Alcohol use as a risk factor for sexually transmitted infections: A systematic review and conclusions for prevention

Alcohol use has been associated with multiple sexual risk behaviors and outcomes, such as condomless sex, multiple sexual partners, unwanted pregnancy and sexually transmitted infections (STI). The aim of this review was to present updated evidence to demonstrate an association and to establish causality between alcohol consumption and STI risk, as well as to present interventions that reduce alcohol consumption and its effect on STIs. We conducted a systematic review according to the PRISMA guidelines using PUBMED and EMBASE. Narrative and systematic reviews, cohort studies, and case-control studies were included. Any type of alcohol use was considered as the exposure variable, with the outcome restricted to non-HIV STIs, as reviews on alcohol use and HIV already exist. In total, 18 publications satisfied the inclusion criteria. The evidence suggests that there is an association between alcohol use, especially heavy drinking occasions, and STIs, with 9 articles finding a statistical significant association. With respect to decision-making and sexual behavior, there is good evidence, including experimental evidence, that alcohol use increases risk-taking sexual behavior. It is important to have a deeper understanding of the association to develop effective prevention programs at community and individual levels. Preventive interventions should be implemented targeting the general population, in addition to specific campaigns directed at vulnerable subpopulations in order to reduce the risks.