Binge drinking (5+ alcoholic beverages at one time) is associated with risky sexual behaviors. A new study is one of the few to examine this association by gender in an urban clinic for sexually transmitted diseases (STDs).
Results show that binge drinking among women attending the clinic was linked to unsafe sexual practices – such as multiple partners and anal sex – and high rates of gonorrhea.
"The link between binge drinking and risky sexual behavior is complex," said Heidi E. Hutton, assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine as well as corresponding author for the study. "We wanted to examine one component of that relationship, whether binge drinking increased the risk of engaging in sexual behaviors and having STDs. We found gender differences in binge drinking among patients at an STD clinic, and also that binge drinking increased STD risk for women."
"Binge drinking results in a decreased ability to make clear decisions," noted Geetanjali Chander, assistant professor of medicine in the division of general internal medicine at Johns Hopkins University School of Medicine, "and can enable individuals to engage in behaviors that they would not if sober. Initially, some individuals may drink with the expectation of decreasing inhibitions, or some may drink because they are anxious, or depressed, and they expect alcohol to alleviate their symptoms. Regardless of why they choose to drink, many people do not perceive the potential risk or harm that may result from binge drinking."
Between July 2000 and August 2001, researchers approached 795 STD-clinic patients being evaluated/ treated for STDs. Of those approached, 671 (322 males, 349 females; 95% African American, 83% heterosexual) agreed to answer questions about their recent alcohol/drug use and risky sexual behaviors using audio computer-assisted-self interview technology. The association between binge drinking and sexual behaviors/STDs was then analyzed, adjusting for age, employment, and drug use.
"We found that binge drinking among women STD-clinic patients is associated with certain risky sexual behaviors," said Hutton. "Across gender, women binge drinkers are more likely to have anal sex than men binge drinkers. Within gender, women binge drinkers are three times as likely to have anal sex, and twice as likely to have multiple sex partners compared to women who do not drink alcohol. Compared to non-drinking women, women binge drinkers are also five times as likely to have gonorrhea."
"Gonorrhea is a sexually transmitted disease which reflects unsafe sexual practices," added Chander. "This association between binge drinking and high-risk sexual behaviors is especially important as risky behaviors are associated with HIV acquisition and transmission."
Hutton said that both binge drinking and risky sexual behaviors are more hazardous to women than men.
"If women and men consume the same dose of alcohol, women will have a higher concentration of alcohol in their system, and substantially greater alcohol-caused impairment than men," she said. "Furthermore, anatomical differences place women at greater risk than men of contracting some sexually transmitted infections. As a result, men transmit some infections to women more efficiently than women do to men. For example, men are eight to 10 times more likely to transmit HIV to a female partner through repeated, unprotected sexual intercourse than women are to transmit the virus to men."
"While other studies have demonstrated that alcohol use is associated with high-risk behaviors, this study demonstrates a gender-specific association between binge drinking and risky behaviors which merits further exploration," said Chander. "Linking binge drinking to an actual biological marker that reflects high-risk sexual behaviors strengthens the argument that alcohol use is associated with high-risk behaviors."
Hutton and her colleagues recommend that clinicians at STD clinics routinely screen for binge drinking. "While it is standard practice in most STD clinics to discuss behavioral factors for STD risk," said Hutton, "binge drinkers may be harder to identify than alcohol-dependent individuals because the latter have more obvious impairment of function."
Authors were: Mary E. McCaul and Patricia B. Santora of the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine; and Emily J. Erbelding of the Department of Medicine at Johns Hopkins University School of Medicine, and the Baltimore City Health Department. The study was funded by the National Institutes of Health, and the Blades Center for Clinical Practice and Research in Alcohol/Drug Dependence.
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