Thursday June 24 2010
Using a condom protects against unwanted pregnancies and STIs
Older ‘swingers’ seeking sexual thrills are to blame for soaring rates of sexually transmitted infections (STIs), the Daily Mail has warned.
The story is based on Dutch research, which found that the rates of STIs in swingers are comparable to other recognised high-risk groups such as young heterosexuals and men who have sex with men. The researchers conclude that swingers need to be identified and targeted as an ‘at-risk group’ in terms of STI prevention and treatment.
The finding that people who swap partners and engage in group sex are also vulnerable to higher rates of STDs, is perhaps unsurprising. But the study’s conclusion that this group need recognition is important in the provision of STI services. It should be stressed that this study was carried out in the Netherlands and its findings may not apply to the UK. Nor it is clear how large the swinger population may be in either country.
However, the message of this study is clear and cross-cultural: unprotected sex with multiple partners greatly increases the risk of STIs, regardless of age or gender.
Where did the story come from?
The study was carried out by researchers from the South Limburg Public Health Service and Maastricht University in the Netherlands. No information about how it was funded is given. It was published in the peer-reviewed journal, Sexually Transmitted Infections.
Several newspapers reported on this study, with some focusing on the idea that swingers are an ‘STI bridge’ to the rest of the population. The Express said older swingers appear to be the ‘worst offenders’ for unsafe sex. It focused on the possibility that older swingers may pose a risk ‘to all’, a claim based on the study’s suggestion that swingers may act as an STI transmission bridge to the entire population, therefore identifying and testing them early is important.
The Daily Mail’s link between the study and the 'spread of STIs' among older adults (or divorced women) in the UK is unsubstantiated. The study did not look at any possible overall increase in STIs but only at the data from Dutch clinics showing the STI rates for swingers. Nor was it concerned with divorced women, since the group it looked was defined as heterosexual couples.
Only the BBC added that swingers need to be screened regularly for STIs and offered appropriate services.
What kind of research was this?
This was a statistical analysis of data from three sexual health clinics in the Netherlands, which has systematically recorded whether attending patients were ‘swingers’ since 2007. The researchers used recognised statistical methods to assess the swingers’ share of consultations and STI diagnoses, and the prevalence of STIs among swingers, compared with other recognised risk groups.
The researchers say they carried out the study because it is essential to identify groups at high risk of STIs to improve prevention and medical care. It is already known that certain types of sexual behaviour, such as frequently changing sexual partners and having more than one partner at the same time, are associated with a high risk of STIs. Although swingers are a likely target for STI prevention and care, they have until now not been targeted as such.
What did the research involve?
Since January 2007, all people attending the STI clinics in South Limberg, the Netherlands have been asked whether they are swingers, defined as being in a heterosexual relationship and having sex with other heterosexuals. They also appear to have been asked about their sexual orientation, age and also whether they were prostitutes. All were then tested for chlamydia and gonorrhoea. In the statistical analysis, they were classified into the categories: heterosexual, female prostitute, men who have sex with men (MSM) and swinger.
Researchers then analysed the clinics’ surveillance data from January 2007 to December 2008, to assess the STI prevalence and share of diagnoses in each risk group and age category. The researchers used diagnoses of chlamydia and gonorrhoea and did not focus on other STIs such as syphilis or HIV because these diseases occur in fewer people.
What were the basic results?
During the study, 8,971 consultations took place (most of whom were Dutch). Overall, about one in nine (11.6%) of these attendees were swingers. The largest group (74-75%) were young heterosexuals (excluding swingers).
The researchers found that swingers had comparable STI rates to other high-risk groups, such as young heterosexuals and gay men. Here are the main findings, showing the combined rate of the two infections:
- about one in ten (10.1%) heterosexuals (excluding swingers) had an STI
- between one and two in ten men (14.2%), who had sex with men, had an STI
- less than one in ten (4.8%) of the female prostitutes had an STI
- just over one in ten (10.4%) swingers had an STI, with female swingers having higher infection rates than men
The study also found that among swingers increasing age increased the risk, with between one and two (13.7%) of those aged 45 having an STI and with older women swingers having the highest prevalence.
More than half (55%) of all the STI diagnoses in the over-45s were made in swingers, compared with about one-third (31%) in gay men. However, on average, other groups tended to be younger than swingers, whose average age was 43 years, compared with an average 24 years for heterosexuals. Overall, only about 1,000 (11.7%) of the total attendees were over 45.
How did the researchers interpret the results?
The researchers conclude that swingers are generally a missed target for STI services and that older swingers in particular contribute considerably to both STI consultations and diagnoses.
They also speculate that the swinger population is probably large worldwide, yet no single country mentions them as a special focus group for STI prevention. They say that by identifying and regularly testing swingers, the individual and population burden of STI and its spread could be reduced.
The study draws attention to a group at high risk of STIs, yet who have previously been unrecognised as such. The STI infection rates of swingers would appear to be comparable to other risk groups such as men who have sex with men and young heterosexuals, at least in the Netherlands. However, the study’s finding that 55% of the STIs in older people were in swingers should be seen in context. Only 11.7% of people, just over 1,000 people, attending the clinic were over 45 years, so 55% of this group is a relatively small number (about 577).
It should be highlighted that the study relies on self-reported sexual behaviour and so may be prone to error. Also, this is a study of the population from the Netherlands and its figures may not apply to other countries including the UK. It is also unclear how the STI rates of infection in the Netherlands compare to the UK. However, the message of this study is clear and cross-cultural - unprotected sex with multiple partners greatly increases the risk of STIs, regardless of age or sex.