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Sexual Health as Part of Travel Medicine
Sexual health is an important part of comprehensive travel preparation. Those who are well informed can make more conscious decisions and protect themselves more effectively. At the same time, sexual health is a fundamental part of personal preventative health care, not only when one is traveling.
Our Sexual Health Consultation is a service offered by the Medizinisches Zentrum am Central (MZC). Both the MZC and the Travel Clinic UZH (ZRM) are part of the Department of Public & Global Health (DPGH) at the University of Zurich. The Sexual Health Consultation is integrated into the premises of the ZRM at Hirschengraben 84 in Zurich and is open to people of all ages, sexual orientations and gender identities. This service includes counseling, diagnostics, treatment and prevention related to sexually transmitted infections.
This includes STI checks with and without symptoms, medical assessments and treatment for STIs, PrEP counseling and follow-up care, as well as any relevant vaccinations. The MZC therefore offers a contact point for questions related to sexual health before, during, after, but also independent of, travel.
For the sake of simplicity, only the abbreviation ZRM will be used in the following blog.
From Need to Consultation: How the Offer Was Developed
The development of the Sexual Health Consultation grew out of an existing area of expertise within the Department of Public & Global Health (DPGH) at the University of Zurich. This is where the SwissPrEPared program was developed. Under the responsibility of Prof. Dr. med. Jan Fehr and the project leadership of Dr. med. Benjamin Hampel, the program aims to improve medical care for people using PrEP and those interested in PrEP. The participants are mostly men who have sex with men (MSM) and trans people.
As a SwissPrEPared-associated center, the ZRM has been caring for PrEP users and people interested in PrEP for a little over two years. The development of the Sexual Health Consultation took place in parallel. The aim was to offer PrEP, STI testing, diagnostics, counseling and treatment as part of one holistic service.
At the same time, sexual health has also proven to be an important topic in travel medicine. Questions about STIs, HIV prevention, PrEP or protection options may be relevant before, during or after a trip. The Sexual Health Consultation is therefore not only an independent offer, but also a valuable addition to the pre-travel medical consultation.
Development With a Clear Attitude
Manuela Rasi, Advanced Practice Nurse (APN), played a central role in the development from the very beginning. Together with the medical leadership of the ZRM, she took on project leadership and coordinated the implementation. This included project management, operational and personnel management, as well as organizational decisions. Structurally, a major focus was also placed on integrating the new offer into the clinic’s existing processes.
Just as important as the organizational processes was the attitude behind the offer. “It was particularly important to us to communicate and model an open, respectful and non-judgmental attitude toward topics of sexual health and toward the people who use our services,” emphasizes Manuela Rasi. The consultation is intended to be a place where clients can speak openly, respectfully and without shame about sexual health. Conversations about sexual health should be experienced as something natural, just like any other medical consultation.
To ensure and further develop the quality of care, the consultation continues to be evaluated and optimized in close collaboration with the medical leadership.
Looking Ahead
For Manuela Rasi, the fact that the consultation now exists and continues to develop is an important step. “The tasks during the pandemic significantly delayed our development plans. That makes it all the more gratifying today to see how the Sexual Health Consultation is continuously developing and being used more and more. In my opinion, the successful development of such an offer is only possible thanks to a committed and diverse team with different professional skills and perspectives.” She also particularly appreciates the strong commitment of the specialist staff, who support the further development of the offer with great motivation and enthusiasm.
Looking ahead, she hopes that the Sexual Health Consultation will become even better known and will be perceived by people from all population groups as a natural health care service. In the long term, competent, non-judgmental counseling on sexual health should be as easily accessible as possible, regardless of origin, gender, sexual orientation or financial means.
The Sexual Health Consultation: Consultation, Assessment and Treatment
The Sexual Health Consultation is provided by a interdisciplinary team of specialists with expertise in travel medicine and sexual health. In addition to other team members, this includes the physicians Hadrien Komaromi, Rodolfo Novillo, Nikolas Van Hemelrijck Meneses and Linus Egli, who share insights into their work in this article. Together, they care for people with symptoms of a possible STI, as well as people who need a medical assessment, counseling or treatment after an STI check, and PrEP users or people interested in PrEP.
The offer includes assessment of symptoms, treatment of viral, bacterial and parasitic STIs, as well as treatment following STI tests carried out externally. This includes infections such as genital herpes, HIV, hepatitis, chlamydia, gonorrhea, syphilis, scabies, pubic lice or trichomoniasis. Vaccinations that may be relevant in connection with sexual health are also part of the offer, such as vaccinations against HPV, hepatitis A and hepatitis B, and mpox.
Diagnostics and treatment in the Sexual Health Consultation are provided by physicians, and the costs can be billed through mandatory health insurance.
The consultation is intended to be a place where patients and their questions are first met with openness and care. Linus Egli explains: “I like to give my patients space to talk at the beginning and at the end of the consultation. Whether or not the consultation is specifically about PrEP is secondary. I see the consultation as an ideal opportunity to care for people holistically and, where appropriate, to identify areas of concern that might otherwise not have come up.”
Great importance is placed on counseling on equal footing. Hadrien Komaromi sums up this attitude: “You do not need to feel ashamed with us. We have already heard and seen everything!” The consultation is intended to be a place where people can speak openly, respectfully and without judgment.
The five specialists who support this offer are introduced in short portraits at the end of the article.
STI Checks: Creating Clarity, Even Without Symptoms
An STI check is a useful and straightforward way to get tested for sexually transmitted infections. The team explains why this matters: “Most STIs are asymptomatic and can have serious consequences, which is why testing is important.”
Safer sex can significantly reduce the risk, but it does not completely prevent all sexually transmitted infections. Regular testing allows infections to be detected and treated early. This also helps prevent further transmission.
At the ZRM, clients can be tested for HIV, syphilis and hepatitis C through a blood sample, and for chlamydia and gonorrhea through swabs. The testing process is simple and quick. Thanks to our in-house laboratory, results are available promptly.
The team also emphasizes an important point: “A positive test result is not the end of the world. STIs are very treatable.” The earlier an infection is detected, the sooner it can be treated and further transmission can be prevented.
PrEP: Protection Against HIV With Individual Support
HIV pre-exposure prophylaxis, or HIV-PrEP for short, is an effective way to protect oneself against HIV infection. HIV-negative people take a medication that contains two active substances effective against HIV. Depending on individual risk and personal preference, PrEP can be taken daily or event-based.
PrEP counseling can be useful for people who have an increased risk of HIV or who are unsure whether PrEP might be suitable for them. During counseling, it is discussed together whether PrEP is appropriate, which dosing regimen fits best and which medical check-ups are necessary. Linus Egli sees the team size as an advantage in this context: “We see our patients at regular intervals, and because we are a small team, this also allows us to establish a good relationship and revisit topics at the next appointment.”
Common questions during counseling concern possible side effects and correct use. “The tablets can only work if they are taken correctly. That is the most important point,” emphasizes Hadrien Komaromi. Which form of use is appropriate in each individual case is discussed during counseling.
It is important to note that PrEP reliably protects against HIV, but not against other sexually transmitted infections. That is why PrEP follow-up care also includes regular medical check-ups with HIV and STI testing, as well as additional laboratory tests depending on the situation.
The ZRM participates in the national SwissPrEPared program. This means that PrEP can be billed through mandatory health insurance under certain conditions. The exact criteria are discussed during counseling and can be viewed here:
https://www.swissprepared.ch/de/frequently-asked-questions/#prep1
TravelPrEPared: Including Sexual Health in Travel Counseling
Sexual health is an important part of the pre-travel medical consultation. Questions about STIs, HIV prevention, PrEP or access to medication and testing abroad are therefore part of comprehensive travel preparation at the Travel Clinic UZH.
TravelPrEPared is conducted under the leadership of Dr. sc. med. Dunja Nicca, builds on the experience of SwissPrEPared and specifically integrates counseling on sexual health into the classic pre-travel medical consultation. The focus is on the prevention of HIV and other sexually transmitted infections, as well as counseling on PrEP for travelers. In addition, a training program was developed for travel medicine specialists to strengthen their ability to competently address sexual risks and HIV during consultations.
The background: A relevant proportion of HIV infections is associated with travel. At the same time, sexual health is still addressed too rarely during pre-travel medical consultations, and modern prevention options such as HIV-PrEP are still not widely known among many people outside specialized services. TravelPrEPared is therefore intended to help include sexual health as part of travel preparation and to promote access to effective prevention strategies.
A conversation about sexual health in a pre-travel medical consultation differs from a targeted consultation in the Sexual Health Consultation. In a pre-travel medical consultation, clients usually have other topics in mind, such as vaccinations or malaria prophylaxis. “In a pre-travel medical consultation, most people do not expect to talk about sexual health. That is why it sometimes takes a little more time and tact to address the topic,” explains Rodolfo Novillo. “Many people do not initially expect this topic to come up in a travel consultation. Nevertheless, we have often experienced that important conversations can arise from it.”
Sexual contacts while traveling also often happen spontaneously, which is why people do not always see a concrete need for counseling beforehand. This makes it all the more important to address the topic openly and naturally as part of comprehensive travel preparation. Rodolfo Novillo emphasizes that practical questions also play an important role, such as access to medication or testing abroad: “Depending on the travel destination, it cannot always be guaranteed that PrEP, PEP, HIV medication or recommended tests, for example, will be available. That is why we discuss this as early as possible, so that travelers are well prepared and know what options they have locally or what they should organize before their trip.”
Well Informed and Supported
Sexual health is a natural and important part of personal preventive health care, both when traveling and in everyday life. Whether someone has questions about STIs, has had a risk contact, is experiencing symptoms, wants an STI check or would like to clarify whether PrEP could be useful: the Sexual Health Consultation at the Medizinisches Zentrum am Central offers a competent, discreet and non-judgmental point of contact for everyone.
Anyone who is unsure which offer is right for them can contact us without obligation or book an appointment directly for the Sexual Health Consultation.
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Nikolas Van Hemelrijck Meneses, Resident Physician
Could you briefly introduce yourself: What is your role at ZRM and in which area do you mainly work? I also trained in general internal medicine and am working toward a second specialist qualification in travel and tropical medicine. I work in travel and vaccination counseling, in the assessment of returning travelers with symptoms and in the Sexual Health Consultation.
What personally motivates you about working in the field of sexual health? I find it exciting that our clients actively take an interest in prevention and want well-founded information about their sexual health. What motivates me in particular is that after a visit with us, clients can go home with more knowledge, greater awareness and a better understanding of their health.
What is particularly important to you when counseling clients? For me, creating a trusting and pleasant atmosphere is always the top priority. Only in such an environment can people speak openly and freely about their concerns, regardless of how personal or sensitive they may be. |
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