Predictors identifying those at increased risk for STDs: a theory-guided review of empirical literature and clinical guidelines

Abstract

SummarySexually transmitted diseases (STDs) are leading causes of substantial morbidity worldwide. Identification of risk factors for estimating STD risk provides opportunities for optimising service delivery in clinical settings, including improving case finding accuracy and increasing cost-efficiency by limiting the testing of low-risk individuals. The current study was undertaken to synthesise the evidence supporting commonly cited chlamydia and gonorrhoea risk factors. The level of empirical support for the following predictors was strong/moderate: age, race/ethnicity, multiple lifetime sexual partners, sex with symptomatic partners and concurrent STD diagnosis. The following predictors had weak evidence: socio-economic status, transactional sex, drug/alcohol use, condom use and history of STD diagnosis. The most frequently listed predictors among nine clinical guidelines were younger age and multiple sexual partners; the least consistently listed predictor was inconsistent condom use. We found reasonably good concordance between risk factors consistently listed in the recommendations and predictors found to have strong empirical support in the literature. There is a need to continue building the evidence base to explicate the mechanisms and pathways of STD acquisition. We recommend periodic reviews of the level of support of predictors included in clinical guidelines to ensure that they are in accordance with empirical evidence.

Alcohol Use Predicts Number of Sexual Partners for Female but not Male STI Clinic Patients

“…Because the number of sexual partners is positively associated with risk of STI infection (9), our findings have implications for HIV/STI prevention. Risk reduction interventions for women should address the role of alcohol and other drugs in contribution to sexual risk.…”

“…Many studies document the association between alcohol use and multiple sexual partners (3,7), an established risk factor for STIs (8,9). …”

Identifying young people exposed to or at risk of sexual ill health: pilot implementation of an evidence-informed toolkit (SEXIT) at Swedish youth clinics

“…The final instrument comprises 16 items with fixed response options (Supplemental material). The first items provide background information about the visitor (age, gender and sexual orientation) that can affect the assessment of the remaining items [3,23,24]. One item concerning living arrangements was included based on sexual health risks among youth in the care of the state [12].…”

“…One item concerning living arrangements was included based on sexual health risks among youth in the care of the state [12]. Three items concern alcohol and drug use: behaviours with a complex but well-established association with sexual risktaking and ill health [3,8,12,[25][26][27]. The inclusion was further motivated by convenience for the youth clinic staff, who are already advised to ask about alcohol and drug use.…”

“…Different manifestations of sexual ill health tend to be interrelated and share many associated factors. To mention a few, STIs are associated with multiple sexual partners, early sexual debut, alcohol use and experience of transactional sex [2,3]. Experience of sexual violence is associated with unintended pregnancy and STIs through unprotected sex, and a greater likelihood of engaging in transactional sex [4][5][6][7][8].…”