Background: It has not been determined conclusively whether greater knowledge of sexually transmitted infections (STIs) is associated with lower rates of STIs. Purpose: This study sought to determine STI knowledge among high school students and factors associated with such knowledge, and to determine whether poor STI knowledge is associated with chlamydia or gonorrhea infection. Methods: Students in an urban United States school district serving a predominantly African American student population participated in a urine-based chlamydia and gonorrhea screening. Participants (N=3563) were surveyed about their knowledge of selected basic facts concerning STIs. Point-scores were assigned to knowledge items. Results: The mean knowledge score was 3.65 (range: 0 to 6; median: 4.00). In a multiple regression analysis, knowledge score was significantly associated with female gender (P <0.001), upper grade level (P<0.001) and a past infection with chlamydia or gonorrhea (P=0.001). In logistic regressions, knowledge score was not significantly associated with current infections with chlamydia (P=0.22) or gonorrhea (P=0.74). Discussion: There was an insufficient basic knowledge of STIs among students and a lack of association between knowledge and current infections with chlamydia and gonorrhea. Translation to Health Education Practice: Health education curricula taught throughout the high school years should incorporate basic facts concerning STIs.
Am J Health Educ. 2010;41(4):206-217. This paper was submitted to the Journal on July 11, 2009, revised and accepted for publication on September 10, 2009.
From the late 1980s to the early 1990s, the recognition of the primarily sexual transmission of human immunodeficiency virus (HIV) and the growing concerns about sexual exposure of American adolescents to HIV led to an increased provision of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) instruction to adolescents through sexuality education campaigns that resulted in adolescents' increased knowledge of HIV/AIDS. (1-7) Although HIV/AIDS has a significant impact on the health of adolescents, other pathogens that are transmitted through the same sexual behavior pathways such as Chlamydia trachomatis and Neisseria gonorrhoeae are more prevalent, presumably a result of their differential greater transmissibility compared to HIV. (8,9)
Infections with C. trachomatis and N. gonorrhoeae are the two most commonly reported notifiable diseases in the United States, and the highest rates of infections are among adolescents and young adults under the age of 25. (9) Untreated or inadequately treated infections may lead to severe complications, especially among women who may develop pelvic inflammatory disease, tubal infertility, ectopic pregnancy, or chronic pelvic pain. (10,11) Despite the greater prevalence and serious health consequences of sexually transmitted infections (STIs), knowledge and awareness of STIs other than HIV/AIDS among American adolescents remain poor. (7,12-14) Even among healthcare professionals, knowledge of STIs may at best be inadequate. (15)
In 1997, the Committee on Prevention and Control of Sexually Transmitted Diseases of the Institute of Medicine estimated that STIs in the United States were in epidemic proportions, and that the epidemic was partly due to the poor knowledge of Americans about STIs. (16) Because the rates of STIs are disproportionately higher among adolescents and young adults than in other age-groups, (9,16) the Committee recommended, as part of a national system to prevent STIs among adolescents, that clinicians utilize routine clinical encounters to educate all adolescents and screen for STIs those who are sexually active. (16) Implicit to this grim assessment of STIs by the Committee and its recommendation is the contention that the more Americans would know about STIs, the more likely they would protect themselves against and take appropriate actions to control STIs, which should contribute to drive the epidemic down. …