STD avoidance strategies were often poorly documented and difficult to disentangle from other drives such as aesthetics, sexual variety, and contraception. Some examples were douching; systemic and topical prophylactic antimicrobials; non-penetrative sexual practices, post-coital urination; and examining sexual partners' genitalia.
Interest in some practices has been recently revived—for example, vaginal microbicides and post-exposure chemoprophylaxis, while others—for example, withdrawal and non-penetrative sexual practices, receive scant attention but may be much more widely used.
In this article, the STD avoidance strategies that people initiate at the time they have sex or shortly thereafter are listed.
A clinician faced with an HIV discordant couple who flatly refuse to use condoms, despite repeated counselling, may need to discuss withdrawal and/or diaphragm use, to promptly manage any inflammatory genital conditions, and to ensure that the HIV positive partner has the lowest viral load that is achievable.
The effects of informal STD avoidance strategies can be wide ranging.
Post-coital genital washing, urinating, and applying topical antiseptics (table 2) are all strategies that were more common before better quality condoms and modern antibiotics became available, though they were of dubious value for reasons of poor compliance.
By the 1970s, before high risk people were willing to accept condoms on any scale, systemic antibiotic prophylaxis was thought to provide the most promise for STD prevention despite its inherent problems.
The costs of condom use—including financial, interpersonal, aesthetic, and social costs—are too high for most people.
Instead, many people in different settings adapt their sexual practices in ways that do not include male condoms (table 1), often with unknown or only marginal benefit for STD prevention.Conclusion: The full spectrum of STD avoidance strategies warrants further study because some are ubiquitous across cultures and because they have the potential to complement or undermine safer sex programmes.Because of their greater acceptability, some less efficacious strategies may have greater public health importance than less popular but more efficacious strategies such as condoms.Too little is known about them to determine how much these practices are intended to avoid infection or to cater to an increasing market for sexual variety.though insufficient data are available to determine their relative efficacy, prevalence (which varies widely between cultures), or how the people engaging in these behaviours construct and combine them.A further barrier to determining the efficacy of alternative strategies through randomised trials is that many of the techniques are readily available and blinding is usually impossible.