Table 2

Actions that individuals use after sex to alter the risk of STDs

Vaginally doucheDouching is a second rate contraceptive method that is also used for aesthetic and STD preventive reasons, with or without additional chemicals.70 A very common practice, douching possibly increases the risk of pelvic infections and ectopic pregnancy.71 It is often ambiguous as to what constitutes “douching,”—ie, washing out using a device that provides hydrostatic pressure or simply diligent washing of the lower vagina with the fingers (clinical observation). In the Philippines, some private doctors provide a douching service.28
Wash the external genitaliaWashing is frequently performed by sex workers on themselves72 73 and their clients (clinical observation). One study suggested a protective effect against HIV infection for sex workers if soap and water was used but not water alone.72 Washing the genitalia with soap and water was a component of post-exposure prophylaxis regimens used by the military16 (table 3). Showering is a more subtle alternative.55
Pass urineUrinating immediately after sex is sometimes recommended to women to avert recurrent urinary tract infections and to (particularly military) men to avert urethral infections, but it was never proved to be of benefit for the latter.16 74 It is still common practice for some groups of men (clinical observation).28
Apply topical and intravaginal antimicrobialsProphylaxis was provided; in the form of portable “blue light kits” or “pro-kits,” or calomel and carbolic acid ointments at “prophylaxis stations”; to military men and in ports well into this century.16 36 75–77 Post-coital antisepsis is often practised by sex workers but without any evidence of benefit. Products used include mustard oil,73 lemon and alcohol,28 toothpaste,28 soap,34 72 disinfectants,34 deodorants,34 and mouthwash.34 Some commercial sex worker organisations recommend the use of spermicide only in the event of condom failure.
Irrigate the male urethraChemical (usually dilute potassium permanganate) post-coital irrigation services were provided to soldiers16 17 and in ports75 around the world well into this century. Often used in combination with topical antiseptics such as calomel, its value was never formally proved.
Drink huge quantities of beerA folk variant of the former strategy.15
Take post-exposure systemic antimicrobialsPost-exposure antibiotics are a frequently used informal strategy,28 78 and more formally applied after sexual assault. Antibiotics were of proved benefit for gonorrhoea77 but discouraged for routine use because of the potential for the development of antibiotic resistance and the lack of a single agent to cover all important STD pathogens.9 79 This issue recently increased in profile because of the potential for direct chemoprophylaxis against HIV.10 11
Get vaccinated against hepatitisHepatitis B vaccination (active and/or passive) is sometimes provided after sexual assault and some other high risk sexual exposures. Hepatitis A vaccination is appropriate after confirmed sexual exposure.
Get tested for STDsGetting tested is a form of tertiary prevention intended to avert complications of STD if already infected and also to protect future sexual partners. This strategy is limited by test “window periods,” test insensitivity, and lack of protection against new infections but it enjoys widespread approval.22 23 52 80–83
Notify past sexual partner(s) if infected with an STDFor curable STDs, contact tracing reduces the likelihood of reinfection for the index case.