partner had an STI [ 43 ]. This same study also revealed that some travellers succumbed to peer pressure, were more willing to let their partner make the decision, and had a fear of being seen as promiscuous (among heterosexual women) or a fear of ‘ruining the moment’ (among heterosexual men), leading to reduced condom usage. Other factors associated with reduced usage were the belief that foreign condoms were of poorer quality [ 34 ], spontaneous sexual encounters or embarrassment at purchasing condoms [ 43 ], substance use [ 15 , 32 , 43 ], and travel to Latin America or the Caribbean [ 15 ]. An examination of male sex tourists to Thailand also revealed that unprotected sex was seen as more masculine and enjoyable, and there was a general misconception among male sex tourists that unprotected heterosexual intercourse was a low risk activity [ 44 ]. This same study also showed that male heterosexual sex tourists were aware of risks, but due to their own personal or peer experiences being at variance with the warnings they received regarding risky sexual behaviour, they were more likely to engage in unprotected sex with CSW. The low rates of condom usage put sexually active travellers at an obvious risk for contraction of STIs.

It is accepted that contracting an STI increases the risk of HIV transmission, and vice versa [ 45 ]. A Geosentinel analysis from 2013 indicated that, out of a sample of 64,335 travellers, 117 returned home with acute symptoms of HIV transmission [ 46 ]. In addition, links between clusters of HIV acquisition in Belize, Mexico, Guatemala and Honduras have been found. This finding highlighted the role migration and travel play in the transmission of HIV within Central America. This study also found half of Honduran woman sampled with HIV belonged to viral clusters that were linked to international clusters. Memish and Osoba also noted in their paper on STIs and travel that travellers to Sub-Saharan Africa, Southeast Asia and India were most likely to acquire HIV from unprotected sexual encounters [ 2 ]. The voluminous literature relating to STIs and travel indicates that this is an area of key importance to the travel medicine practitioner. While the effectiveness to date of interventions in altering risk behaviours in travellers has been questionable, it is clear that travellers require better access to effective methods of preventing HIV, such as pre-exposure prophylaxis (PrEP), and better education on HIV prevention.

The LGBTQ+ community and travel sex behaviour

A meta-analysis published in 2018 revealed that gay, bisexual and other men who have sex with men (MSM) travellers were 3 times more likely to have casual sex while travelling [ 5 ]. Travel or migration may allow members of the LGBTQ+ community to escape from societal pressures they face in their home countries and explore their sexuality [ 17 ]. MSM are also more likely than heterosexual men to have multiple partners during their travels. MSM have also shown to be at least twice as likely to pay for sex compared to heterosexual men [ 10 ]. A report on MSM travellers in the United States also found that 19.4% of those surveyed reported that having sex with a new partner was one of their main goals while on vacation [ 18 ]. Further studies in the US on MSM travellers to Key West, a popular destination for LGBTQ+ travellers in Florida, found that of the sexually active participants, 34% had new partners, and 59% had unprotected anal intercourse (UAI) [ 19 ]. Among Swedish MSM travellers, 13.5% reported UAI during their overseas travels, the majority of whom met a new partner abroad [ 20 ]. Additional studies in China involving MSM found that 5% identified as sex tourists, a third of this group identified the purchase of sex as a primary reason for travel, and another third had UAI while travelling [ 21 ].

While limited research exists on other categories of travellers within the LGBTQ+ community, one paper on transgender women in Bangladesh revealed that those who crossed international borders had a greater number of transactional sex partners and reduced use of condoms [ 22 ]. Across all of these studies, regular associations between travel and drug and alcohol use, transactional sex, group sex, a history of STIs and a greater number of past partners were reported [ 18 , 19 , 20 , 21 , 22 , 23 ].

Another interesting area of development in LGBTQ+ international travel trends is the resurgence of circuit parties [ 47 ]. These parties involve weekend-long social activities and dance events. Party-goers were found more likely to have a greater number of partners in the previous 6 months, greater use of recreational drugs, more likely to seek transactional sex, and more likely to report a personal history of STI and UAI. A common finding with these parties was attendees travelling from low HIV prevalence countries to high prevalence countries. This finding was replicated among Chinese MSM travellers [ 21 ]. These social events are commonly associated with the use of drugs which heighten sexual arousal, an activity referred to as ‘chemsex’.

Networks of MSM travellers have also been described around the world. A group of MSM referred to as “Geoflexibles” was identified by Gesink et al. in 2018 [ 48 ]. The authors described a group of men who were willing to travel for sex, and who were less particular about where they had sex. Gesink proposed that these travellers could act as a bridge between MSM in Toronto and, although his study did not specifically mention international travel, it is certainly applicable in the travel context. Networks of MSM implicated in the transmission of STIs and HIV have been suggested in the literature. Persson et al. suggested the presence of a network in Sweden with a high prevalence of STI/HIV [ 20 ], and an examination of HIV clusters in Central America found that half of the people living with HIV were MSM, with serotypes closely related to international clusters [ 49 ]. The suggestion of international MSM networks and travel playing a role in the dispersion of STI/HIV was reinforced by Takebe et al. in 2014 [ 50 ]. Their research revealed the worldwide dispersal of the JP.MSM.B1 subtype of HIV, and confirmed the interactions of HIV epidemics between Japan, China and the rest of the world. These networks have also been implicated in Shigella transmission in San Francisco [ 51 ], in addition to an outbreak of Hepatitis A in Northern Italy [ 52 ].

These findings have implications for LGBTQ+ travellers who engage in sexual behaviour while abroad. Mathematical modelling of LGBTQ+ tourists to Key West estimated that 1 in 196.5 MSM who engage in risk behaviour will acquire HIV [ 19 ], roughly equating to 200 new infections per 100,000 tourists, a number which could drop to as low as 45 with consistent condom use. In 77% of sexual interactions in this study, HIV serostatus was not discussed. Studies about MSM travellers in San Francisco showed that, among those who engaged in casual sex, there was a decreased probability of HIV serodisclosure when communication was an issue owing to language barriers [ 53 ]. A follow up study was conducted on the health-seeking behaviour of MSM travellers, revealing that a quarter of those surveyed had not received the Hepatitis B virus vaccine, and of the men living with HIV, a third had not been vaccinated [ 54 ].

Another facet of the intersection between sex tourism and HIV transmission that warrants attention is the relatively new phenomenon of “holiday pre-exposure prophylaxis” (PrEP) for HIV. With PrEP being a relatively new phenomenon, limited literature exists on the subject in relation to travel, but interviews conducted by Underhill et al. suggest that MSM travellers regard themselves as at greater risk for HIV while travelling and are more willing to take PrEP [ 55 ]. However, travel has also been associated with disruption in PrEP regimens due to inconvenience [ 56 , 57 ], so the role it plays in sex tourism warrants further research.

Travel for the purposes of sexual exploration and casual sex among MSM presents a challenge to travel medicine practitioners. Analysis of Swedish MSM travellers in 2015 revealed that there was little HIV or STI prevention information received in Sweden or abroad [ 58 ]. In addition, only 3% of the surveyed population sought out this information before travelling. A further investigation of the knowledge, attitudes and practices of MSM travellers is required to plan successful interventions in this population of international travellers. More research on how sex tourism is experienced by women and gender diverse people within the LGBTQ+ community is also warranted.

The effects of alcohol and drugs on sex tourism

Drugs and alcohol play a major role as risk factors for and cofactors in casual sexual behaviour while abroad. A study of British summer workers in Ibiza found that almost all those surveyed drank alcohol, while 85.3% used drugs during their stay, a high proportion of whom used drugs that they had never tried before [ 59 ]. This study found that the odds of having sex increased with the use of amphetamines or higher frequency of drinking, while the odds of having multiple partners increased with greater frequency of drinking. Unprotected sex was also found to be more likely when alcohol was involved.

Extensive analysis of American students on Spring Break has also been conducted to analyse the role alcohol plays in high risk behaviour during this period. Patrick et al. found that a greater proportion of students drank alcohol before having sex or making risky sexual decisions [ 60 ]. This finding was particularly prevalent among students who travelled abroad. Another study of Spring Break students found that risky behaviours such as unprotected sex or multiple partners were cumulative [ 61 ], such that engaging in one activity increased risk for the other. Almost half of the students in this study reported binge drinking before sex. The role alcohol and drugs play in exposing travellers to risky sexual behaviour is clear, but this appears to be poorly appreciated by the traveller. Travel health practitioners must emphasise the risks travellers expose themselves to when misusing alcohol and drugs.

Sexual assault and violence in travellers

A cross-sectional survey on travellers returning from Mediterranean resorts reported that 1.5% were subject to non-consensual sex during their travels, with gay and bisexual males reporting higher levels [ 62 ]. In this same report, 8.6% of respondents experienced some form of sexual harassment, with females and gay/bisexual males more frequently reporting this. Another finding was that being a gay/bisexual male, using marijuana, and patronising bars where there were opportunities for sex were factors associated with being subject to non-consensual sex. A similar study on the harassment of tourists in Barbados found between 7 and 12% of tourists reported sexual harassment, depending on their country of origin [ 63 ]. Kennedy and Flaherty also asserted that up to 4% of Irish citizens reporting sexual violence experience it while travelling [ 64 ]. A review from Canada of all reported sexual assault cases associated with mass gathering events found a significant association between being overseas and being sexually assaulted at such an event [ 65 ]. Table  4 outlines the pre-travel health advice which should be available to travellers who may engage in sex tourism.

Child sex tourism

Klain described two main types of child sex tourist, the “elective sex tourist” who travels for leisure or business and makes unplanned use of child sex workers when given the opportunity, and the “core sex tourist”, the purpose of whose trip is solely to engage in sexual contact with a child [ 66 ]. A study of German tourists conducted in 2017 found that 0.4% reported being child sex tourists [ 67 ]. This same study found that these individuals usually had personal experiences of abuse, paedophilic and antisocial behaviours. With an estimated 1.2 million children trafficked worldwide annually [ 67 ], more research is urgently needed on this topic.

The effects of wealth and mobility on sex tourism

Aggleton et al. describe in their paper a specific group of travellers, “mobile men with money” [ 68 ]. These men come from diverse backgrounds and various employments, but share two common features, high spending power and high mobility. In the paper, these men were said to frequently use their high spending power and resources to engage in casual and transactional sex encounters. This group of men was found to be at high risk for HIV. The paper proposed that these men lacked social support and were frequently influenced by the behaviour of their peers. While further literature on this sub-group is lacking, travel to lower income countries and the resulting increase in spending power for the traveller have been documented as risk factors for acquisition of STI/HIV [ 32 ]. This would suggest that wealth inequality may have a role in influencing risk behaviours in certain individuals.

Impact of sex tourism on host communities

While a detailed consideration of the impact of sex tourists on sex tourism destinations is beyond the scope of the current work, some key issues are worthy of discussion. Local cultural attitudes towards sex tourism are complex and are influenced by harsh economic conditions, where impoverished families may find themselves with few options for survival and have to resort to sending their children to urban centres visited by sex tourists. There may be an expectation in some cultures that children will share the family’s financial burden. Remittances from a family member engaged in the sex tourism industry may be vital to enable families to improve their quality of life.

Child sex tourism produces a detrimental impact on the children’s capacity to achieve their goals within the education system. Sex tourism may reinforce traditional colonial attitudes towards race and gender, which serve to deepen existing socioeconomic inequalities. Local communities are often reluctant to intervene in cases of child sexual exploitation, given the complex underlying economic precipitants and the greater level of public acceptability of prostitution in some countries. Such attitudes render children far more vulnerable to being absorbed by the adult sex trade and becoming sexually exploited by sex tourists, who may use the anonymity afforded by the dark web as a global networking tool to share information with other sex tourists.

The COVID-19 pandemic has led to school closures and a higher risk of contact between children and online sexual predators. It has isolated victims of child trafficking and sex tourism from available support structures and jeopardised their usual escape routes. The reported 30% increase in consumption of online child pornography during recent periods of pandemic lockdown in Europe, for example, have further increased the demand for child exploitation [ 69 ]. The current restrictions on international travel will undoubtedly influence sex tourism patterns worldwide, leading to greater degrees of domestic child abuse and online sexual exploitation. Further research may shed a light on this and other COVID-related secondary effects on the sex tourism industry.

Future considerations in sex tourism

While the world prepares for a cautious return to routine international travel in a future post-COVID era [ 70 ], we may ponder what constitutes a traveller or a tourist in the modern era. Opperman proposed the idea of a ‘cyberspace tourist’ in his paper on sex tourism [ 71 ]. While we have not found any further literature on this subject, is a person who sits at a computer in his/her home and pays for a voyeuristic virtual reality experience involving a foreigner thousands of miles away a cyber-sex tourist? With the rapid advancements in technology in recent years, we may contemplate whether people even need to leave their home to “travel”. It is conceivable that future sexual experiences will mirror these changes in travel patterns. With PrEP being a recent development, the role it plays in protecting travellers exposed to HIV overseas remains to be seen. This is a potential area of research activity as it becomes established as a mainstay preventive option. Possible areas of unmet need in sex tourism research are presented in Table  5 .

Limitations of current review

Strengths of our review include its multidisciplinary authorship, its broad coverage of diverse facets of sex tourism, and the focus on the most recent literature on the subject. Limitations of our approach include its restriction to articles published in the English language and the use of a single medical literature database. Accessing literature on sex tourism from Latin America and the Caribbean, using the Latin American and Caribbean Health Sciences Literature virtual library, for example, may have provided deeper insights into the impact of sex tourism on host communities. It is reasonable to assume that relevant literature on sex tourism resides in the social sciences literature such as the Social Sciences Citation Index of the Web of Science. Future reviews on this topic should also consult an appropriate social sciences database and refer to relevant material from the anthropological literature.

In our review of the literature associated with sex and travel, it was clear that the same set of risk behaviours and consequences applied to diverse groups. We recommend that more research be conducted into novel and effective interventions for modifying these high-risk behaviours. Travellers should be informed of the increased risks of STI before they travel. They should be aware of the prevalence of STIs in the area they plan to visit, and the risks associated with their sexual practices when they travel, including engaging with commercial sex workers, practising chemsex, engaging in unprotected sexual intercourse, and becoming the victim of sexual violence. They should also be informed about how to access appropriate medical care overseas and as returned travellers, should they require it.

Availability of data and materials

All material referenced in the preparation of this work are available from the corresponding author.

Roser M. Tourism [Internet]. Our World in Data. 2017 [cited 2019 Jul 8]. Available from: https://ourworldindata.org/tourism .

Memish ZA, Osoba AO. Sexually transmitted diseases and travel. Int J Antimicrob Agents. 2003;21(2):131–4.

Article   CAS   PubMed   Google Scholar  

Sex Tourism | Travelers’ Health | CDC [Internet]. [cited 2019 Jul 8]. Available from: https://wwwnc.cdc.gov/travel/page/sex-tourism .

Sundbeck M, Emmelin A, Mannheimer L, Miörner H, Agardh A. Sexual risk-taking during travel abroad – a cross-sectional survey among youth in Sweden. Travel Med Infect Dis. 2016 May 1;14(3):233–41.

Article   PubMed   Google Scholar  

Svensson P, Sundbeck M, Persson KI, Stafström M, Östergren P-O, Mannheimer L, et al. A meta-analysis and systematic literature review of factors associated with sexual risk-taking during international travel. Travel Med Infect Dis. 2018 Jul 1;24:65–88.

Tanton C, Johnson AM, Macdowall W, Datta J, Clifton S, Field N, et al. Original article: forming new sex partnerships while overseas: findings from the third British National Survey of sexual attitudes &amp; lifestyles (Natsal-3). Sex Transm Infect. 2016;92(6):415.

Article   PubMed   PubMed Central   Google Scholar  

Garrick D. Excuses, excuses: Rationalisations of Western sex tourists in Thailand. Curr Issues Tour. 2005;8(6):497–509.

Article   Google Scholar  

Berdychevsky L, Gibson HJ. Sex and risk in young women’s tourist experiences: context, likelihood, and consequences. Tour Manag. 2015;51:78–90.

Deborah P, Suzanne L. For love and money: romance tourism in Jamaica. Ann Tour Res. 1995;22(2):422–40.

Ward BJ, Plourde P. Travel and sexually transmitted infections. J Travel Med. 2006;13(5):300–17.

Simkhada PP, Sharma A, van Teijlingen ER, Beanland RL. Factors influencing sexual behaviour between tourists and tourism employees: A systematic review. Nepal J Epidemiol. 2016;6(1);530-8.

Simoni V. Coping with ambiguous relationships- sex, tourism, and transformation in Cuba. J Tour Cult Chang. 2014;12(2):166–83.

Johnson LC. ‘Men at risk’: sex work, tourism, and STI/HIV risk in Jamaica. Cult Health Sex. 2016 Sep 22;18(9):1025–38.

Beauté J, Cowan S, Hiltunen-Back E, Kløvstad H, Velicko I, Spiteri G. Travel-associated gonorrhoea in four Nordic countries, 2008 to 2013. Euro Surveill. 2017 May;18:22(20).

Google Scholar  

Alcedo S, Kossuth-Cabrejos S, Piscoya A, Mayta-Tristán P. Factors associated with non-use of condoms in an online community of frequent travellers. Travel Med Infect Dis. 2014;12(6):750–6.

Sundbeck M, Agardh A, Östergren P-O. Travel abroad increases sexual health risk-taking among Swedish youth: a population-based study using a case-crossover strategy. Glob Health Action. 2017;10(1):1330511.

Mole RCM, Parutis V, Gerry CJ, Burns FM. The impact of migration on the sexual health, behaviours and attitudes of central and east European gay/bisexual men in London. Ethn Health. 2014;19(1):86–99.

Elsesser SA, Oldenburg CE, Biello KB, Mimiaga MJ, Safren SA, Egan JE, et al. Seasons of risk: anticipated behavior on vacation and interest in episodic antiretroviral pre-exposure prophylaxis (PrEP) among a large National Sample of U.S. men who have sex with men (MSM). AIDS Behav. 2016;20(7):1400–7.

Benotsch EG, Mikytuck JJ, Ragsdale K, Pinkerton SD. Sexual risk and HIV acquisition among men who have sex with men travelers to Key West, Florida: a mathematical modeling analysis. AIDS Patient Care STDs. 2006;20(8):549–56.

Persson KI, Berglund T, Bergström J, Tikkanen R, Thorson A, Forsberg B. Place and practice: sexual risk behaviour while travelling abroad among Swedish men who have sex with men. Travel Med Infect Dis. 2018 Sep 1;25:58–64.

Wong NS, Tang S, Tang W, Wei C, Tucker JD, Liu C, et al. Sex tourism among Chinese men who have sex with men: a cross-sectional observational study. BMC Public Health. 2018;18(1):1–12.

Rana AKMM, Reza MM, Alam MS, Khatun M, Khan SI, Azim T. Effects of in-country and cross-border mobility on condom use among transgender women (hijras) in Bangladesh: a cross-sectional study. AIDS Behav. 2016;20(10):2165–77.

Zablotska IB, Holt M, de Wit J, Mao L, Down I, Prestage G. At home and away: gay men and high risk sexual practices. AIDS Behav. 2014;18(8):1436–42.

PubMed   Google Scholar  

De J, Longo D, Simaléko MM, Ngbale R, Grésenguet G, Brücker G, et al. Spectrum of female commercial sex work in Bangui, Central African Republic. J Social Aspects of HIV/AIDS. 2017;14(1):171–84.

Avery AK, Zenilman JM. Sexually transmitted diseases and travel: from boudoir to bordello. Microbiol Spectr. 2015;1:3(5).

Lau J, Tang A, Tsui H. The relationship between condom use, sexually transmitted diseases, and location of commercial sex transaction among male Hong Kong clients. AIDS. 2003;17(1):105–12.

Hsieh C-S, Kovářík J, Logan T. How central are clients in sexual networks created by commercial sex? Sci Rep. 2014;4:7540.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Gezinski LB, Karandikar S, Levitt A, Ghaffarian R. ‘Total girlfriend experience’: examining marketplace mythologies on sex tourism websites. Cult Health Sex. 2016 Jul 2;18(7):785–98.

Syvertsen JL, Robertson AM, Palinkas LA, Rangel MG, Martinez G, Strathdee SA. “Where sex ends and emotions begin”: love and HIV risk among female sex workers and their intimate, non-commercial partners along the Mexico-US border. Cult Health Sex. 2013;15(5):540–54.

Cohen E. Tourism and AIDS in Thailand. Ann Tour Res. 1988;15(4):467–86.

George A, Richards D. A paradigm shift in the relationship between tourists and their hosts: the impact on the HIV/AIDS epidemic in Trinidad and Tobago. J Hum Resour Hosp Tour. 2012;11(3):197–209.

Crawford G, Lobo R, Brown G, Macri C, Smith H, Maycock B. HIV, Other Blood-Borne Viruses and Sexually Transmitted Infections amongst Expatriates and Travellers to Low- and Middle-Income Countries: A Systematic Review. Int J Environ Res Public Health. 2016;13:12.

Hawkes S, Hart GJ, Bletsoe E, Shergold C, Johnson AM. Risk behaviour and STD acquisition in genitourinary clinic attenders who have travelled. Sex Transm Infect. 2008;71(6):351–4.

Korzeniewski K, Juszczak D. Travel-related sexually transmitted infections. Int Marit Health. 2015 Dec 22;66(4):238–46.

Ansart S, Hochedez P, Perez L, Bricaire F, Caumes E. Sexually transmitted diseases diagnosed among travelers returning from the tropics. J Travel Med. 2009;16(2):79–83.

Fang L-Q, Sun Y, Zhao G-P, Liu L-J, Jiang Z-J, Fan Z-W, et al. Travel-related infections in mainland China, 2014–16: an active surveillance study. Lancet Public Heal. 2018 Aug 1;3(8):e385–94.

Luchsinger I, Bosshard PP, Kasper RS, Reinhardt D, Lautenschlager S. Tinea genitalis: a new entity of sexually transmitted infection? Case series and review of the literature. Sex Transm Infect. 2015 Nov;91(7):493–6.

Baker KS, Dallman TJ, Ashton PM, Day M, Hughes G, Crook PD, et al. Intercontinental dissemination of azithromycin-resistant shigellosis through sexual transmission: a cross-sectional study. Lancet Infect Dis. 2015;15(8):913–21.

Senn N, de Valliere S, Berdoz D, Genton B. Motivational brief intervention for the prevention of sexually transmitted infections in travelers: a randomized controlled trial. BMC Infect Dis. 2011;11. https://doi.org/10.1186/1471-2334-11-300 .

Croughs M, Remmen R, Van Den Ende J. The effect of pre-travel advice on sexual risk behavior abroad: a systematic review. J Travel Med. 2014;21(1):45–51.

Qvarnström A, Oscarsson MG. Perceptions of HIV/STI prevention among young adults in Sweden who travel abroad: a qualitative study with focus group and individual interviews. BMC Public Health. 2014 Sep 1;14:897.

Vivancos R, Abubakar I, Hunter PR. Foreign travel, casual sex, and sexually transmitted infections: systematic review and meta-analysis. Int J Infect Dis. 2010;14(10):e842–51.

Lejelind E, Westerling R, Sjögren Fugl-Meyer K, Larsson K. Condom use among swedes while traveling internationally: a qualitative descriptive study. Nurs Health Sci. 2017;19(2):257–63.

Bishop S, Limmer M. Performance, power and condom use: reconceptualised masculinities amongst Western male sex tourists to Thailand. Cult Health Sex. 2018;20(3):276–88.

Salavec M, Bostik V, Kapla J, Plisek S, Prasil P, Prymula R, et al. A repeated syphilis infection imported from Thailand in an HIV positive couple of men-who-have-sex-with-men in Czech Republic. Travel Med Infect Dis. 2014;12(1):84–7.

Matteelli A, Schlagenhauf P, Carvalho AC, Weld L, Davis XM, Wilder-Smith A, Barnett ED, Parola P, Pandey P, Han P, Castelli F; GeoSentinel Surveillance Network. Travel-associated sexually transmitted infections: an observational cross-sectional study of the GeoSentinel surveillance database. Lancet Infect Dis. 2013;13(3):205–13. https://doi.org/10.1016/S1473-3099(12)70291-8 .

Cheung DH, Lim SH, Guadamuz TE, Koe S, Wei C. The potential role of circuit parties in the spread of HIV among men who have sex with men in Asia: a call for targeted prevention. Arch Sex Behav. 2015 Feb;44(2):389–97.

Gesink D, Wang S, Guimond T, Kimura L, Connell J, Salway T, et al. Conceptualizing Geosexual archetypes: mapping the sexual travels and egocentric sexual networks of gay and bisexual men in Toronto, Canada. Sex Transm Dis. 2018;45(6):368–73.

Chaillon A, Avila-Ríos S, Wertheim JO, Dennis A, García-Morales C, Tapia-Trejo D, et al. Identification of major routes of HIV transmission throughout Mesoamerica. Infect Genet Evol. 2017;54:98–107.

Takebe Y, Naito Y, Raghwani J, Fearnhill E, Sano T, Kusagawa S, et al. Intercontinental dispersal of HIV-1 subtype B associated with transmission among men who have sex with men in Japan. J Virol. 2014;88(17):9864–76.

Article   PubMed   PubMed Central   CAS   Google Scholar  

Daskalakis DC, Blaser MJ. Another perfect storm: Shigella men who have sex with men, and HIV. Clin Infect Dis. 2007;44(3):335–7.

Comelli A, Izzo I, Casari S, Spinetti A, Bergamasco A, Castelli F. Hepatitis a outbreak in men who have sex with men (MSM) in Brescia (northern Italy), July 2016-July 2017. Infez Med. 2018;26(1):46–51.

Truong H-HM, Chen Y-H, Grasso M, Robertson T, Tao L, Fatch R, et al. HIV Serodisclosure and sexual behavior during international travel. Sex Transm Dis. 2016;43(7):459.

Truong H-HM, Fatch R, Do TD, McFarland W. Hepatitis B vaccination and infection prevalence among men who have sex with men who travel internationally. Sex Transm Dis. 2018;45(5):e25–8.

Underhill K, Guthrie KM, Colleran C, Calabrese SK, Operario D, Mayer KH. Temporal fluctuations in behavior, perceived HIV risk, and willingness to use pre-exposure prophylaxis (PrEP). Arch Sex Behav. 2018;47(7):2109–21.

Liu A, Cohen S, Follansbee S, Cohan D, Weber S, Sachdev D, et al. Early experiences implementing pre-exposure prophylaxis (PrEP) for HIV prevention in San Francisco. PLoS Med. 2014;11(3):1–6.

Wright E, Grulich A, Roy K, Boyd M, Cornelisse V, Russell D, et al. Australasian society for HIV, viral hepatitis and sexual health medicine HIV pre-exposure prophylaxis: clinical guidelines. J Virus Erad. 2017;3(3):168–84.

Qvarnstrom A, Oscarsson MG. Experiences of and attitudes towards HIV/STI prevention among holidaymaking men who have sex with men living in Sweden: a cross-sectional internet survey. Scand J Public Health. 2015;43(5):490–6.

Kelly D, Hughes K, Bellis MA. Work hard, party harder: drug use and sexual behaviour in young british casual workers in Ibiza, Spain. Int J Environ Res Public Health. 2014;11(10):10051–61.

Patrick ME, Lee CM, Neighbors C. Web-based intervention to change perceived norms of college student alcohol use and sexual behavior on spring break. Addict Behav. 2014;39(3):600–6.

Lewis MA, Patrick ME, Mittmann A, Kaysen DL. Sex on the beach: the influence of social norms and trip companion on spring break sexual behavior. Prev Sci. 2014;15(3):408–18.

Calafat A, Hughes K, Blay N, Bellis MA, Mendes F, Juan M, et al. Sexual harassment among young tourists visiting mediterranean resorts. Arch Sex Behav. 2013;42(4):603–13.

De Albuquerque K, Mcelroy JL. Barbados Survey Results. Science (80- ). 2001;28(2):477–92.

Kennedy KM, Flaherty GT. The risk of sexual assault and rape during international travel: implications for the practice of travel medicine. J Travel Med. 2015;22(4):282–4.

Sampsel K, Godbout J, Leach T, Taljaard M, Calder L. Characteristics associated with sexual assaults at mass gatherings. Emerg Med J. 2016 Feb;33(2):139–43.

Klain EJ. Prostitution of children and child-sex tourism: An analysis of domestic and international responses. 1999. Available at: https://www.ncjrs.gov/pdffiles1/Digitization/189251NCJRS.pdf [cited 2020 28 August].

Koops T, Turner D, Neutze J, Briken P. Child sex tourism - prevalence of and risk factors for its use in a German community sample. BMC Public Health. 2017;17(1):1–8.

Aggleton P, Bell S, Kelly-Hanku A. “Mobile men with money”: HIV prevention and the erasure of difference. Glob Public Health. 2014;9(3):257–70.

European Commission. 2020. EU commissioner Johansson’s hearing on "Schengen, migration and asylum policy and the EU security strategy in the context of COVID-19" at the Committee on Civil Liberties, Justice and Home Affairs, European Parliament, 7th May 2020. Available at: https://ec.europa.eu/commission/commissioners/2019-2024/johansson/announcements/opening-statement-commissioner-johansson-schengen-migration-and-asylum-policy-and-eu-security_en (accessed 9 November 2020).

Flaherty GT, Nizrull N. Reiseangst: travel anxiety and psychological resilience during and beyond the COVID-19 pandemic. J Travel Med. 2020; accepted, in press.

Opperman M. Sex tourism. Ann Tour Res. 1999;26(2):251–66.

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News & Insights

Sexual Exploitation in Travel and Tourism

Equality Now tackles sexual exploitation in travel and tourism, often called “sex tourism”, a global issue that cuts across national borders and state lines. “Sex tourists” travel to buy sex from vulnerable women, girls and other vulnerable people, often from poor and marginalized communities.

Sexual exploitation in travel and tourism has become far more complex, involving not only tourists but business travelers, migrant/transient workers, and ‘voluntourists’ intent on exploiting women, girls, and other vulnerable people, as well as large numbers of domestic travelers.  ECPAT’s global study on sexual exploitation in travel and tourism  confirms that offenders can come from any background and do not all fit the stereotypical profile: a white, Western, wealthy, middle-aged male pedophile. Some may be pedophiles but most are not. Both the age of the clients and the age of the victims are  decreasing . 

There is increasing recognition of the links between organized sexual exploitation and travel for business or leisure, including for major sporting events such as the Super Bowl. 

Trafficking for Sexual Exploitation in Travel and Tourism

Women, girls, and other vulnerable people are often trafficked domestically or internationally to meet demand. Equality Now was one of the first human rights organizations to recognize the link between “sex tourism” and sex trafficking, and to focus on shutting down sex tour operators.

What is Equality Now doing to end sexual exploitation in travel and tourism?

Equality Now is working with Trace Kenya and LifeBloom Services International to call for legal reform that will protect women and girls from sexual exploitation and end impunity for perpetrators. As well as working on reform of national law including the Sexual Offenses Act, the Counter Trafficking In Persons Act, and the Children Act we are also engaging with local government to promote county-level laws and policies. Through our partners, we also engage with judiciary and law enforcement to encourage them to take a more gendered, survivor-centered approach. 

Our Impact: Tackling Sexual Exploitation in Travel and Tourism

Taking on big apple oriental tours.

We campaigned to shut down Big Apple Oriental Tours, a New York City-based company exploiting women and girls in the Philippines and Thailand. In 2007, our efforts led New York to amend its anti-trafficking law, which gave police the tools to prosecute sex tour operators. After many investigations, we helped convict the company’s co-owner Douglas Allen of promoting prostitution in 2013.

Passing First US State Law Against Sex Tourism

We began our campaign to shut down Hawaii-based sex tour operator Video Travel, a company exploiting women and girls in Thailand. Our campaign and legal support inspired Hawaii to introduce and pass the first state law to criminalize sex tourism. Video Travel’s proprietor had his travel agency license revoked and is no longer allowed to operate in Hawaii.

Calling on the US Government to End Sex Tourism

We called on the US government to stop sex tourism and to investigate GF Tours, a company exploiting women in Southeast Asia. We lobbied for stronger enforcement of federal anti-trafficking laws, which make sex tourism a crime, to shut them down. Due to our efforts, GF Tours removed graphic content from its materials.

First Sex Tourism Conviction in New York State

Equality Now brought the case of Jump Off Destinations, a New York-based sex tour operator traveling to the Dominican Republic, to the attention of the Manhattan District Attorney. In 2007, the owner was found guilty, the first time that New York State law prohibiting the promotion of prostitution was used to prosecute a sex tour operator and the first conviction of its kind in the US.

Standing Up for Exploited Girls

We led a civil case in the US on behalf of Brazilian girls who were sexually exploited by a US-based sex tour operator. With pro bono support from a law firm, we filed the first known civil action under the Trafficking Victims Protection Act. In 2015, the case was settled. The funds helped the girls rebuild their lives. 

60 Sex-Relevant Terms You May Not Know — and Why You Should

As sex-relevant words proliferate, so do our ways of living and loving..

Posted April 6, 2017 | Reviewed by Ekua Hagan

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Matters of sex, relationships, sexual orientation , and gender identity all used to seem much simpler than they are now — even if they really weren’t. Now, the list of letters that used to be limited to LGBT never stops growing.

The additions to all the sexual orientations include some non-sexual , or not very sexual, orientations. We’ve also learned to appreciate orientations other than sexual ones, such as orientations toward relationships. A binary that once seemed utterly self-evident, male vs. female, is now routinely questioned.

Reading a terrific thesis, “Party of One,” by Kristen Bernhardt, woke me up to the proliferation of new concepts relevant to relationships, sexual orientations, gender identities, and more. (Thank you, Kristen.) So I set out to spend an evening gathering some relevant definitions.

Many days later, I was still at it. I admit to shaking my head in exasperation a few times along the way. Ultimately, though, I ended up feeling enormously optimistic . No longer is there just one way to approach sex, love, or relationships that is valued and appreciated.

People who, not so very long ago, may have wondered what was wrong with them now have a new answer: Nothing. People who secretly wondered why romantic relationships were valued above all others can now find validation for their perspective. Maybe they aren’t oddballs, but forward-looking, open-minded, democratic thinkers.

I’ll share definitions for 60 terms — just a sampling of the universe of possibilities that are out there. One of the most comprehensive sources I found was a glossary provided by the University of California at Davis. Unless I specifically mention one of the other sources I drew from, my definitions are from that glossary.

To try to make sense of the 60 terms, I’ve organized them into five sections. Other categorizations would have been possible.

• Sex vs. gender: What’s the difference? And what about sexual orientation vs. gender identity ?
• What is your sexual orientation?
• What kind of attraction do you feel toward other people?
• What is your orientation toward relationships?
• How do you value different relationships?

I. Sex vs. gender: what’s the difference? And what about sexual orientation vs. gender identity?

“Sex” and “gender” aren’t the same.

• Sex (1) is “a medically constructed category often assigned based on the appearance of the genitalia, either in ultrasound or at birth.”
• Gender (2) is “a social construct used to classify a person as a man, woman, or some other identity.”

Remember when we thought there were just two sexes, male and female, and everyone just assumed that anyone born male or female was, in fact, a male or a female? Now it is much more complicated. Here are some of the concepts that challenge those notions:

• Non-binary (3) : “A gender identity and experience that embraces a full universe of expressions and ways of being that resonate for an individual. It may be an active resistance to binary gender expectations and/or an intentional creation of new unbounded ideas of self within the world. For some people who identify as non-binary there may be overlap with other concepts and identities like gender expansive and gender non-conforming.”
• Gender expansive (4) : “An umbrella term used for individuals who broaden their own culture’s commonly held definitions of gender, including expectations for its expression, identities, roles, and/or other perceived gender norms. Gender expansive individuals include those who identify as transgender , as well as anyone else whose gender in some way is seen to be stretching the surrounding society’s notion of gender.”
• Gender non-conforming (5) : “People who do not subscribe to gender expressions or roles expected of them by society.”
• Gender fluid (6) : “A person whose gender identification and presentation shifts, whether within or outside of societal, gender-based expectations. Being fluid in motion between two or more genders.”
• Bigender (7) : “Having two genders, exhibiting cultural characteristics of masculine and feminine roles.”
• Gender queer (8) : “A person whose gender identity and/or gender expression falls outside of the dominant societal norm for their assigned sex, is beyond genders, or is some combination of them.”
• Polygender (9) or Pangender (10) : “Exhibiting characteristics of multiple genders, deliberately refuting the concept of only two genders.”
• Neutrois (11) : “A non-binary gender identity that falls under the genderqueer or transgender umbrellas. There is no one definition of Neutrois, since each person that self-identifies as such experiences their gender differently. The most common ones are: Neutral-gender (12), Null-gender (13), Neither male nor female (14), Genderless (15) and/or Agender (16) .”

At Aeon , Rebecca Reilly-Cooper challenged the notion that gender is a spectrum . At Vox , 12 people explained why the male/female binary doesn’t work for them .

Sexual orientation and gender identity aren’t the same.

• Gender identity (17) : When you say that you are a man or a woman, you are describing your gender identity. Gender identity is “a sense of one’s self as trans,* genderqueer, woman, man, or some other identity, which may or may not correspond with the sex and gender one is assigned at birth.” (For more on trans* and genderqueer, see the section below, “What is your sexual orientation?”) Transgender is a gender orientation; it is also included in the list of letters referring to sexual orientations.
• Sexual orientation (18) : “an enduring emotional, romantic, sexual or affectional attraction or non-attraction to other people.”

II. What is your sexual orientation?

If you are old enough, you may remember a time when “straight” and “gay” (or heterosexual and homosexual) covered all the sexual orientations that got any attention . Gay people were often described as queer (and worse) when the word was still solely a pejorative.

The terms then expanded to include LGBT : lesbian, gay, bisexual, and transgender. A lesbian (19) is “a woman whose primary sexual and affectional orientation is toward people of the same gender.” Although “gay” (20) has often been used to refer to men who are attracted to other men, it is also used more broadly to refer to anyone attracted to someone of the same sex. Bisexuals (21) are attracted to both men and women, though not always to the same degree. Transgender (22) people are also called “trans” (23) or “trans*” (24) (the asterisk “indicates the option to fill in the appropriate label, i.e., Trans man”). The term “describes a wide range of identities and experiences of people whose gender identity and/or expression differs from conventional expectations based on their assigned sex at birth.”

Trans Man and Trans Woman are further explained by the Resource Center at the University of California at San Diego:

• Trans Man/Trans Male (25) : “A female-to-male (FTM) transgender person who was assigned female at birth, but whose gender identity is that of a man.” FTM is sometimes expressed as F2M.
• Trans Woman/Trans Female (26) : “A male-to-female (MTF) transgender person who was assigned male at birth, but whose gender identity is that of a woman.” MTF is sometimes expressed as M2F.

If you are not transgender, you may think that you don’t need a special term. But you have one. You are cisgender (28) : “a gender identity, or performance in a gender role, that society deems to match the person’s assigned sex at birth. The prefix cis- means ‘on this side of’ or ‘not across’.”

The list of letters has continued to expand. The letters added most often are QIA, giving us LGBTQIA .

• Q stands for Queer or for Questioning.
• Queer (29) is a broad label, which can refer to “people whose gender, gender expression and/or sexuality do not conform to dominant expectations.” It is sometimes used even more broadly to refer to “not fitting into norms” of all sorts, including size, physical abilities, and more.
• Questioning (30) is “the process of exploring one’s own gender identity, gender expression, and/or sexual orientation.”
• I is for Intersex (31) : “People who naturally (that is, without any medical intervention) develop primary or secondary sex characteristics that do not fit neatly into society's definitions of male or female… Hermaphrodite (32) is an outdated and inaccurate term that has been used to describe intersex people in the past.”

[Another A word is Allosexual, which is very different from Asexual. Allosexual (36) is “a sexual orientation generally characterized by feeling sexual attraction or a desire for partnered sexuality.”]

[Still another A word — one that does not describe a sexual orientation — is ally. Allyship (37) is “the action of working to end oppression through support of, and as an advocate with and for, a group other than one’s own.”]

There’s more. Among the other letters sometimes added to the list are P and K, giving us LGBTQIAPK .

• P can refer to Pansexual (or Omnisexual) or Polyamorous .
• Pansexual (38) and Omnisexual (39) are “terms used to describe people who have romantic, sexual or affectionate desire for people of all genders and sexes.”
• Polyamory (40) “denotes consensually being in/open to multiple loving relationships at the same time. Some polyamorists (polyamorous people) consider ‘poly’ to be a relationship orientation. Sometimes used as an umbrella term for all forms of ethical, consensual, and loving non-monogamy.”
• K stands for Kink (41) . According to Role/Reboot , “‘K’ would cover those who practice bondage and discipline, dominance-submission and/or sado-masochism, as well as those with an incredibly diverse set of fetishes and preferences.” If you are rolling your eyes, consider this: “According to survey data, around 15% of adults engage in some form of consensual sexual activity along the ‘kink’ spectrum. This is a higher percentage than those who identify as gay or lesbian.”

Not everyone identifies as either sexual or asexual. Some consider asexuality as a spectrum that includes, for example, demisexuals and greysexuals. These definitions are from AVEN :

• Demisexual (42) : “Someone who can only experience sexual attraction after an emotional bond has been formed. This bond does not have to be romantic in nature.”
• Gray-asexual (gray-a) (43) or gray-sexual (44) : “Someone who identifies with the area between asexuality and sexuality, for example because they experience sexual attraction very rarely, only under specific circumstances, or of an intensity so low that it's ignorable.” (Colloquially, sometimes called grey-ace (45) .)

There is also more than one variety of polyamory. An important example is solo polyamory. At Solopoly , Amy Gahran describes it this way:

• Solo polyamory (46) : “What distinguishes solo poly people is that we generally do not have intimate relationships which involve (or are heading toward) primary-style merging of life infrastructure or identity along the lines of the traditional social relationship escalator. For instance, we generally don’t share a home or finances with any intimate partners. Similarly, solo poly people generally don’t identify very strongly as part of a couple (or triad etc.); we prefer to operate and present ourselves as individuals.” As Kristen Bernhardt pointed out in her thesis, solo poly people often say: “I am my own primary partner.”

(For a definition of “relationship elevator,” see the section below, “What is your orientation toward relationships?”)

III. What kind of attraction do you feel toward other people?

Interpersonal attraction is not just sexual. AVEN lists these different kinds of attraction (47) (“emotional force that draws people together”):

• Aesthetic attraction (48) : “Attraction to someone’s appearance, without it being romantic or sexual.”
• Romantic attraction (49) : “Desire of being romantically involved with another person.”
• Sensual attraction (50) : “Desire to have physical non-sexual contact with someone else, like affectionate touching.”
• Sexual attraction (51) : “Desire to have sexual contact with someone else, to share our sexuality with them.”

Asexual is the term used for people who do not feel sexual attraction. Another term, aromantic, describes something different. According to the AVEN wiki :

• Aromantic (52) : “A person who experiences little or no romantic attraction to others. Where romantic people have an emotional need to be with another person in a romantic relationship, aromantics are often satisfied with friendships and other non-romantic relationships.” (Want to know more? Check out these five myths about aromanticism from Buzzfeed .)

People who experience romantic attraction have crushes. Aromantics have squishes. Again, from the AVEN wiki :

• Squish (53) : “Strong desire for some kind of platonic (nonsexual, nonromantic) connection to another person. The concept of a squish is similar in nature to the idea of a ‘friend crush.’ A squish can be towards anyone of any gender and a person may also have many squishes, all of which may be active.”

IV. What is your orientation toward relationships? (For example, do you prefer monogamy? Do you think your relationships should progress in a certain way?)

Many of the alternatives to monogamy fit under the umbrella term of “ethical non-monogamy.”

• Monogamy (54) : “Having only one intimate partner at a time.”
• Consensual non-monogamy ( or ethical non-monogamy) (55) : “all the ways that you can consciously, with agreement and consent from all involved, explore love and sex with multiple people.” (The definition is from Gracie X, who explores six varieties here . Polyamory is just one of them.)

According to the conventional wisdom , romantic relationships are expected to progress in a certain way. That’s called the “ relationship escalator .” Amy Gahran describes it this way:

• Relationship escalator (56) : “The default set of societal expectations for intimate relationships. Partners follow a progressive set of steps, each with visible markers, toward a clear goal. The goal at the top of the Escalator is to achieve a permanently monogamous (sexually and romantically exclusive between two people), cohabitating marriage — legally sanctioned if possible. In many cases, buying a house and having kids is also part of the goal. Partners are expected to remain together at the top of the Escalator until death. The Escalator is the standard by which most people gauge whether a developing intimate relationship is significant, ‘serious,’ good, healthy, committed or worth pursuing or continuing.”

V. How do you value different relationships?

Do you think that everyone should be in a romantic relationship, that everyone wants to be in a romantic relationship, and that such a relationship is more important than any other? Thanks to the philosopher Elizabeth Brake , there’s a name for that assumption, amatonormativity . Importantly, amatonormativity is an assumption, not a fact. A related concept is mononormativity. (The definition below is Robin Bauer’s, as described in Kristen Bernhardt’s thesis.) In the same family of concepts is heteronormativity. (Definition below is from Miriam-Webster .) An entirely different way of thinking about relationships has been described by Andie Nordgren in her concept of “relationship anarchy.”

• Amatonormativity (57) : “The assumption that a central, exclusive, amorous relationship is normal for humans, in that it is a universally shared goal, and that such a relationship is normative, in the sense that it should be aimed at in preference to other relationship types.” (Drake Baer’s discussion of the concept in New York magazine is excellent.)
• Mononormativity (58) : “Based on the taken for granted allegation that monogamy and couple-shaped arranged relationships are the principle of social relations per se, an essential foundation of human existence and the elementary, almost natural pattern of living together.”
• Heteronormative (59) : “Of, relating to, or based on the attitude that heterosexuality is the only normal and natural expression of sexuality.”
• Relationship anarchy (60) : “Relationship anarchists are often highly critical of conventional standards that prioritize romantic and sex-based relationships over non-sexual or non-romantic relationships. Instead, RA seeks to eliminate specific distinctions between or hierarchical valuations of friendship versus love-based relationships, so that love-based relationships are no more valuable than are platonic friendships.”

Bella DePaulo, Ph.D. , an expert on single people, is the author of Single at Heart and other books. She is an Academic Affiliate in Psychological & Brain Sciences, UCSB.

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Sexually Transmitted Infections

Cdc yellow book 2024.

Author(s): Hilary Reno, Laura Quilter

More than 2 dozen bacterial, viral, and parasitic pathogens can cause sexually transmitted infections (STIs). STIs are among the most common infectious diseases reported worldwide. In 2018, ≈26 million new STI cases were reported in the United States; and in 2016, ≈376 million cases of chlamydia, gonorrhea, syphilis, and trichomonas were reported globally. STIs can be transmitted from person to person during sexual activity involving anal, genital, or oral mucosal contact.

Epidemiology

Casual sex during travel is common; a systematic review showed a 35% prevalence. In addition, some people travel for sex tourism (see Sec. 9, Ch. 12, Sex & Travel ). Sex partners abroad might include commercial sex workers among whom STI prevalence is elevated. International travel was an independent risk factor for chlamydia infection in a study conducted at one sexual health clinic. Among travelers, documented risk factors for acquiring STIs or HIV include alcohol and other drug use, longer duration of travel, male gender, and increased number of new partners.

Before travel, counsel travelers at risk of engaging in condomless sex to have condoms available, and provide guidance regarding other risk-modifying behaviors. Providers caring for returning travelers should know where to find current information about global epidemiology and antimicrobial resistance patterns of STIs from national and international public health authorities, such as the Centers for Disease Control and Prevention (CDC) Antibiotic-Resistant Gonorrhea website and World Health Organization (WHO), Gonococcal Antimicrobial Resistance (AMR) Surveillance Programme .

The epidemiology and clinical presentations of common bacterial, viral, and parasitic STIs are shown in Table 11-13 , Table 11-14 , and Table 11-15 , respectively. Ask returning travelers about sexual activity during their trip, and include specific questions about region of travel, sexual partners, types of sexual exposure, and condom use. Assessing risk in men who have sex with men (MSM) is important because they have elevated rates of certain infections, including chlamydia, gonorrhea, lymphogranuloma venereum, and syphilis. Screen travelers seeking an evaluation for STI or with evidence of STI for other common STIs as well as HIV. For patients with HIV infection, provide information on HIV care and treatment services if they are not already receiving care.

Table 11-13 Epidemiology, clinical manifestations, diagnosis, & treatment of select bacterial STIs

Abbreviations: BID, twice daily; IM, intramuscularly; MU, million units; NAAT, nucleic acid amplification testing; PO, orally; STI, sexually transmitted infection; TID, 3 times daily.

Table 11-14 Epidemiology, clinical manifestations, diagnosis & treatment of select viral STIs

Abbreviations: BID, twice daily; IM, intramuscularly; PCR, polymerase chain reaction; PO, orally; STI, sexually transmitted infection; TID, 3 times daily.

Table 11-15 Epidemiology, clinical manifestations, diagnosis & treatment of select parasitic STIs

Abbreviations: BID, twice daily; NAAT, nucleic acid amplification testing; PO, orally; STI, sexually transmitted infection

Clinical Presentation

Because many infections are asymptomatic, assess for chlamydia, gonorrhea, HIV, and syphilis in returning travelers who had sex outside of a monogamous relationship while traveling. Advise any traveler who develops STI symptoms (e.g., rectal, urethral, or vaginal discharge; unexplained rash or genital lesion; genital or pelvic pain) following a sexual exposure to abstain from sex and seek prompt medical evaluation.

Human papillomavirus (HPV) infection is commonly acquired ≤2 years of sexual debut and usually clears spontaneously. Although most STIs involve the genital tract, some (e.g., gonorrhea, herpes, syphilis) also cause disseminated disease. Consider STIs in returning travelers, because infection can result in serious and long-term complications including adverse birth outcomes, cancer (anal and cervical), infertility, pelvic inflammatory disease, and an increased risk for HIV acquisition and transmission.

Although not considered an STI, transmission of mpox virus during the 2022 multinational outbreak has been associated with close skin-to-skin contact, including that which occurs during sex. Moreover, some patients have presented with physical findings and/or symptoms that could be consistent with an STI (e.g., anogenital lesions, proctitis, dysuria). In some instances, this has resulted in misdiagnosis and delays in initiating proper medical management. In other cases, patients have been co-infected with mpox virus and an STI. For details on the transmission, epidemiology, and management of mpox during the 2022 mpox outbreak, see Sec. 5, Part 2, Ch. 22, Smallpox & Other Orthopoxvirus-Associated Infections ; Sec. 9, Ch. 12, Sex & Travel ; and the CDC mpox website .

Base STI evaluation, management, and follow-up on the most recent national and international guidelines from CDC and WHO. Because of limited availability of diagnostic testing in many countries, WHO follows a syndromic approach to STI management; in the United States, therefore, following CDC treatment guidelines is preferred. Consider drug resistance if an infection does not respond to first-line therapy. This is particularly relevant in travelers who have a persistent gonococcal infection, given the global spread of multidrug-resistant Neisseria gonorrhoeae .

Prevention and control of STIs is based on accurate risk assessment, counseling and education, early identification of asymptomatic infection, and effective treatment of travelers; prompt evaluation and treatment of sex partners also is necessary to prevent reinfection and to disrupt STI transmission. As part of pretravel advice, include specific messages and strategies on how to avoid acquiring or transmitting STIs. Abstinence or mutual monogamy between uninfected partners is the most reliable way to avoid acquiring and transmitting STIs.

For people whose sexual behaviors place them at risk for STIs, correct and consistent use of external or internal latex condoms can reduce the risk for HIV infection and other STIs, including chlamydia, gonorrhea, and trichomoniasis. Preventing lower genital tract infections might reduce the risk for pelvic inflammatory disease in female patients. Correct and consistent use of latex condoms also reduces the risk of chancroid, genital herpes, HPV infection, and syphilis. Advise travelers to use only water-based lubricants with latex condoms, because oil-based lubricants (e.g., massage oil, mineral oil, petroleum jelly, shortening) can weaken latex. Also remind travelers that contraceptive methods that are not mechanical barriers (e.g., oral contraceptives) do not protect against HIV or other STIs, and that spermicides containing nonoxynol-9 do not prevent HIV or STIs.

Preexposure vaccination is among the most effective methods for preventing certain STIs. HPV vaccines, for example, are available and licensed for people ≤45 years of age. Both hepatitis A and hepatitis B can be transmitted sexually (see Sec. 5, Part 2, Ch. 7, Hepatitis A , and Sec. 5, Part 2, Ch. 8, Hepatitis B ). The Advisory Committee on Immunization Practices (ACIP) recommends hepatitis B vaccination for all adults aged 19–59 years, and hepatitis A vaccine for MSM. Travelers at risk of acquiring HIV infection might benefit from preexposure prophylaxis (see Sec. 5, Part 2, Ch. 11, Human Immunodeficiency Virus / HIV , and HIV: Pre-Exposure Prophylaxis (PrEP) .

CDC Sexually Transmitted Diseases (STDs) website

The following authors contributed to the previous version of this chapter: Jodie Dionne-Odom, Kimberly Workowski

Bibliography

Aung ET, Chow EP, Fairley CK, Hocking JS, Bradshaw CS, Williamson DA, et al. International travel as risk factor for Chlamydia trachomatis infections among young heterosexuals attending a sexual health clinic in Melbourne, Australia, 2007 to 2017.

Euro Surveill. 2019;24(44):1900219. Avery AK, Zenilman JM. Sexually transmitted diseases and travel: from boudoir to bordello. Microbiol Spectr. 2015;3(5):IOL5-0011-2015.

Crawford G, Lobo R, Brown G, Macri C, Smith H, Maycock B. HIV, other blood-borne viruses and sexually transmitted infections amongst expatriates and travellers to low- and middle-income countries: a systematic review. Int J Environ Res Public Health. 2016;13(12):1249.

Meites E, Kempe A, Markowitz LE. Use of a 2-dose schedule for human papillomavirus vaccination—updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2016;65(49):1405–8.

Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N, et al. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PLoS One. 2015;10(12):e0143304.

Svensson P, Sundbeck M, Persson KI, Stafström M, Östergren PO, Mannheimer L, et al. A meta-analysis and systematic literature review of factors associated with sexual risk-taking during international travel. Travel Med Infect Dis. 2018;24:65–88.

Vivancos R, Abubakar I, Hunter PR. Foreign travel, casual sex, and sexually transmitted infections: systematic review and meta-analysis. Int J Infect Dis. 2010;14(10):e842–51.

Weston EJ, Wi T, Papp J. Strengthening global surveillance for antimicrobial drug-resistant Neisseria gonorrhoeae through the Enhanced Gonococcal Antimicrobial Surveillance Program. Emerg Infect Dis. 2017;23(13):S47–52.

Workowski KA, Bachmann L, Chan P, Johnston CM, Muzny CA, Park I, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(RR-04):1–187.

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The Shocking Truth About What Is Skiing Sexually: Uncovering a Taboo Topic

There is a topic that remains taboo and shrouded in mystery – skiing sexually. Despite its increasing prevalence, many people are not familiar with the term or the implications of engaging in this practice. So, what is skiing sexually? It involves a sexual act in which a person uses their partner’s body as a ski slope, gliding on them as if they were skiing downhill.

The practice of skiing sexually may seem harmless to some, but it poses significant physical and psychological risks. Engaging in this activity without proper consent, communication, and safety precautions can result in serious injuries and long-term trauma. Furthermore, the taboo nature of skiing sexually can lead to feelings of shame, guilt, and secrecy, making it difficult for individuals to seek help when necessary.

In this article, we will delve into the controversial topic of skiing sexually, examining its definition, risks, and effects on relationships. We will explore the different forms of skiing sexually and the psychology behind why people engage in this activity. We will also discuss why it is crucial to break the stigma and shame surrounding skiing sexually and address it as a legitimate and potentially harmful practice.

If you are curious about this taboo topic or have engaged in skiing sexually and want to learn more, keep reading. Our comprehensive guide will provide you with the information you need to make informed decisions about your sexual practices and promote healthy communication and consent in your relationships.

Table of Contents

Understanding the Definition of Skiing Sexually

Skiing sexually is a taboo term that refers to a sexual act that involves a man ejaculating on a partner’s face, particularly on the nose and cheeks, and then rubbing their penis back and forth across the semen, resembling a skiing motion. Despite being a common fetish and sexual act, skiing sexually remains controversial and often misunderstood.

While some may find the idea of skiing sexually arousing, others find it degrading and disrespectful. It’s essential to understand that all sexual acts should be consensual and that partners should have an open and honest conversation before engaging in any activity.

The Origins of Skiing Sexually

The origin of skiing sexually is not entirely clear, but it’s believed to have emerged in the pornography industry in the 1990s. Some sources suggest that it may have originated from an old French slang term, “faire du ski,” which translates to “to ski.” Regardless of its origins, the term skiing sexually has become more prevalent in recent years, largely due to its widespread depiction in pornography.

The Controversy Surrounding Skiing Sexually

• Some people view skiing sexually as a form of objectification and degradation, particularly when it’s forced upon a partner.
• Others argue that skiing sexually can be an empowering act, especially when it’s a consensual and enthusiastic choice between partners.
• There is also a debate around the potential health risks associated with skiing sexually, such as the transmission of sexually transmitted infections (STIs) or the potential for eye irritation and infections from semen exposure.

Exploring the Psychological and Emotional Aspects of Skiing Sexually

Despite the controversy surrounding skiing sexually, some individuals find the act to be a turn-on, with some describing the sensation of semen on their skin as pleasurable or even empowering. Additionally, skiing sexually can be a form of dominance and submission play, where one partner takes on a more dominant role and the other a more submissive role. Like any sexual act, the psychological and emotional aspects of skiing sexually can vary from person to person.

Overall, while skiing sexually remains a controversial and often taboo topic, it’s essential to approach it with an open and non-judgmental attitude. Communication, respect, and consent are key in any sexual encounter, and this includes skiing sexually.

The Risks and Dangers of Skiing Sexually

While skiing sexually may seem like an exciting and fun activity, it is important to be aware of the potential risks and dangers involved. Physical injury is a major risk associated with this activity, as skiing at high speeds while engaged in sexual activity can lead to falls and collisions. In addition, skiing while distracted can increase the risk of accidents and injuries for both the individuals involved and other skiers on the slopes.

Legal consequences are another risk of skiing sexually, as engaging in sexual activity in a public place is considered indecent exposure and is illegal in many areas. Depending on the location and circumstances, those caught engaging in this activity may face fines, community service, or even imprisonment. It is important to check local laws and regulations before engaging in any sexual activity in a public place.

Physical Risks

• Increased risk of falls and collisions
• Potential for serious injury
• Danger to other skiers on the slopes

Legal Consequences

Engaging in sexual activity in public places is illegal in many areas, and those caught may face legal consequences such as fines, community service, or imprisonment.

Social Stigma

Engaging in skiing sexually is a taboo topic and can lead to social stigma and ostracization. It is important to consider the potential social consequences before engaging in this activity.

It is important to weigh the potential risks and consequences before engaging in skiing sexually. It is recommended to engage in this activity in a private and safe location to minimize the risks involved. Always practice safe skiing and sexual practices, and be aware of local laws and regulations to avoid any legal consequences.

The Psychology Behind Why People Engage in Skiing Sexually

Skiing sexually is a taboo subject that is rarely discussed in public. However, research suggests that it is more common than people think. While some individuals might engage in skiing sexually as a form of sexual expression, others might do so to fulfill a deep psychological need.

One of the reasons people might engage in skiing sexually is the thrill it provides. It can be a rush to engage in such an unconventional activity, and some people might find the taboo nature of skiing sexually to be exciting. Additionally, skiing sexually might provide individuals with a sense of power and control. It can be a way to push boundaries and feel dominant.

The Role of Trauma

For some individuals, engaging in skiing sexually might be a coping mechanism for past traumas. Trauma survivors might find skiing sexually to be a way to take back control and power over their bodies, helping them to reclaim their sense of autonomy.

On the other hand, engaging in skiing sexually can also be a way to reenact traumatic experiences. In these cases, individuals might be subconsciously trying to work through their trauma by repeating it in a controlled environment.

The Influence of Media and Culture

The media and culture we consume can also play a role in why some people engage in skiing sexually. Popular culture often portrays skiing sexually as an exciting, taboo activity, which can normalize and even encourage the behavior. Additionally, the anonymity provided by the internet can make it easier for individuals to explore and engage in skiing sexually without fear of judgment or repercussion.

The Connection Between Skiing Sexually and Mental Health

While skiing sexually itself is not a mental health disorder, individuals who engage in the behavior might be at a higher risk for other mental health issues. Shame, guilt, and secrecy can lead to feelings of isolation and anxiety. Additionally, engaging in skiing sexually can put individuals at risk for legal consequences and physical harm.

Exploring the Various Forms of Skiing Sexually

Skiing sexually is a term that refers to engaging in sexual activities on the slopes or during a ski vacation. It can take many forms, and the level of risk and danger involved can vary depending on the specific activity. While skiing sexually is not an inherently dangerous activity, it does carry certain risks that participants should be aware of.

Here are three common forms of skiing sexually:

Uphill skiing

Uphill skiing is a form of skiing sexually that involves skiing up the mountain, often using specialized equipment like skins that attach to the bottom of skis. It can be a physically demanding activity that requires a high level of fitness and skill. While uphill skiing is not inherently dangerous, the risk of injury is increased due to the steep terrain and the potential for collisions with other skiers or obstacles.

Chairlift sex

Chairlift sex is a form of skiing sexually that involves engaging in sexual activity while riding a chairlift. It can be a thrilling and exciting experience, but it is also illegal and can lead to serious consequences, including arrest and prosecution for public indecency. Additionally, engaging in sexual activity in a public place can also carry social and personal risks, such as humiliation and embarrassment.

Après-ski partying

Après-ski partying is a form of skiing sexually that involves attending parties and social events after a day of skiing. These events often involve heavy drinking and sexual activity, and participants may feel pressured to engage in risky behaviors. While it can be a fun and enjoyable way to unwind after a day on the slopes, it is important to be aware of the risks and to make safe choices.

How Skiing Sexually Affects Relationships and Communication

While skiing sexually can be a thrilling and exciting experience, it can also have significant effects on relationships and communication. Partners who engage in this activity may feel closer and more connected to each other, but it can also lead to misunderstandings and conflicts.

Communication is key in any relationship, but it’s especially important when engaging in sexual activities that involve risk and vulnerability. Partners need to be able to discuss their desires, boundaries, and expectations beforehand to ensure that both parties are comfortable and safe. Without clear communication, skiing sexually can lead to misunderstandings, hurt feelings, and even physical harm.

Effects on Relationships

• Heightened intimacy and connection between partners
• Possible feelings of guilt, shame, or regret
• Increased risk of jealousy or insecurity

Importance of Communication

Clear communication is essential before, during, and after engaging in skiing sexually. Partners should discuss their boundaries, desires, and expectations to ensure that both parties are comfortable and safe. Additionally, partners should establish a plan for what to do if one or both of them become uncomfortable or want to stop.

Misunderstandings and Conflicts

• Misunderstandings can occur when partners have different expectations or boundaries
• Conflicts can arise when one partner feels pressured or coerced into participating
• Resentment can develop if one partner feels that their desires or boundaries were ignored or disregarded

Why Skiing Sexually Should Be Discussed and Addressed

It’s important to have open and honest conversations about skiing sexually because it can have a significant impact on individuals and their relationships. Skiing sexually can be a source of pleasure and excitement, but it can also be a source of confusion and conflict. By talking about skiing sexually, individuals can better understand their desires and boundaries, and communicate them effectively to their partners. This can help build trust and strengthen the relationship.

Ignoring the topic of skiing sexually can lead to misunderstandings, resentment, and even harm. Without communication, partners may unknowingly push each other’s boundaries, leading to uncomfortable or unwanted experiences. Additionally, if one partner is uncomfortable with skiing sexually, but feels pressured to engage in it, it can lead to emotional distress and strain on the relationship. It’s important for individuals to feel comfortable expressing their needs and boundaries, and for partners to respect them.

Skiing Sexually Can Be a Sensitive Topic

Discussing skiing sexually can be difficult and uncomfortable for some individuals. It may bring up past experiences or emotions that they are not ready to confront. However, it’s important to recognize that having these conversations can lead to a greater understanding of oneself and one’s partner. If the topic feels too sensitive to discuss alone, seeking the help of a therapist or counselor can be a helpful option.

Cultural Stigma Surrounding Skiing Sexually

There can be a stigma associated with skiing sexually, particularly in certain cultures or communities. This can make individuals hesitant to discuss or explore their desires, leading to a lack of communication and potential harm. By acknowledging and addressing cultural stigma surrounding skiing sexually, individuals can feel more comfortable expressing their needs and desires.

Importance of Consent in Skiing Sexually

• Consent is a crucial aspect of skiing sexually, and should always be respected. It’s important for partners to communicate their boundaries and to check in with each other regularly throughout the experience. If consent is not given or is withdrawn at any point, the activity should stop immediately.
• Safe words can be a useful tool for individuals to communicate their boundaries and limits. They can indicate when an activity should stop or slow down, without interrupting the flow of the experience.

By discussing skiing sexually and the importance of consent, individuals can better understand their desires and boundaries, and communicate them effectively to their partners. This can lead to a more fulfilling and satisfying experience for all involved.

Breaking the Stigma and Shame Surrounding Skiing Sexually

There is no denying that the topic of skiing sexually can be a sensitive and uncomfortable subject for many. However, it is important to break the stigma and shame surrounding this topic in order to promote healthy relationships and open communication. By addressing this topic, we can create a safe and supportive environment for individuals to share their experiences and seek the help they need.

One of the main reasons why the stigma and shame surrounding skiing sexually persists is due to a lack of education and awareness. Many people are not aware of what constitutes skiing sexually and are therefore unable to recognize when it occurs. This can lead to feelings of shame and self-blame for victims, as well as a lack of accountability for perpetrators.

Why Education and Awareness are Essential

Education and awareness are essential in breaking down the stigma and shame surrounding skiing sexually. By educating individuals on what skiing sexually is, we can help them recognize when it is occurring and empower them to speak out against it. It also helps to hold perpetrators accountable for their actions and prevent future incidents from occurring.

The Importance of Speaking Out

Speaking out about skiing sexually can be incredibly difficult, but it is important in order to break the stigma and shame surrounding it. By sharing our experiences and opening up about the impact skiing sexually has had on our lives, we can help others feel less alone and create a supportive community for those who have been affected by this issue.

Creating a Safe and Supportive Environment

• Creating a safe and supportive environment is crucial in breaking down the stigma and shame surrounding skiing sexually. This can be done by promoting open and honest communication, providing access to resources and support services, and actively working to prevent skiing sexual incidents from occurring.
• It is also important to create a culture of consent, where all individuals feel respected and valued, and where skiing sexually is never tolerated.

Breaking the stigma and shame surrounding skiing sexually is essential in promoting healthy relationships and open communication. Through education, awareness, speaking out, and creating a safe and supportive environment, we can work towards ending skiing sexual violence and creating a world where all individuals feel safe and valued.

What Is Skiing Sexually?

Is skiing sexually a real thing.

Yes, skiing sexually is a real thing. It refers to the act of using the ski slopes as a place for sexual encounters, either with a partner or a stranger.

What are the risks of skiing sexually?

The risks of skiing sexually include injury, exposure to the elements, and the potential for legal consequences. Additionally, it can also perpetuate harmful stereotypes about skiing communities and their values.

Is skiing sexually illegal?

While skiing sexually itself is not necessarily illegal, the act of engaging in sexual activity in public places, including ski slopes, is illegal and can result in criminal charges.

Why is skiing sexually stigmatized?

Skiing sexually is stigmatized because it goes against traditional norms of sexual behavior, and because it is often viewed as disrespectful to the sport of skiing and to others who are using the slopes for their intended purpose.

Can skiing sexually be done ethically and safely?

While engaging in sexual activity on ski slopes can never be completely risk-free, it is possible to approach it ethically and with respect for others. This includes choosing a private and secluded location, obtaining enthusiastic and explicit consent from all parties involved, and taking appropriate safety measures.

How can we break the stigma and shame surrounding skiing sexually?

We can break the stigma and shame surrounding skiing sexually by promoting open and honest conversations about sex and sexuality, and by challenging harmful stereotypes and prejudices. We can also work to educate ourselves and others about how to approach sexual encounters in a respectful and consensual way.

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Donald Trump is now a convicted felon: Can he still run for president?

Donald Trump is the first former president convicted of a crime in U.S. history, but it won't stop him from running for president again. His conviction on Thursday does not bar him from seeking a return to the Oval Office in the meantime, even if his possible sentence makes that more difficult.

Twelve Manhattan jurors found Trump guilty on 34 counts of falsifying business records after prosecutors showed he covered up reimbursements to his former lawyer Michael Cohen . Cohen paid porn star Stormy Daniels $130,000 to stay quiet about an alleged sexual affair ahead of the 2016 election. Trump denies taking part in a tryst with Daniels.

He is expected to appeal the verdict.

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Live updates: Former President Donald Trump found guilty on all counts in hush money case

Can Trump run for President?

The U.S. Constitution only lists three necessary qualifications for being president: the candidate must be a "natural born" citizen, at least 35 years old and a resident of U.S. for at least 14 years. There is no requirement that the president not be a convicted felon.

A few presidential candidates in history have campaigned after an indictment or conviction: Socialist candidate Eugene V. Debs ran for president for the fifth time in 1920 while in prison for sedition. Former Texas Gov. Rick Perry ran for president alongside Trump in the 2016 Republican primary after being indicted two years earlier for abuse of official capacity and coercion of a public official, but he dropped out of the race a few months into the primary.

What if Trump is in jail?

Judge Juan Merchan scheduled Trump's sentencing for July 11, and he is out free until then.

Trump will also likely to remain at liberty until the election. As a first time felon and given it is a non-violent crime, his sentence could be as light as probation. Even if he does receive a  jailtime sentence , he probably push it off until the appeal is resolved.

What happens to Trump now?

Experts say states are unlikely to succeed in passing additional eligibility requirements for a candidate to get on the presidential ballot.

The U.S. Supreme Court already rejected an effort from several states to bar Trump from the ballot based on the 14th Amendmen t, which prevents anyone who has engaged in insurrection after swearing to uphold the Constitution (by being sworn into office, for example), from holding office again.

Trump can probably vote for himself in Florida

The high court did not want a “state-by-state patchwork” of rules for Trump's eligibility.

The variety of state laws on voting rights for convicted felons could impact Trump's ability to cast a vote for himself , but not in this case. Florida, where Trump is registered to vote, gives felons the right to vote if the state where they were convicted allows it. New York only removes a felon’s right to vote while they are imprisoned, and as Trump may not receive jail time at all, let alone before the election, he will likely remain eligible.

Contributing: Natasha Lovato, Ella Lee, Karissa Waddick , Aysha Bagchi , Maureen Groppe, Bart Jansen

This article originally appeared on USA TODAY: Donald Trump is now a convicted felon: Can he still run for president?

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Breaking news, why you shouldn’t check luggage early at the airport, according to a baggage handler.

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If you’re someone who arrives at the airport many hours before your flight, it might be time to reassess your strategy.

There’s nothing worse than waiting in a long line to check your bag knowing that you still have to go through security before you can settle in with food and a drink at your gate.

But is getting there early to check your luggage really worth it?

I am an airport baggage/ramp handler, AMA! by u/SimPilotAdamT in IAmA

Many assume that the first bag checked is also the first to make it to the other side — but it turns out that’s no guarantee.

An expert in the know took to Reddit to share the intel that everyone wonders about.

In a thread titled “I am an airport baggage/ramp handler, AMA,” a man named Adam said he was “up to answering basically anything” — and naturally the questions came pouring in.

“I have a theory that the earlier you check in, the lower in the stack your suitcase will be. Then it gets loaded onto the plane and is now on the top of the pile. Upon arriving at the destination, it gets unpacked again going to the bottom of the pile, which means your suitcase will come out to the carousel last,” one person asked . “Any truth to this?”

The handler replied, “There is some truth to this, but it isn’t a hard and fast rule. A lot of the times when dollies of bags are picked up by the ramp team, they get mixed up.”

So, it’s probably not worth your while to make a fuss about getting to the airport super early.

Adam provided more advice to the curious minds as well, including suggestions for the best and worst luggage to buy.

“Some of the worst bags to buy are the ones which have no wheels,” he shared .

“In my airline, none of our holds are bin loaded, so we have to manually stack the bags inside each hold, and they can get fairly long. If your bag has at least 2 high quality wheels, then it allows us to roll them down the hold quickly, making it easier for us. Otherwise, we have to throw the bags in order to keep to the scheduled times.”

He added that the “absolute least favorite” bags are ones that have four wheels, but one wheel isn’t working, because they fall when rolling down.

However, a bag with four good wheels is crucial to preventing your stuff from getting damaged.

“To stop stuff getting damaged, you want to have a bag that has 4 good wheels, with soft lining on the inside and a hard outer shell. The wheels are important bc we tend to throw those bags less when inside the hold of an aircraft, and the other features help keep your stuff cushioned,” he advised.

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Louisiana lawmakers approve bill to allow surgical castration of child sex offenders

A bill that would allow people convicted of sex crimes with victims under the age of 13 to be surgically castrated has been approved by Louisiana legislators.

SB 371 overwhelmingly passed by lawmakers Monday on the final day of the legislative session and will now go to Louisiana Gov. Jeff Landry for consideration, the Daily Advertiser , part of the USA TODAY Network reported. It has not yet been signed or made into law.

The bill was authored by Sen. Regina Ashford Barrow, D-Baton Rouge.

Louisiana is one of a few states that already has laws giving judges power to order chemical castration in some cases, Reuters reported. But if this law is passed, it would make Louisiana the first state to allow judges to impose surgical castration as a penalty.

Here's what to know about the bill.

Louisiana legislature: What does Louisiana's new abortion pill law mean for patients?

How would it be enforced?

The bill gives judges the option to assess the penalty against people convicted of aggravated rape, aggravated crime against nature or aggravated incestuous crime.

Any surgery would be conducted inside the prisons by a doctor supplied by the Department of Public Safety and Corrections, and the court would have to find the defendant to be suitable for castration at least 60 days before treatment.

Under the bill, failure to submit to the court order of castration would carry with it a 3-5 year prison term on top of any other prison sentence imposed.

The bill also notes that castration would not be done if it were contraindicated medically in any way.

What does surgical castration mean?

Also known as an orchiectomy, surgical castration is a procedure to remove one or both testicles and will permanently reduce the level of testosterone in the body, according to the Cleveland Clinic. It is used to treat and prevent testicular cancer, prostate cancer and male breast cancer.

Unlike a chemical castration, a surgical castration is permanent and cannot be reversed.

What is chemical castration?

Chemical castration is also sometimes called medical castration and involves using chemicals or drugs to stop sex hormone production, the Cleveland Clinic says .

While it is used in some states including Louisiana as a punishment for sex offenders, it can also be used as a treatment for tumors including for breast cancer and prostate cancer.

Contributing: Reuters; Jordyn Wilson, The Daily Advertiser

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Trump Has Been Convicted. Here’s What Happens Next.

Donald J. Trump has promised to appeal, but he may face limits on his ability to travel and to vote as he campaigns for the White House.

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By Jesse McKinley and Maggie Astor

• May 30, 2024

The conviction of former President Donald J. Trump on Thursday is just the latest step in his legal odyssey in New York’s court system. The judge, Juan M. Merchan, set Mr. Trump’s sentencing for July 11, at which point he could be sentenced to as much as four years behind bars, or to probation.

It won’t stop him from running for president, though: There is no legal prohibition on felons doing that . No constitutional provision would stop him even from serving as president from a prison cell, though in practice that would trigger a crisis that courts would almost certainly have to resolve.

His ability to vote — for himself, presumably — depends on whether he is sentenced to prison. Florida, where he is registered, requires felons convicted there to complete their full sentence, including parole or probation, before regaining voting rights. But when Floridians are convicted in another state, Florida defers to the laws of that state, and New York disenfranchises felons only while they are in prison.

The Trump Manhattan Criminal Verdict, Count By Count

Former President Donald J. Trump faced 34 felony charges of falsifying business records, related to the reimbursement of hush money paid to the porn star Stormy Daniels in order to cover up a sex scandal around the 2016 presidential election.

“Because Florida recognizes voting rights restoration in the state of conviction, and because New York’s law states that those with a felony conviction do not lose their right to vote unless they are incarcerated during the election, then Trump will not lose his right to vote in this case unless he is in prison on Election Day,” said Blair Bowie, a lawyer at the Campaign Legal Center, a nonprofit watchdog group.

Mr. Trump will almost certainly appeal his conviction, after months of criticizing the case and attacking the Manhattan district attorney, who brought it, and Justice Merchan, who presided over his trial.

Long before that appeal is heard, however, Mr. Trump will be enmeshed in the gears of the criminal justice system.

A pre-sentencing report makes recommendations based on the defendant’s criminal record — Mr. Trump had none before this case — as well as his personal history and the crime itself. The former president was found guilty of falsifying business records in relation to a $130,000 payment to Stormy Daniels, a porn star who says she had a brief sexual tryst with Mr. Trump in 2006, in order to buy her silence.

At the pre-sentence interview, a psychologist or social worker working for the probation department may also talk to Mr. Trump, during which time the defendant can “try to make a good impression and explain why he or she deserves a lighter punishment,” according to the New York State Unified Court System.

The pre-sentencing report can also include submissions from the defense, and may describe whether “the defendant is in a counseling program or has a steady job.”

In Mr. Trump’s case, of course, he is applying — as it were — for a steady job as president of the United States, a campaign that may be complicated by his new status as a felon. Mr. Trump will likely be required to regularly report to a probation officer, and rules on travel could be imposed.

Mr. Trump was convicted of 34 Class E felonies, New York’s lowest level , each of which carry a potential penalty of up to four years in prison. Probation or home confinement are other possibilities that Justice Merchan can consider.

That said, Justice Merchan has indicated in the past that he takes white-collar crime seriously . If he did impose prison time, he would likely impose the punishment concurrently, meaning that Mr. Trump would serve time on each of the counts he was convicted of simultaneously.

If Mr. Trump were instead sentenced to probation, he could still be jailed if he were later found to have committed additional crimes. Mr. Trump, 77, currently faces three other criminal cases: two federal, dealing with his handling of classified documents and his efforts to overturn the 2020 election , and a state case in Georgia that concerns election interference.

Mr. Trump’s lawyers can file a notice of appeal after sentencing, scheduled for July 11 at 10 a.m. And the judge could stay any punishment during an appeal, something that could delay punishment beyond Election Day.

The proceedings will continue even if he wins: Because it’s a state case, not federal, Mr. Trump would have no power as president to pardon himself .

Jesse McKinley is a Times reporter covering upstate New York, courts and politics. More about Jesse McKinley

Maggie Astor covers politics for The New York Times, focusing on breaking news, policies, campaigns and how underrepresented or marginalized groups are affected by political systems. More about Maggie Astor

Our Coverage of the Trump Hush-Money Trial

Guilty Verdict : Donald Trump was convicted on all 34 counts  of falsifying records to cover up a sex scandal that threatened his bid for the White House in 2016, making him the first American president to be declared a felon .

What Happens Next: Trump’s sentencing hearing on July 11 will trigger a long and winding appeals process , though he has few ways to overturn the decision .

Reactions: Trump’s conviction reverberated quickly across the country  and around the world . Here’s what voters , New Yorkers , Republicans , Trump supporters  and President Biden  had to say.

The Presidential Race : The political fallout of Trump’s conviction is far from certain , but the verdict will test America’s traditions, legal institutions and ability to hold an election under historic partisan tension .

Making the Case: Over six weeks and the testimony of 20 witnesses, the Manhattan district attorney’s office wove a sprawling story  of election interference and falsified business records.

Legal Luck Runs Out: The four criminal cases that threatened Trump’s freedom had been stumbling along, pleasing his advisers. Then his good fortune expired .

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FACT SHEET: President   Biden Announces New Actions to Secure the   Border

New actions will bar migrants who cross our Southern border unlawfully from receiving asylum Biden taking action as Congressional Republicans put partisan politics ahead of national security, twice voting against toughest reforms in decades

Since his first day in office, President Biden has called on Congress to secure our border and address our broken immigration system. Over the past three years, while Congress has failed to act, the President has acted to secure our border. His Administration has deployed the most agents and officers ever to address the situation at the Southern border, seized record levels of illicit fentanyl at our ports of entry, and brought together world leaders on a framework to deal with changing migration patterns that are impacting the entire Western Hemisphere.  Earlier this year, the President and his team reached a historic bipartisan agreement with Senate Democrats and Republicans to deliver the most consequential reforms of America’s immigration laws in decades. This agreement would have added critical border and immigration personnel, invested in technology to catch illegal fentanyl, delivered sweeping reforms to the asylum system, and provided emergency authority for the President to shut down the border when the system is overwhelmed. But Republicans in Congress chose to put partisan politics ahead of our national security, twice voting against the toughest and fairest set of reforms in decades. President Biden believes we must secure our border. That is why today, he announced executive actions to bar migrants who cross our Southern border unlawfully from receiving asylum. These actions will be in effect when high levels of encounters at the Southern Border exceed our ability to deliver timely consequences, as is the case today. They will make it easier for immigration officers to remove those without a lawful basis to remain and reduce the burden on our Border Patrol agents. But we must be clear: this cannot achieve the same results as Congressional action, and it does not provide the critical personnel and funding needed to further secure our Southern border. Congress still must act. The Biden-Harris Administration’s executive actions will:   Bar Migrants Who Cross the Southern Border Unlawfully From Receiving Asylum

• President Biden issued a proclamation under Immigration and Nationality Act sections 212(f) and 215(a) suspending entry of noncitizens who cross the Southern border into the United States unlawfully. This proclamation is accompanied by an interim final rule from the Departments of Justice and Homeland Security that restricts asylum for those noncitizens.
• These actions will be in effect when the Southern border is overwhelmed, and they will make it easier for immigration officers to quickly remove individuals who do not have a legal basis to remain in the United States.
• These actions are not permanent. They will be discontinued when the number of migrants who cross the border between ports of entry is low enough for America’s system to safely and effectively manage border operations. These actions also include similar humanitarian exceptions to those included in the bipartisan border agreement announced in the Senate, including those for unaccompanied children and victims of trafficking.

Recent Actions to secure our border and address our broken immigration system: Strengthening the Asylum Screening Process

• The Department of Homeland Security published a proposed rule to ensure that migrants who pose a public safety or national security risk are removed as quickly in the process as possible rather than remaining in prolonged, costly detention prior to removal. This proposed rule will enhance security and deliver more timely consequences for those who do not have a legal basis to remain in the United States.

Announced new actions to more quickly resolve immigration cases

• The Department of Justice and Department of Homeland Security launched a Recent Arrivals docket to more quickly resolve a portion of immigration cases for migrants who attempt to cross between ports of entry at the Southern border in violation of our immigration laws.
• Through this process, the Department of Justice will be able to hear these cases more quickly and the Department of Homeland Security will be able to more quickly remove individuals who do not have a legal basis to remain in the United States and grant protection to those with valid claims.
• The bipartisan border agreement would have created and supported an even more efficient framework for issuing final decisions to all asylum seekers. This new process to reform our overwhelmed immigration system can only be created and funded by Congress.

Revoked visas of CEOs and government officials who profit from migrants coming to the U.S. unlawfully

• The Department of State imposed visa restrictions on executives of several Colombian transportation companies who profit from smuggling migrants by sea. This action cracks down on companies that help facilitate unlawful entry into the United States, and sends a clear message that no one should profit from the exploitation of vulnerable migrants.
• The State Department also imposed visa restrictions on over 250 members of the Nicaraguan government, non-governmental actors, and their immediate family members for their roles in supporting the Ortega-Murillo regime, which is selling transit visas to migrants from within and beyond the Western Hemisphere who ultimately make their way to the Southern border.
• Previously, the State Department revoked visas of executives of charter airlines for similar actions.

Expanded Efforts to Dismantle Human Smuggling and Support Immigration Prosecutions

• The Departments of State and Justice launched an “Anti-Smuggling Rewards” initiative designed to dismantle the leadership of human smuggling organizations that bring migrants through Central America and across the Southern U.S. border. The initiative will offer financial rewards for information leading to the identification, location, arrest, or conviction of those most responsible for significant human smuggling activities in the region.
• The Department of Justice will seek new and increased penalties against human smugglers to properly account for the severity of their criminal conduct and the human misery that it causes.
• The Department of Justice is also partnering with the Department of Homeland Security to direct additional prosecutors and support staff to increase immigration-related prosecutions in crucial border U.S. Attorney’s Offices. Efforts include deploying additional DHS Special Assistant United States Attorneys to different U.S. Attorneys’ offices, assigning support staff to critical U.S. Attorneys’ offices, including DOJ Attorneys to serve details in U.S. Attorneys’ Offices in several border districts, and partnering with federal agencies to identify additional resources to target these crimes.

Enhancing Immigration Enforcement

• The Department of Homeland Security has surged agents to the Southern border and is referring a record number of people into expedited removal.
• The Department of Homeland Security is operating more repatriation flights per week than ever before. Over the past year, DHS has removed or returned more than 750,000 people, more than in every fiscal year since 2010.
• Working closely with partners throughout the region, the Biden-Harris Administration is identifying and collaborating on enforcement efforts designed to stop irregular migration before migrants reach our Southern border, expand investment and integration opportunities in the region to support those who may otherwise seek to migrate, and increase lawful pathways for migrants as an alternative to irregular migration.

Seizing Fentanyl at our Border

• Border officials have seized more fentanyl at ports of entry in the last two years than the past five years combined, and the President has added 40 drug detection machines across points of entry to disrupt the fentanyl smuggling into the Homeland. The bipartisan border agreement would fund the installation of 100 additional cutting-edge inspection machines to help detect fentanyl at our Southern border ports of entry.
• In close partnership with the Government of Mexico, the Department of Justice has extradited Nestor Isidro Perez Salaz, known as “El Nini,” from Mexico to the United States to face prosecution for his role in illicit fentanyl trafficking and human rights abuses. This is one of many examples of joint efforts with Mexico to tackle the fentanyl and synthetic drug epidemic that is killing so many people in our countries and globally, and to hold the drug trafficking organizations to account.

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