title: The effect of pre-travel advice on sexual risk behavior abroad: a systematic review.
abstract: BACKGROUND
  Travelers often have casual sex abroad and the risk of acquiring a sexually transmitted infection (STI) associated with casual travel sex is considered to be threefold higher compared to the risk of casual sex in the home country. Consequently, international guidelines recommend including STI advice in the pre-travel consultation. We performed a systematic review on the effect of a pre-travel STI intervention on sexual risk behavior abroad.
  
  
  METHODS
  In September 2012, a systematic analysis and meta-analysis of peer reviewed literature were performed on the relation between pre-travel STI advice for travelers and sexual risk behavior abroad. Primary outcome measure consisted of the number of travelers with a new sexual partner abroad; secondary outcome measure entailed the proportion of consistent condom use.
  
  
  RESULTS
  Six studies were identified for inclusion in the review, of which three clinical trials on the effect of a motivational intervention compared to standard pre-travel STI advice qualified for the meta-analysis. Two of these trials were performed in US marines deployed abroad and one in visitors of a travel clinic. The extensive motivational training program of the marines led to a reduction in sexual risk behavior, while the brief motivational intervention in the travel clinic was not superior to standard advice. The meta-analysis established no overall effect on risk behavior abroad. No clinical trials on the effect of a standard pre-travel STI discussion were found, but a cohort study reported that no relation was found between the recall of a nonstructured pre-travel STI discussion and sexual risk behavior, while the recall of reading the STI information appeared to be related to more consistent condom use.
  
  
  CONCLUSIONS
  Motivational pre-travel STI intervention was not found to be superior to standard STI advice, while no clinical trials on the effect of standard pre-travel STI advice were found.
authors.affiliation: Department of General Health, GGD Hart voor Brabant,'s-, Hertogenbosch, The Netherlands; Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Mieke
authors.initials: M
authors.lastname: Croughs
authors.forename: Roy
authors.initials: R
authors.lastname: Remmen
authors.forename: Jef
authors.initials: J
authors.lastname: Van den Ende
mesh_terms: D003253:Consultants / Q000706:statistics & numerical data*; D054626:Consumer Health Information / Q000379:methods / Q000458:organization & administration; D017408:Guidelines as Topic; D006801:Humans; D038622:Internationality; D009042:Motivation; D017063:Outcome Assessment, Health Care; D012309:Risk-Taking; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D014195:Travel