Swingers have been identified separately by previous studies as being more likely to engage in high-risk sexual behavior and use recreational drugs.
Having observed this association, alongside high rates of risky sexual behavior and drug use, the authors believe that swingers can play a key role in the spread of sexually transmission infection (STI). The study is published online in Sexually Transmitted Infections.
The researchers define swingers as "heterosexuals who, as a couple, practise mate swapping or group sex, and/or visit sex clubs for couples." They have recently been classified as a high-risk group for STI, on account of the frequency of high-risk sexual behavior - multiple sex partners, unprotected sex - within this group.
Recreational drug use has also been linked to high-risk sexual behavior as well as STI in previous studies. However, this prior research has tended to focus on women and on men who have sex with men; no studies have specifically looked at swingers in this manner.
The authors note that a pilot study found a high prevalence of drug use among a sample group of swingers, with 70% of 57 couples reporting taking drugs. More specific knowledge about swingers, STIs and drug use, including the types of drugs used and any impact on health, was not available, driving the need for further research.
Sex, drugs and infections
A total of 289 people participated in the study. The participants all identified themselves as swingers and visited the STI clinic of the South Limburg Public Health Service in the Netherlands for STI testing between 2009 and 2012.
They were asked to complete a questionnaire on their sexual behavior and drug use while swinging during the preceding 6 months. The average age of the participants was 49. The researchers then assessed the results of the questionnaires, looking for associations between the swingers' behavior, use of recreational drugs and STI diagnoses.
Recreational drugs reported included alkyl nitrates (poppers), cannabis, cocaine, gamma hydroxybutyrate (GHB) and methylenedioxymethamphetamine (MDMA). STI diagnoses included Chlamydia trachomatis (CT), Neisseria gonorrhea (NG) and syphilis.
The researchers found that over half of the participants had taken part in group sex over the preceding 6 months, with half of them not using condoms. Around a quarter of the male participants had had sex with male swing partners during the same period.
Half of the participants also reported having at least six sex partners during the preceding 6 months and not using a condom for vaginal sex. Overall, the researchers did not note any difference in sexual risk behavior between male and female swingers.
Recreational drug use - including alcohol and the use of erectile dysfunction drugs - was reported in 79% of swingers, with 46% reporting multiple drug use. When excluding alcohol and erectile dysfunction drugs, 48% of swingers reported recreational drug use, and this was linked to risky sexual behavior in both men and women.
More attention warranted for 'key population'
The only STIs observed within the participants were CT and NG, for which the prevalence was found to be 13%. Drug use was only found to have an independent association with STIs in female swingers, and most commonly in those who practiced group sex.
The authors note that their study assesses a relatively small number of swingers, reducing the statistical power of their research and their ability to detect associations. They believe that this lack of statistical power could be why they were unable to find an association between drug use and STIs in male swingers.
"High rates of multiple drug use, as well as risky sexual behavior and STIs among swingers, warrant paying more attention to this key population in prevention and care, as they are a risk group that is generally under-recognized and underserved in care," conclude the authors.
They suggest that both individuals and society, with a reduced STI burden, can benefit from more tailored prevention and enhanced STI screening, in order to increase rates of safe sex and prevent further harmful drug use.
Earlier in the year, Medical News Today reported on a study suggesting that, for men having sex with men, finding a sex partner using a phone app is associated with an increased risk of STI.