Check binge drinking in reviewing STD risks

When discussing risks for sexually transmitted diseases (STDs), you cover such topics as condom use, but do you also address alcohol use, specifically binge drinking? Results of a new study indicate that you should. Researchers who examined such behavior by gender at an STD clinic found that drinking five or more alcoholic beverages at one time increased the risk of unsafe sexual behaviors and having an STD for female patients.1

To conduct the study, researchers approached 795 STD clinic patients at the Baltimore City Health Department who were being evaluated and/or 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 computer-assisted self-interview technology. The association between binge drinking and sexual behaviors/STDs was analyzed and adjusted for age, employment, and drug use.

The research findings indicate that binge drinking among female STD clinic patients was associated with certain risky sexual behaviors. Within gender, women binge drinkers were twice as likely to have multiple sex partners compared to women who did not drink alcohol. Compared to nondrinking women, women binge drinkers also were five times as likely to have gonorrhea, researchers found.1

"While our study did not examine cause, it certainly showed that binge drinking is associated with risky sex in women, a fact backed up the finding of higher rates of gonorrhea in women," says Heidi Hutton, PhD, assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine and corresponding author for the study.

The National Institute of Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as a pattern of alcohol consumption that brings a person's blood alcohol concentration to 0.08 g% or above. To achieve this blood level concentration, men typically need to consume five or more drinks, and women need to consume four or more drinks, in about two hours.2

To determine possible binge drinking behavior, Geetanjali Chander, MD, MPH, assistant professor of medicine in the Division of General Internal Medicine at Johns Hopkins University School of Medicine, suggests a standard approach recommended by the NIAAA. First, ask, "Do you sometimes drink beer, wine, or other alcoholic beverages?" If yes, then ask a screening question about heavy drinking days: "How many times in the past year have you had four or more drinks in a day (for women) or five or more drinks per day (for men)?"

Adolescents and young adults are at special risk for binge drinking. About 90% of the alcohol consumed by U.S. citizens under age 21 is in the form of binge drinks.3 The proportion of current drinkers that binge drinking is highest in the 18- to 20-year-old group.4

Results from a 2003 published survey indicate that most sexually active single women believe they are at low risk for contracting STDs, yet their risk profiles are similar to those in higher-risk populations.5 Researchers surveyed 1,210 women ages 18-25 by telephone about demographic characteristics and risk behaviors such as episodes of binge drinking, history of vaginal sex and STDs, perceived STD risk, overall condom use, and partner-specific condom use. Both students and nonstudents were included in the survey. An analysis of the results indicates binge drinking significantly was associated with unprotected sex among nonstudents, but not so with students. The finding might be due to the fact that while colleges offer educational programs on binge drinking and impaired judgment, most nonstudents may not have access to such programs and information, researchers report.5

When discussing alcohol use with patients, use the following tips from the NIAAA to help them curb alcohol use:6

  • When you do drink, pace yourself. Sip slowly. Have no more than one drink with alcohol per hour. Alternate "drink spacers" — nonalcoholic drinks such as water, soda, or juice — with drinks containing alcohol.
  • Don't drink on an empty stomach — have some food so the alcohol will be absorbed more slowly into your system.
  • What triggers your urge to drink? If certain people or places make you drink even when you don't want to, try to avoid them. If certain activities, times of day, or feelings trigger the urge, plan what you'll do instead of drinking. If drinking at home is a problem, keep little or no alcohol there.
  • When an urge to drink hits, consider these options: Remind yourself of your reasons for changing, or talk it through with someone you trust. Get involved with a healthy, distracting activity. "Urge surf" — instead of fighting the feeling, accept it and ride it out, knowing that it soon will crest like a wave and pass.
  • You are likely to be offered a drink at times when you don't want one. Have a polite, convincing "no, thanks" ready. The faster you can say no to those offers, the less likely you are to give in. If you hesitate, it allows time to think of excuses to go along.

Note that a person's blood alcohol concentration can continue to rise even while he or she is passed out. Even after a person stops drinking, alcohol in the stomach and intestine continues to enter the bloodstream and circulate throughout the body, so do not assume a person will be fine by "sleeping it off." Talk about the critical signs for alcohol poisoning: mental confusion, stupor, coma, or person cannot be roused; vomiting; seizures; slow breathing (fewer than eight breaths per minute); irregular breathing (10 seconds or more between breaths); hypothermia, bluish skin color, paleness.7

Students whose roommates are unconscious or close to unconscious from binge drinking should be taken immediately to the university infirmary, says Robert Hatcher, MD, MPH, professor of gynecology and obstetrics at Emory University School of Medicine in Atlanta.

References

  1. Hutton HE, McCaul ME, Santora PB, et al. The relationship between recent alcohol use and sexual behaviors: Gender differences among sexually transmitted disease clinic patients. Alcoholism: Clinical and Experimental Research 2008; DOI 10.1111/ j.1530-0277.2008.00788.
  2. National Institute of Alcohol Abuse and Alcoholism. NIAAA council approves definition of binge drinking. Accessed at pubs.niaaa.nih.gov/publications.
  3. Office of Juvenile Justice and Delinquency Prevention. Drinking in America: Myths, Realities, and Prevention Policy. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention; 2005.
  4. Naimi TS, Brewer RD, Mokdad A, et al. Binge drinking among U.S. adults. JAMA 2003; 289:70-75.
  5. Yarnall KS, McBride CM, Lyna P, et al. Factors associated with condom use among at-risk women students and nonstudents seen in managed care. Prev Med 2003; 37:163-170.
  6. National Institute of Alcohol Abuse and Alcoholism. Tips for Cutting Down on Drinking. Accessed at pubs.niaaa.nih.gov/publications/Tips/tips.htm.
  7. National Institute of Alcohol Abuse and Alcoholism. Facts about Alcohol Poisoning. Accessed at www.collegedrinkingprevention.gov.