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Alcohol and drug use during sex and its association with sexually transmitted infections: a retrospective cohort study among young people aged under 25 years visiting Dutch STI clinics
  1. Ymke J Evers1,2,
  2. Kiki P L op den Camp1,2,
  3. Mischa Lenaers1,2,
  4. Nicole H T M Dukers-Muijrers1,3,
  5. Christian J P A Hoebe1,2
  1. 1Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Heerlen, The Netherlands
  2. 2Social Medicine and Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
  3. 3Health Promotion, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
  1. Correspondence to Dr Ymke J Evers, Sexual Health, Infectious Diseases, and Environmental Health, Public Health Service South Limburg, 6411 TE Heerlen, The Netherlands; ymke.evers{at}ggdzl.nl

Abstract

Introduction Alcohol use and drug use are common behaviours among young people. STI positivity is higher in young people than in people aged above 25 years. While there is an increasing amount of knowledge about drug use during sex among men who have sex with men (MSM), data on this behaviour among young women and heterosexual men are scarce. Therefore, this study aims to assess the proportion and characteristics of women and heterosexual men aged under 25 years reporting alcohol and/or drug use during sex and its association with STI positivity.

Methods Surveillance data of heterosexual individuals younger than 25 years visiting two Dutch STI clinics between 2016 and 2019 were assessed (n=11 714). We used multivariable logistic regression analyses to assess associations between alcohol and drug use during sex and STI positivity (Chlamydia trachomatis and/or Neisseria gonorrhoeae diagnosis), adjusting for sociodemographic characteristics (sex, age, ethnicity, educational level, socioeconomic status and urbanisation) and sexual behaviour (condom use, number of sex partners).

Results Alcohol use during sex was reported by 45.3% (5311/11 714; 49.5% in men vs 43.2% in women, p<0.001) and drug use during sex by 22.0% (2580/11 714; 30.7% in men vs 17.6% in women, p<0.001). The most reported drugs were cannabis (17.9%), ecstasy (XTC)/methylenedioxymethamphetamine (MDMA) (6.9%) and cocaine (4.7%). The use of at least one of the following drugs (XTC/MDMA, cocaine, speed, ketamine, gamma-hydroxybutyrate (GHB)/gamma-butyrolactone (GBL), heroin, crystal meth and/or designer drugs) was significantly associated with STI positivity after adjustment for sociodemographic characteristics (adjusted OR (aOR): 1.3, 95% CI 1.1 to 1.4), but this association did not remain significant after adjustment for sexual behaviour (aOR: 1.12, 95% CI 0.94 to 1.34). Significant associations between drug use during sex and inconsistent condom (aOR: 2.5, 95% CI 1.9 to 3.2) use and having four or more sex partners (aOR: 3.2, 95% CI 2.8 to 3.6) in the past 6 months were assessed.

Discussion Alcohol and drug use during sex was highly prevalent among young women and heterosexual men visiting the STI clinic and drug use during sex was associated with an increased risk for STI, probably mediated by sexual behaviour. This indicates that a holistic health promotion strategy, addressing STI prevention and alcohol and drug use-related harm reduction, is important in this group. STI clinics should address this behaviour not only among MSM, but also among young women and heterosexual men.

  • drug use during sex
  • young people
  • sexually transmitted infections
  • Chlamydia trachomatis
  • Neisseria gonorrhoeae

Data availability statement

Data are available upon reasonable request. Interested researchers may contact the head of the data archiving (Helen Sijstermans: helen.sijstermans@ggdz.nl) to receive the data.

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Data availability statement

Data are available upon reasonable request. Interested researchers may contact the head of the data archiving (Helen Sijstermans: helen.sijstermans@ggdz.nl) to receive the data.

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Footnotes

  • Handling editor Adam Huw Bourne

  • Contributors All authors were involved in the conception and design of the study. YJE was the guarantor of this study. YJE, KodC and ML produced the database and analysed the data. YJE wrote the first draft of the manuscript. NHTMD-M and CJPAH contributed to writing the paper. All authors were involved in the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.