Teenage women who receive a diagnosis of a sexually transmitted disease (STD) may learn about prevention as a result, but the experiences of a sample of adolescents in Alabama suggest that they do not apply that knowledge to subsequent behavior.1 The odds of scoring high on a measure of STD prevention knowledge were nearly doubled among young women who had ever had an STD, but these teenagers also had elevated odds of having unprotected intercourse, using condoms inconsistently and having sex when either they or their partner were drinking. Furthermore, young women with a history of STD were no more motivated to use condoms than were those who had never had an STD.
The sample consisted of black sexually active 14-18-year-olds attending adolescent medicine clinics, health department clinics and school health classes in low-income areas of Birmingham between December 1996 and April 1999. Participants completed a self-administered questionnaire covering knowledge about STD prevention and attitudes toward condom use, followed by an interview in which they were asked about their STD history and their recent sexual behavior; they also provided vaginal swab specimens for STD testing.
Twenty-six percent of the 522 participants reported ever having been told that they had gonorrhea, syphilis, chlamydia, herpes, genital warts or trichomoniasis. Laboratory results showed that 28% had a current infection (predominantly chlamydia, trichomoniasis or gonorrhea); 5% tested positive for at least two STDs. Both lifetime and current rates of STD were elevated among 17-18-year-olds, women with partners two or more years their senior, those who were pregnant when surveyed and those in relationships of more than six months' duration. These factors served as controls in logistic regression analyses examining the association between STD history and current prevention knowledge, risk-related behavior and infection status.
In the multivariate analyses, teenagers who had had an STD were more likely than others to score above the median on a scale assessing knowledge of preventive measures (odds ratio, 1.8); they did not differ from young women who had never had an STD in their motivation to use condoms.
On almost all measures studied, adolescents with an STD history reported riskier behavior in the previous 30 days than did women with no history of STDs. They were significantly more likely to say that they had not used a condom the last time they had sex (odds ratio, 2.5), that they had failed to use a condom at least once (1.8) and that they had had unprotected sex with two or more partners (3.3). Although teenagers with an STD history had elevated odds of having had sex on at least one occasion when they or their partner had been drinking (2.1), they were not at increased risk of having had unprotected sex in conjunction with drinking.
The odds of current infection with gonorrhea or trichomoniasis were roughly doubled among women who had had an STD in the past (odds ratios, 2.5 and 2.1, respectively), but the risk of testing positive for chlamydia was not significantly elevated for this group. Results of additional analyses suggested that the increased current STD risk among those with a history of such disease was not attributable to their greater likelihood of engaging in risky behavior.
In discussing their findings, the researchers note that teenagers who have had an STD may know more than others about prevention because of counseling they received during treatment or because of their heightened desire for such information. However, these young people often fail to translate that knowledge into preventive behavior and thus remain at risk of further infection. Additionally, according to the researchers, the finding that current risky behavior does not explain the risk of current infection is an indication that teenagers with an STD history have been involved in high-risk sexual networks. Reducing STD rates among young people, the investigators conclude, will require intensified clinic-based counseling to "increase adolescents' adoption and long-term maintenance" of preventive behavior.
1. DiClemente RJ et al., Association of adolescents' history of sexually transmitted disease (STD) and their current high-risk behavior and STD status, Sexually Transmitted Diseases, 2002, 29(9):503-509.