Abstract
Sir: We read with interest the original article published in the December 2007 edition of the Int J STD AIDS by K Standerwick et al. 1 showing significant associations between heavy and episodic (binge) drinking and risks of sexually transmitted infection (STI) acquisition in genitourinary medicine (GU) medicine attendees.
As the authors state these links have been long suspected but have proved difficult to demonstrate. We too have been interested in this group and have investigated the links between drinking habits and compliance with therapy for STIs.
In a small prospective study, we have looked at 274 GU medicine attendees requiring treatment with a one-week course of doxycycline (168 [61%] men and 106 [38%] women).
All patients had detailed alcohol histories taken during their initial clinic attendance. At the initiation of therapy patients were advised to take all their medication and to be sexually abstinent during their treatment period. No advice was given to moderate or limit their alcohol consumption. At a routine compliance check follow-up details of the extent to which such advice had been followed was ascertained, the extent and patterns of drinking during the treatment period as well as any history of non-compliance with the doxycycline therapy.
Generally, there were high levels of compliance with therapy and behavioural advice. A total of 267 (97%) patients reported compliance with prescribed medications, 253 (93%) reported compliance with advice concerning sexual abstinence and 249 (91%) reported compliance with both aspects.
In a univariant analysis significant associations were found between failure to follow behavioural advice and total amounts of alcohol taken (P < 0.001) as well as binge drinking (eight or more units for men and six or more units for woman on a single day)2,3 (P < 0.001) over the treatment period. Non-significant trends were found in relation to alcohol usage and compliance with medication (P < 0.09).
High levels of alcohol consumption, especially binge drinking, during therapy is associated with a greater level of non-compliance to behavioural advice regarding sexual abstinence.
We would suggest that there remains value in taking an alcohol history in GU medicine and that clinicians may wish to take special care with counselling, choice of therapy or follow-up for those patients with high levels of consumption or a history of binge drinking.