Self-reported Sexually Transmitted Diseases Research Articles

Bacterial sexually transmitted infection testing and diagnoses among men who have sex with men and report prescription opioid misuse––American Men's Internet Survey, 2017–2018

PurposePrescription opioid misuse is associated with behaviors which increase bacterial sexually transmitted diseases (STD) risk among men who have sex with men (MSM). Annual syphilis, gonorrhea, and chlamydia screening is recommended for sexually active MSM at anatomical sites of contact, regardless of condom use. We describe the prevalence of self-reported bacterial STD testing and diagnoses in the past 12 months among sexually active MSM who report prescription opioid misuse. MethodsWe used data from the 2017 and 2018 American Men's Internet Survey to examine the prevalence of self-reported bacterial STD testing and diagnoses in the past 12 months. We calculated unadjusted prevalence ratios, adjusted prevalence ratios (APR), and 95% confidence intervals (CI) to compare bacterial STD testing prevalence across demographic, clinical, and behavioral factors. ResultsOf 932 sexually active MSM who reported prescription opioid misuse, 433 (46.5%) self-reported bacterial STD testing in the past 12 months. Of those who reported being tested, 131 (30.2%) self-reported ≥ 1 bacterial STD. Approximately 50% of respondents who reported condomless anal sex (CAS), casual sex, or exchange sex reported bacterial STD testing in past 12 months. Factors associated with bacterial STD testing among MSM who misused prescription opioids included visiting a healthcare provider in the past 12 months (APR = 1.70, 95% CI = 1.09–2.67), ever disclosing same-sex behavior to a healthcare provider (APR = 1.78, 95% CI = 1.27–2.50), and CAS in the past 12 months (APR = 1.51, 95% CI = 1.10–2.04). ConclusionsPrevalence of self-reported bacterial STD testing in this sample was low and one-third of tested MSM reported ≥ 1 bacterial STD in the past 12 months. Innovative approaches to identify MSM who misuse prescription opioids and expand bacterial STD testing in this population are needed.

Multiple psychosocial health problems and sexual risk among African American females in juvenile detention: A cross-sectional study

ObjectivesAfrican American girls in juvenile detention are disproportionately affected by sexually transmitted diseases (STDs) and other psychosocial health problems, yet few studies have examined associations between experiencing multiple psychosocial health problems and sexual risk behaviors and STD diagnosis. MethodThe study included 188 detained African American girls aged 13–17 years. We conducted three sets of logistic regressions. First, bivariate analyses assessed associations among seven psychosocial factors (substance use disorder; depression; post-traumatic stress disorder [PTSD]; emotional abuse; pregnancy coercion; physical abuse; and sexual abuse) and four outcomes (early sexual initiation; condomless sex; multiple sexual partners; self-reported STD) to examine their interrelationships. Second, we examined associations between experiencing multiple psychosocial factors and outcomes. Third, psychosocial factors were categorized into four domains: substance use disorder; mental health (depression, PTSD); psychological abuse (emotional abuse, pregnancy coercion); and violence (physical abuse, sexual abuse) and included as independent associations with each outcome to assess their relative importance. ResultsMultiple interrelationships among psychosocial factors and outcomes were identified. An increase of one psychosocial health problem was associated with an 18% to 27% increased odds of sexual risk behaviors or a previous STD diagnosis. Reporting violence was associated with increased odds of having multiple partners (odds ratio = 3.31; confidence interval = 1.57–6.97), and experiencing psychological abuse was associated with increased odds of reporting an STD diagnosis (odds ratio = 3.95; confidence interval = 1.62–9.63). ConclusionMultiple psychosocial health problems, particularly psychological abuse and violence, are associated with sexual risk and STDs in this vulnerable population.

Community-Level HIV Stigma as a Driver for HIV Transmission Risk Behaviors and Sexually Transmitted Diseases in Sierra Leone: A Population-Based Study.

Although HIV stigma has been identified as an important risk factor for HIV transmission risk behaviors, little is known about the contribution of community-level HIV stigma to HIV transmission risk behaviors and self-reported sexually transmitted diseases (STDs) or how gender may modify associations. We pooled data from the 2008 and 2013 Sierra Leone Demographic and Health Surveys. For HIV stigma, we examined HIV stigmatizing attitudes and HIV disclosure concerns at both individual and community levels. Outcomes of HIV transmission risk behaviors were recent condom usage, consistent condom usage, and self-reported STDs. We assessed associations with multivariable logistic regressions. We also analyzed gender as an effect modifier of these associations. Of 34,574 respondents, 24,030 (69.5%) who had heard of HIV were included in this analysis. Community-level HIV stigmatizing attitudes and disclosure concerns were associated with higher odds of self-reported STDs (adjusted odds ratio = 2.07; 95% confidence interval: 1.55 to 2.77; adjusted odds ratio = 2.95; 95% confidence interval: 1.51 to 5.58). Compared with men, community-level HIV stigmatizing attitudes among women were a stronger driver of self-reported STDs (interaction P = 0.07). Gender modified the association between community-level HIV disclosure concerns and both recent and consistent condom usage (interaction P = 0.03 and P = 0.002, respectively). Community-level HIV disclosure concerns among women were observed to be a driver of risky sex and self-reported STDs. This study shows that community-level HIV stigma may be a driver for risky sex and self-reported STDs, particularly among women. Our findings suggest that community-held stigmatizing beliefs and HIV disclosure concerns among women might be important targets for HIV stigma reduction interventions.

Young Women Sexual Behaviour and Self-Reported Sexually Transmitted Diseases in Northern Ethiopia: A Cross Sectional Study

Background: Globally, sexually transmitted diseases (STDs) remain a significant public health problem especially among young women. In Ethiopia, the prevalence of STDs among femal youths aged 15-24 years old continues to be a problem of young population. However, the factors associated with this problem is poorly studied. Thus, the purpose of this study is to assess sexual behavior and prevalence of STDs and factors associated among young women attending health facilities in Northern Ethiopia. Methods: A Facility-based cross-sectional study was employed among 326 young women aged 15 to 24 years from May 1 to 30, 2013. A multistage sampling technique was used to select young women attending outpatient facility. A pre-tested interviewer guided structured questionnaire was used for data collection. Data was entered, cleaned and analyzed using SPSS version 20.0. Bivariate and multivariate logistics regression analyses were done to identify the associated variables. A p-value of 0.05 with 95% CI were used as a cutoff point to examine the statistical association. Results: From the total of 326 sample, 305 young women were participated in this study with a response rate of 93.6%. The median age at first sex was 17 years (range 9-24 years). The prevalence of self-reported STDs in the last 12 months preceding the survey was 21.3%. One hundred fourteen (40.4%) of the young women had poor knowledge on STDs mode of transmission and prevention. Having two or more sex partners, not using condoms, poor knowledge on STDs mode of transimission and prevention, and a previous history of STDs were found to be significantly associated with self reported STDs. Conclusions: In this study the sexual behavior, not using condom and prevalence of STD was found to be high. Many young women had started early sexual contact and have poor utilization of condom. Hence, the youth friendly services, partner treatment and life skill communication with parents should be enhanced through the joint effort of all concerned stakeholders.

Developmental Trajectories of Substance Use Among Sexual Minority Girls: Associations With Sexual Victimization and Sexual Health Risk

To examine mechanisms underlying the development of sexual health risk behaviors in sexual minority girls (SMGs) and its association with sexual victimization. Data were drawn from the Project on Human Development in Chicago Neighborhoods cohorts, aged 15 and 18 years (N = 391; 54 SMGs). Sexual minority girls reported more sexual victimization and steeper positive trajectories of substance misuse over time than heterosexual girls. Growth in alcohol use during adolescence mediated the link between SMG status and past year number of partners, whereas growth in marijuana use mediated the link between SMG status and self-reported sexually transmitted diseases (STDs). Adding unwanted sexual experiences to the models resulted in a reduction of significance in the direct or indirect effects from SMG status on the sexual health outcomes. Unwanted sexual experiences emerged as a robust predictor directly and indirectly related to past-year number of partners via growth in alcohol use. Unwanted sexual experiences also directly predicted STD history. The increased risk of SMGs for alcohol and marijuana during adolescence, higher rates of sexual partners, and STD diagnosis may also be linked to their significant risk for sexual victimization. Findings highlight the importance of preventive interventions targeting victimization of SMGs.

Variation in Concurrent Sexual Partnerships and Sexually Transmitted Diseases Among African Men in Cape Town, South Africa

Most studies that assess the relationship between concurrent sexual partnerships and sexually transmitted diseases (STDs) use dichotomous measures of whether concurrency was reported or not. However, different forms of concurrency have different degrees of associated risk for disease transmission, and this should be considered. This article examines variation in both individual concurrency and partner concurrency among African men in Cape Town, South Africa, and assesses the relationship between different types of concurrent partnerships and STDs. Longitudinal data from sexual partner history tables are used to form measures of concurrency and the type of partner (main vs. nonmain) and degree of condom use (consistent vs. inconsistent) associated with these concurrent relationships. Cross-sectional data from a self-administered module are also used to assess the number of partners men have had concurrently and duration of individual concurrency. Probit regression models assess the association between the partner concurrency measures and self-reported STD history. Substantial differences between concurrent sexual partnerships were observed and these variations were associated with different disease risk. Men had a greater chance of reporting an STD when partner concurrency was associated with main partners and inconsistent condom use. Partnership dynamics must be taken into account in studies assessing the role of concurrency in STD transmission.

Infecciones de transmisión sexual en la región Pacífica colombiana: implicaciones para población en situación de vulnerabilidad étnica, social y económica.

Objective. Describe and analyze the presence of diagnosis of self-reported Sexually Transmitted Diseases (STDs) in adult population of the Colombian Pacific Region, as well as the consequences among population with ethnic, social and economical vulnerability. Method. A secondary source study, using data from the National Health Survey (2007) with a final sample of 4,622 persons, was conducted. Results. A self-reported STD diagnosis of 1.2% was found; the highest percentage occurred on the Pacific Coast, where the population is 1

Association of MDMA/ecstasy and other substance use with self-reported sexually transmitted diseases among college-aged adults: A national study

MDMA/ecstasy use among college students has increased and reportedly leads to risky sexual behaviours. However, little is known about its association with sexually transmitted diseases (STDs). To evaluate this public health concern, this study examined the association between substance use (particularly MDMA) and self-reported STDs (chlamydia, gonorrhoea, herpes and syphilis) among college students and non-students aged 18-22 years (n=20,858). A cross-sectional data analysis of a national survey. Data were drawn from the 2005-2006 National Surveys on Drug Use and Health; a nationally representative survey of non-institutionalized Americans. Self-reported STDs and substance use were assessed by the audio computer-assisted self-interviewing method. The association between MDMA use and STDs was determined while taking into account young adults' use of other substances, healthcare utilization and sociodemographic characteristics. Overall, 2.1% of college students and 2.5% of non-students reported contracting an STD in the past year. MDMA use in the past year was not associated with STDs. Among non-students, onset of MDMA use before 18 years of age increased the odds of past-year STDs. In both groups, alcohol use, marijuana use, female gender and African American race increased the odds of both past-year and lifetime STDs. Additional analyses indicated that, regardless of college-attending status, greater odds of past-year STDs were noted among users of alcohol and drugs, and users of alcohol alone, but not among users of drugs alone. Alcohol use is a robust correlate of STDs. Irrespective of college-attending status, young women and African Americans have a higher rate of STDs than young men and Whites.

HIV and syphilis infections among men who have sex with men in Chongqing municipality, China

To examine the prevalence and predictors of HIV and syphilis infections among men who have sex with men (MSM) in Chongqing municipality, China. Cross-sectional studies were conducted in three districts of Chongqing municipality from July to September, 2006 and 2007, respectively. Questionnaire-based interviews were conducted to provide information on demographic characteristics, behaviors on sex and drug use, and HIV and sexually transmitted diseases (STD) related health services. Blood samples were tested for HIV and syphilis infections. Of 1773 participants, 10.6% were HIV-positive and 8.4% were sero-positive for syphilis infection. Factors independently associated with HIV infection included older age (26-35 year: AOR = 1.7, 95% CI: 1.1-2.6; >35 years of age: AOR = 2.3, 95% CI: 1.4-3.8), low level of education (AOR = 2.3, 95% CI: 1.5-3.5), having had multiple male sex partners (AOR = 1.8, 95% CI: 1.2-2.8), venues of recruitment from bathhouses/sauna (AOR = 2.3, 95% CI: 1.1-4.7), with self-reported STD symptoms in the past 12 months (AOR = 1.8, 95% CI: 1.2-2.7) and syphilis infection (AOR = 1.7, 95% CI: 1.1-2.9). The prevalence rates on both HIV and syphilis infections were considered to be high among MSM in Chongqing city. Unprotected anal sex and multiple sex partners were common in this group. Education, condom promotion, combination of HIV and STD screening, and treatment to the diseases are essential to this population in Chongqing. However, MSM had not hitherto been perceived to be in the epidemic mainstream in this area.

The relationship between condom use, sexually transmitted diseases, and location of commercial sex transaction among male Hong Kong clients.

This study investigated the consistency of condom use and the prevalence of self-reported sexually transmitted diseases (STD) among male Hong Kong commercial sex clients with respect to the geographical location of these transactions. Male clients were identified via three independent, population-based surveys conducted in 1998, 1999, and 2001. A unique confidential telephone system was used to collect sensitive information. Respondents patronizing female sex workers (FSW) in 'mainland China only' or in 'mainland China and other places' were more likely to be inconsistent condom users (28 and 34%) than those patronizing FSW in 'Hong Kong only' (9.1%). A similar pattern was found for self-reported STD in the past 6 months (10.1, 8.1 and 1.0%, respectively). Patronizing FSW in mainland China was associated with a higher prevalence of self-reported STD (adjusted OR 4.16), independent of consistent condom use and other potential confounding factors, including calendar year of survey, age, educational attainment, HIV-related knowledge, perceived efficacy of condom use for HIV/AIDS prevention, number of female sex partners, and the presence of a regular female sex partner in the past 6 months. Clients who had commercial sex both in mainland China and Hong Kong were more likely to use condoms in Hong Kong than in mainland China (paired OR 4.67, < 0.05). The geographical location of commercial sexual activity is related to the consistency of condom use, irrespective of the clients engaged in such activity. Prevention programmes need to be aware of how risk behaviour is dependent on local contexts.

A study of the STD/AIDS related attitudes and behaviors of men who have sex with men in Hong Kong.

A random population based study was carried out to understand HIV-related attitudes and behaviors and self-reported sexually transmitted diseases (STDs) among men who have had sex with men (MSM) in Hong Kong. A special computerized telephone survey method was used and 85 MSM were identified (from a total sample of 2,074 men), 47.1% of whom had at least one male sex partner in the past 6 months. Among these 85 MSM, 29.4% had multiple partners and 37.5% had had anal sex in the last 6 months (67% of them were inconsistent condom users). MSM were more likely to have contracted at least one STD in the last 6 months (10.6%) and were less likely to perceive susceptibility for contracting HIV (62.4%) than those other respondents who visited a female sex worker (FSW) in the past 6 months (4.3% and 43%, respectively). About 45% of the MSM did not perceive condom use to be efficacious for HIV prevention (vs. 30% for male clients of FSW). The study is limited by its small number; however, it suggests that MSM in Hong Kong may be at high risk of contracting HIV. Prevention programs should attempt to change attitudes (e.g., perceived efficacy of condom use, perceived susceptibility, awareness of risk involved, etc.) as well as behaviors. The feasibility for establishing a behavioral surveillance system for this population was demonstrated.

Correct condom application among African-American adolescent females: the relationship to perceived self-efficacy and the association to confirmed STDs.

To assess condom application ability and the relationship between perceived ability and demonstrated ability. Also, to examine the association between high-demonstrated condom application ability and recent sexual risk behaviors and laboratory-diagnosed sexually transmitted diseases (STDs) among African-American adolescent females. A purposeful sample of sexually active African-American females (n = 522) completed a structured interview and provided vaginal swab specimens for STD testing. Subsequent to the interview, adolescents demonstrated their condom application skills using a penile model. A 9-item scale assessed adolescents' perceived self-efficacy to apply condoms. Sexual risk behaviors assessed by interview were noncondom use at last intercourse and the last five intercourse occasions for steady and casual sex partners as well as any unprotected vaginal sex in the past 30 days and the past 6 months. Approximately 28% of the sample tested positive for at least one STD and nearly 26% self-reported a history of STDs. Controlled analyses indicated that adolescents' self-efficacy for correct use was not related to demonstrated skill. Adolescents' demonstrated ability was not related to any of the sexual risk behaviors. Likewise, recent experience applying condoms to a partner's penis and demonstrated ability were not related to laboratory-diagnosed STDs or self-reported STD history. Adolescents may unknowingly be at risk for human immunodeficiency virus and STD infection owing to incorrect condom application. Further, high-demonstrated ability to apply condoms was not related to safer sex or STDs. Reducing sexual risk behaviors may require more than enhancing adolescent females' condom application skills and may require addressing other relational skills.

Adverse childhood experiences and sexually transmitted diseases in men and women: a retrospective study.

Adverse childhood experiences (ACEs) may have long-term consequences on at-risk behaviors that lead to an increased risk of sexually transmitted diseases (STDs) during adulthood. Therefore, we examined the relationship between ACEs and subsequent STDs for both men and women. A total of 9323 (4263 men and 5060 women) adults >/=18 years of age participated in a retrospective cohort study evaluating the association between ACEs and self-reported STDs. Participants were adult members of a managed care organization who underwent routine medical evaluations and completed standardized questionnaires about 7 categories of ACEs, including emotional, physical, or sexual abuse; living with a battered mother; and living with a substance-abusing, mentally ill, or criminal household member. Logistic regression was used to model the association between the cumulative categories of ACEs (range: 0-7) and a history of STDs. We found that 59% (2986) of women and 57% (2464) of men reported 1 or more categories of adverse experiences during childhood. Among those with 0, 1, 2, 3, 4 to 5, and 6 to 7 ACEs, the proportion with STDs was 4.1%, 6.9%, 8.0%, 11.6%, 13.5%, and 20.7% for women and 7.3%, 10.9%, 12.9%, 17.1%, 17.1%, and 39.1% for men. After adjustment for age and race, all odds ratios for reporting an STD had confidence intervals that excluded 1. Among those with 1, 2, 3, 4 to 5, and 6 to 7 ACEs, the odds ratios were 1.45, 1.54, 2.22, 2. 48, and 3.40 for women and 1.46, 1.67, 2.16, 2.07, and 5.3 for men. We observed a strong graded relationship between ACEs and a self-reported history of STDs among adults.

Longitudinal prediction of sexually transmitted diseases among adolescents : Results from a national survey

Background: Although adolescent use of condoms has been increasing, incidence of sexually transmitted diseases (STDs) among young people remains high. To identify adolescent behavioral risk factors for acquiring STDs, this study assessed adolescent self-reports of acquired chlamydia, gonorrhea, syphilis, and trichomoniasis within 1 year after a baseline interview. Methods: We used data from the National Longitudinal Survey of Adolescent Health for this study. Data were collected in the homes of survey respondents, using audio-computer-assisted self-interview (audio-CASI) technology and interviews. Participants were enrolled in grades 7–11 from 134 U.S. schools. A cohort of 4593 sexually experienced adolescents was followed for 1 year. We conducted separate analyses for both genders. Results: About 3.1% of the male adolescents and nearly 4.7% of the female adolescents reported having had at least one STD after the baseline interview. For both genders, self-reported STD infection before baseline interview was the best predictor of self-reported STD infection 1 year after baseline interview. Female adolescents were more likely to report diagnosis with an STD after baseline if they self-identified as a minority race (other than Asian) and perceived that their mother did not disapprove of their having sex. Female adolescents were less likely to report STDs if they perceived that adults care about them. No additional variables predicted STD diagnosis after baseline for male adolescents. Conclusions: We conclude that past history of STD infection is the most important indicator of subsequent STD infection among adolescents. Thus, this study suggests the benefit of specific clinical efforts designed to promote preventive behavior among adolescents newly diagnosed with an STD.

Where Do People Go for Treatment of Sexually Transmitted Diseases?

Major public health resources are devoted to the prevention of sexually transmitted diseases (STDs) through public STD clinics. However, little is known about where people actually receive treatment for STDs. As part of the National Health and Social Life Survey, household interviews were performed from February to September 1992 with 3,432 persons aged 18-59. Weighted population estimates and multinomial response methods were used to describe the prevalence of self-reported STDs and patterns of treatment utilization by persons who ever had a bacterial or viral STD. An estimated two million STDs were self-reported in the previous year, and 22 million 18-59-year-olds self-reported lifetime STDs. Bacterial STDs (gonorrhea, chlamydia, nongonococcal urethritis, pelvic inflammatory disease and syphilis) were more common than viral STDs (genital herpes, genital warts, hepatitis and HIV). Genital warts were the most commonly reported STD in the past year, while gonorrhea was the most common ever-reported STD. Almost half of all respondents who had ever had an STD had gone to a private practice for treatment (49%); in comparison, only 5% of respondents had sought treatment at an STD clinic. Respondents with a bacterial STD were seven times more likely to report going to an STD clinic than were respondents with a viral STD--except for chlamydia, which was more likely to be treated at family planning clinics. Men were significantly more likely than women to go to an STD clinic. Young, poor or black respondents were all more likely to use a family planning clinic for STD treatment than older, relatively wealthy or white respondents. Age, sexual history and geographic location did not predict particular types of treatment-seeking. The health care utilization patterns for STD treatment in the United States are complex. Specific disease diagnosis, gender, race and income status all affect where people will seek treatment. These factors need to be taken into account when STD prevention strategies are being developed.

The trading of sex for money or drugs, sexually transmitted diseases (STDs), and HIV-related risk behaviors among multisubstance using alcoholic inpatients

Data from 802 multisubstance using alcoholic inpatients (481 men and 321 women) were analyzed to determine whether trading sex for money or drugs was associated with self-reported STDs, self-reported HIV infection, and perceptions of current and future probable infection. Logistic and ordinal polychotomous regression models were used to evaluate the statistical significance of sex trade on STDs and HIV-related behaviors while controlling for other potential confounding variables such as cocaine abuse and IV drug use. Involvement in sex trade was associated with higher cocaine abuse, with STDs, and with self-reported HIV infection. The multivariate (adjusted) models supported the significance of sex trade with regard to STDs and HIV-related behaviors. The findings indicated that, among these multisubstance using alcoholic inpatients, high levels of trading sex for money or drugs were independently associated with self-reported STDs, a cofactor of HIV infection, as well as self-reported HIV infection and perceptions of risk for infection.

Risk factors for Kaposi's sarcoma in HIV-positive subjects in Uganda.

Kaposi's sarcoma (KS) is associated epidemiologically with HIV infection and with human herpesvirus 8 (HHV-8 or KSHV). Both KS and HIV infection are common in Uganda. We conducted a case-control study of 458 HIV-seropositive. Ugandan adults with KS and 568 HIV-seropositive subjects without KS to examine risk factors for HIV-associated KS. We recruited newly diagnosed adult KS cases from five hospitals in Kampala, Uganda and controls from a large referral clinic for HIV infection at Mulago Hospital. All cases and controls were counselled and tested for HIV and answered an interviewer-administered questionnaire about their home, socio-economic conditions, lifestyle and sexual behaviour before they became ill. Only HIV-seropositive subjects were included in the analysis. There were 295 males and 163 females with KS and 227 male and 341 female controls. Age distribution was similar but there was a higher proportion of cases (45%) than controls (29%) residing in rural regions of Uganda. KS cases were more likely than controls to have a higher level of education (X2 for trend, 4.8; P = 0.03), to have occupations associated with affluence [chi 2 for heterogeneity, 17.3 on 5 degrees of freedom (df); P = 0.004] and to come from larger settlements [adjusted odds ratio (OR) for settlements of > 1000 versus 10-99 houses, 1.8; 95% confidence interval (CI), 1.1-3.0]. Cases were more likely than controls to have high household income (chi 2 for trend, 32.6; P < 0.001) and other markers of urban or rural wealth such as owning several cows (chi 2 for trend, 9.5; P = 0.002). Cases were more likely to travel away from home (adjusted OR, 1.6; 95% CI, 1.1-2.3) and more likely to have spent increasing time in contact with water (chi 2 for trend, 12.3; P < 0.001). Few indices of sexual behaviour were related to risk of KS, including reported number of sexual partners. Cases were more likely than controls to be married to one rather than several spouses (adjusted OR, 1.6; 95% CI, 1.2-2.2) and to have reported a history of sexually transmitted diseases (STD) (adjusted OR, 1.6; 95% CI, 1.2-2.3). Among HIV-infected subjects, KS cases are characterized by better education and greater affluence, compared with controls. Urban address, travel away from home, exposure to water, monogamous marriage and self-reported STD were also more frequent among KS cases than controls. The higher socio-economic status of persons with HIV and KS may be a marker for enhanced exposure to a possibly sexually transmitted agent, or for a delayed exposure to a childhood infection. The risk posed by exposure to water among KS cases requires further study.

The associations between risk behaviour and reported history of sexually transmitted diseases, among young women: a population-based study.

The aim of this study was to determine the associations between risk behaviour and women's reported sexually transmitted diseases (STDs). All the women aged 19, 21, 23 and 25, residing in a specified housing area, were invited to answer a questionnaire regarding their sexual behaviour, smoking and alcohol consumption and previous history of STD. Of the 611 women participating, one out of 4 women had a history of at least one STD. In an univariate analysis, self-reported STD was found to be related to age, having more than 4 lifetime sexual partners, having practised intercourse at first date, inconsistent use of condoms, alcohol consumption of more than 3 bottles of wine per month and smoking. These factors were, however, not independent of each other and when subjected to a multivariate logistic regression analysis 2 factors, i.e. the lifetime number of sexual partners (more than 4 partners vs one; OR 7.94, (3.41-18.50)) and coitus on first date (practised more than once vs never, OR 2.99 (1.55-5.78)) emerged as independently associated with a previous STD.

RACIAL/ETHNIC DIFFERENCES IN ADOLESCENTS' SELF-REPORT OF A SEXUALLY TRANSMITTED DISEASE. † 7

African-American youths have among the highest rates of sexually transmitted diseases (STDs) of any racial/ethnic group of adolescents. Previously reported difference in sexual behaviors do not appear to be of sufficient magnitude to account for their increased risk for STDs. The objective of this study was to determine to what degree sexual behavioral differences account for racial/ethnic differences in STDs. In this study, we performed a secondary analysis of national data collected as part of the Youth Risk Behavior Survey (YRBS) supplement to the 1992 National Health Interview Survey (NHIS). We used the SUDAAN statistical package and weighted data to compute frequencies and odds ratios. The sample consisted of 5189 sexually active adolescents; 48.5% male. Mean age was 18.5 years (range=14-21 years). Thirty-seven percent were out-of-school. The racial/ethnic distribution was 60.2% white, 18.8% black, 16.7% Hispanic, and 4.4% other. Overall, 7.0% of adolescents reported a history of an STD. Black adolescents were at increased risk for reporting a history of an STD compared to other adolescents: 13.1% of black adolescents had a history of an STD compared to 5.9% of white adolescents, 4.5% of Hispanic adolescents, and 4.6% of other adolescents(p<0.001). Black adolescents remained at high risk for a history of an STD(Odds Ratio= 3.67; 95% Confidence Interval=1.55-8.66) after adjusting for sociodemographics (age, gender, highest educational attainment of responsible adult, family income, and region of the country) and sexual behaviors (age of first sex, number of lifetime sexual partners, number of sexual partners in the last three months, use of alcohol or drugs during last sex, and use of condom last sex). These data suggest that racial/ethnic variations in rates of self-reported STDs may be related, in part, to racial/ethnic differences in the risk of being exposed to an infected partner rather than self-reported differences in sexual behaviors.

Sexual intercourse during menstruation and self-reported sexually transmitted disease history among women.

The purpose of this study was to examine the practice of sexual intercourse during menstruation and the relationship of this practice to the experience of sexually transmitted diseases (STD) among women in the United States. Logistic regression technique was used to conduct an analysis of population-based data from a national sample of 1586 sexually active 20- to 37-year-old women to examine the patterns of sexual intercourse during menstruation and its relationship with STD outcome. More than one fourth of the women reported that they usually have vaginal intercourse during their menses, and 16% reported that they had had vaginal intercourse during their last menstrual period. Proportions of women engaging in this practice were higher among those who reported greater frequency of intercourse and larger numbers of lifetime sex partners. Almost half the women who had intercourse more than twice a week and more than one third of the women who had more than seven lifetime sex partners reported that they usually have vaginal intercourse during menses. The findings suggest that this practice is relatively more common among the better educated, young, white women and their sex partners. Most interestingly, despite the fact that sex during menses is most common among women in relatively low-risk groups, we were able to observe a strong statistical association between sexual intercourse during menstruation and self-reported STD history. Sexual intercourse during menstruation may emerge more consistently as a risk factor for the heterosexual transmission of HIV or other sexually transmitted pathogens in future studies. If future epidemiologic studies continue to bolster this finding, then public health efforts should promote abstinence during the female menstrual period and target those groups of women among whom this practice is prevalent.