A Survey on Knowledge, Prevention, and Occurrence of Sexually Transmitted Infections among Freshmen from Four Italian Universities

Abstract

Background. The peak of sexually transmitted infections (STI) among adolescents/young adults suggests a low level of prevention. In order to assess whether the level of sexual health education (SHE), received by several channels, was effective at improving sexual behaviors, we conducted a survey among freshmen from four Italian universities. Methods. This observational cross-sectional study was conducted with an anonymous self-reported paper questionnaire, administered during teaching lectures to university freshmen of the northern (Padua, Bergamo, and Milan campuses) and southern (Palermo campus) parts of the country. Knowledge of STI (a linear numerical score), knowledge of STI prevention (dichotomous variable: yes vs. no) and previous STI occurrence (polytomous variable: “no”; “don’t know”; “yes”) were the outcomes in the statistical analysis. Results. The final number of freshmen surveyed was 4552 (97.9% response rate). The mean age of respondents was 21.4 ± 2.2 years and most of them (70.3%) were females. A total of 60% of students were in a stable romantic relationship. Only 28% respondents knew the most effective methods to prevent STI (i.e., condom and sexual abstinence), with a slightly higher prevalence of correct answers among females (31.3%) than males (25.8%). Students with history of STIs were 5.1%; they reported referring mostly to their general practitioner (GP) (38.1%) rather than discussing the problem with their partner (13.1%). At multivariable analysis, a significantly higher level of STI knowledge was observed in older students (25+ years of age), biomedical students, and those from a non-nuclear family; lower levels were found among students of the University of Palermo, and those who completed a vocational secondary school education. Those who had less knowledge about the most effective tools to prevent STIs included males, students from the University of Palermo, students registered with educational sciences, economics/political sciences, those of foreign nationality, and those whose fathers had lower educational levels. The risk of contracting STI was significantly lower only in students not in a stable relationship (relative risk ratio, RRR = 0.67; 95% confidence interval, 95%CI = 0.48; 0.94), whereas such risk was significantly higher in students with higher STI knowledge (RRR = 1.15; 95%CI = 1.08; 1.22). Discussion and Conclusions. University freshmen investigated in this study had poor knowledge of STIs and their prevention. Unexpectedly, those with higher levels of knowledge had an increased risk of STIs. There were no educational interventions—with good quality and long-term follow-ups—that increased the confidence that such SHE programs could have population level effects. A new high-quality study is therefore required to assess the effectiveness of an intervention generating behavioral changes; increasing only knowledge may not be sufficient.

Associations between Awareness of Sexually Transmitted Infections (STIs) and Prevalence of STIs among Sub-Saharan African Men and Women

“…However, our study revealed that women who had prior knowledge of gonorrhea, syphilis, and HIV had a twofold higher risk of testing positive for an STI. Higher associations between a higher risk of STIs and STI knowledge were also reported by others [ 32 , 33 , 34 , 35 , 36 ]. Interestingly, women who had prior knowledge of chlamydia were 51% less likely to test positive for STIs compared to women who were not aware of chlamydia.…”

“…This might be the reason for the unexpected result of higher STIs among the study participants who had more knowledge of STIs. As others have reported, knowledge about STIs was most likely acquired from direct experience than from learning how to prevent infection [ 32 ]. Nzoputam et al reported that respondents with a good knowledge of STIs had a greater tendency to test positive for STIs [ 33 ].…”

Knowledge difference of sexually transmitted infections between Hong Kong undergraduates from local and international secondary schools: A cross-sectional study

“…Further, students in a higher year of study and those from medical faculties achieved a higher STI quiz score. This finding was similar to that reported in a study among students from four Italian universities ( 19 ).…”

“…Similar to the Italian study (19), the overall STI knowledge among our students, regardless of the type of secondary school attended, was unsatisfactory. The average quiz score of This table shows the comparisons of characteristics between students from international schools and those from local schools.…”

“…Individual schools enjoy flexibility in adopting the approach, contents, and delivery mode of sex education according to their background, mission, ethos, and resources (17,18). It is similar to the situation in some European countries, such as Italy, where sex education is not mandatory (19,20). An evaluation of the implementation of sex education in Hong Kong secondary schools revealed a decrease in the percentage of schools having an overall policy on the implementation of sex education owing to a lack of resources and time (17).…”