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Sexually transmitted infections (STIs) are the infections which are mainly transmitted through sexual intercourse. Young individuals in the age group of 16 to 24 years are considered to be at more risk for STIs compared to older adults. Young individuals are more likely to practice unprotected sex and have multiple sexual partners. If the STIs are not treated adequately, it can lead to various complications.Most of the people may be aware about HIV/AIDs because of the awareness created by media and the government programs, however knowledge about STIs other than HIV/AIDS is low in the developing countries.
This study was a descriptive cross sectional study to assess the knowledge, awareness and attitude of college students about STIs other than HIV. A total of 350 engineering students from various semesters were included in the study. They were asked to fill up an anonymous questionnaire.
Two hundred and fifty six (73%) males and 94 (27%) females participated in the study. 313 (90%) students had heard about sexually transmitted infections (STIs) and 223 (64%) students had heard about STIs other than HIV. 99% of students knew about HIV where as less than 50% of students knew about other STIs. Teachers, internet and media were the source of information for most of the participants. Almost 75% of the students knew about the modes of transmission of STIs. Less than 50% of the participants knew about the symptoms of STIs and complications. Also attitude of the students towards sexual health and prevention of STIs was variable.
The findings of our study shows that it is important to orient the students about sexual health and safe sexual practices as it will go a long way in prevention and control of STIs. Also the morbidities and complications associated with STIs can be prevented.
Sexually transmitted infections (STIs) are the infections which are mainly transmitted through sexual intercourse. The common STIs which we come across in daily practice are gonorrhea, chancroid, syphilis, and chlamydial infections which can be cured and others such as HIV, genital herpes, HPV, and hepatitis B infection which cannot be cured but can be modified with the available treatments.
Young individuals in the age group of 16–24 years are considered to be at more risk for STIs compared to older adults. The World Health Organization estimates that 20% of persons living with HIV/AIDS are in their 20s and one out of twenty adolescents contract an STI each year.
Many young individuals stay away from families for a long time when they take up higher education. They either stay in hostels or in paying guest accommodations and come in contact with people from different sociocultural background.
Young individuals are more likely to practice unprotected sex and have multiple sexual partners. In addition, they may not have access to the required information and services to avoid STIs. Furthermore, they may feel hesitant to approach the facilities where information is available.
If the STIs are not treated adequately, it can lead to various complications such as infertility, urethral stricture, abortions, malignancies, perinatal, and neonatal morbidities.[3,4] Both ulcerative and nonulcerative STIs enhance the transmission of HIV/AIDS.
Knowledge of STI and their complications and attitude of the young generation toward sexual health are important in planning preventive and treatment strategies. Most of the people may be aware about HIV/AIDs because of the awareness created by media and government programs; however, knowledge about STIs other than HIV/AIDS is low in the developing countries.
This study was a descriptive cross-sectional study to assess the knowledge, awareness, and attitude of college students about STIs other than HIV.
This cross-sectional study was conducted among college students in the age group of 18–22 years. A total of 350 engineering students from various semesters were included in the study. A questionnaire was administered to all the students where they had to mention only their age and place. We tried to assess from the questionnaire, knowledge, and attitude of the students regarding the STIs and also their awareness about STIs other than HIV/AIDS. The questions tried to assess their knowledge about symptoms of STI, predisposing/causative factors, preventive measures, complications of STIs, and attitude toward sexual health.
A total of 350 students were administered the questionnaire, 256 (73%) males and 94 (27%) females. One hundred and seventeen students were from Bengaluru and 213 students were from different parts of the country and twenty students were from other countries such as Africa and New Guinea.
One hundred and eighty-six (53%) students were staying with their parents or family and 164 (47%) students were staying with their friends or alone in hostels or paying guest accommodations.
Around 90% (313) of students had heard about STIs and 223 (64%) students had heard about STIs other than HIV. One hundred and eight (30%) students knew that STI can be present in a person even without symptoms, 214 (61%) students did not know if it was possible to have STI without symptoms and 28 (8%) students mentioned that it was not possible to have STI without symptoms.
Tuberculosis, leprosy, and vitiligo were considered as STI by 17 (4.8%), 17 (4.8%), and 20 (5.7%) students, respectively. HIV was known as an STI by 347 (99.2%) students. One hundred and fourteen (32.5%) students knew genital herpes, 95 (27%) syphilis, 108 (30.8%) hepatitis B, 107 (30.5%) genital warts, 92 (26.2%) gonorrhea, 26 (7.4%) lymphogranuloma venereum (LGV), and 13 (3.7%) chancroid as STI [Table 1].
Teachers were the source of information about STIs in 203 (58%) students followed by internet 181 (51.7%), newspaper/magazines 162 (46.2%), TV/radio 158 (45.1%), friends 142 (40.5%), doctor/clinics 96 (27.4%, parents 28 (8%), and relatives 11 (3.1%) [Table 2].
Virus was known to be a causative factor for STI by 169 (48.2%) students followed by bacteria (49, 14%) and fungi (27, 7.7%). Multiple sexual partners and unprotected sex were considered as predisposing factors for STI by 252 (71.7%) and 236 (67.4%), respectively. Other factors considered were sex outside marriage (60, 17.1%), premarital sex (43, 12.2%), alcohol and drug abuse (39, 11.1%), and sex during menstruation (44, 12.5%).
The main modes of transmission of STIs known by students include sex with prostitutes/multiple partners (279, 79.7%), infected needles/drugs (256, 73.1%), blood transfusion (252, 72%), not using condoms (242, 69.1%), and mother to child transmission during childbirth (193, 55.1%). Other factors considered by students were poor hygiene 50 (14.2%), kissing 48 (13.7%), using public toilet (31, 8.8%), mosquitoes (35, 10%), shaking hands (13, 13.7%), and sharing towels 14 (4%) [Table 3].
Fever on and off, vaginal/urethral discharge, genital ulcer, abdominal pain, swelling in the groin, and pain while passing urine were the options given to students to assess their knowledge about symptoms of STIs. Vaginal/urethral discharge was considered as a symptom of STI by 136 (38.8%) students followed by genital ulcer 120 (34.2%), fever on and off 118 (33.7%), pain while passing urine 108 (30.8%), swelling in the groin 90 (25.7%), and abdominal pain 104 (29.7%). All the options were considered as symptoms of STI by 41 (11.7%) students. Around 165 students did not know about the symptoms [Chart 1].
More than 50% (234) of students did not know about the complications of STI. Cervical cancer was answered by 94 (26.8%) students, infertility by 90 (25.7%), and abortion by 62 (17.7%). Forty (11.4%) students thought all the options to be complication of STIs [Table 4].
Only 59 (16.8%) students felt masturbation to be harmful to health whereas 138 (39.4%) students disagreed and 151 (43.1%) participants did not know its effect on health [Table 5].
Majority of the students (330, 94.2%) agreed that sex education should be mandatory for young people. However, 13 (3.7%) students were unsure and 7 (2%) students disagreed about the need for sex education.
One hundred and sixty-two (46.2%) participants felt that one should wait until marriage to have sex, whereas 103 (29.4%) students thought it was okay to have premarital sex. Moreover, 85 (24.2%) students did not have any opinion about premarital sex.
One hundred and nine (31.1%) participants did not mind marrying a person who had sex before marriage, whereas 153 (43.7%) students were against such an idea and 88 (25.1%) students could not opine about the issue.
Isolating patients of STI for the safety of others was considered an appropriate measure by 147 (42%) students; however, 120 (34.2%) students did not agree with such measures and 83 (23.7%) students did not know if it was right to do so.
The idea of banning prostitution to control the spread of STIs was agreed upon by 177 (50.5%) students and disagreed by 65 (18.5%) students. One hundred and eight (30.8%) students did not know if this could help control the spread of STI.
Emergency contraceptive pill was considered as a preventive measure for STI by 119 (34%) students, whereas 70 (20%) students disagreed with this measure and 161 (46%) students did not know if emergency contraceptive pills prevented acquiring STI.
Only 107 (30.5%) students agreed that there was no cure for HIV at present whereas 110 (31.4%) students thought HIV/AIDS can be cured and 108 (30.8%) students did not know if HIV can be cured.
The main objective of the study was to assess the knowledge, awareness, and attitude of the engineering college students about STIs, other than HIV and AIDS.
Our study shows that most of the students had heard about STIs, but they knew mostly about HIV/AIDS. STIs other than HIV were known by only around 64% (223) of students. Conditions such as LGV and chancroid were known only to 3%–7% of students. Furthermore, there were students who thought tuberculosis, leprosy, and vitiligo to be sexually transmitted. The findings are similar to a study conducted by Andersson-Ellström and Milsom and Lal et al.
Most of the participants in our study had known about these infections through teachers, internet, and newspaper/magazines. Information provided in internet and newspaper/magazines might not be complete and also mislead the student as not all content on internet is scrutinized by qualified health professional. Although many students knew about the STIs, they did not have in-depth knowledge about the diseases and their presentations. A similar finding has been published by Amu and Adegun in their study among secondary school adolescents.
Most of the respondents had a good knowledge about prevention and transmission of STIs; however, not many were aware of the clinical features and complications of STIs. Only around 40% of students knew about the symptoms of STIs. Our review of literature shows a similar finding in many studies conducted at different geographic locations.[5,9,10,11,12,13]
The attitude of the students about sexual health was variable. Only about 16% students felt masturbation to be harmful to health and another 43% did not know about its effect on health. Whereas 39.4% felt it is not deleterious to health. One-third of students thought it was okay to have premarital sex and 24.2% students did not opine. Almost 46% students answered that they would wait till marriage to have sex. As mentioned in earlier studies, staying away from families and mingling with people from different sociocultural background might change their attitude toward premarital sex and safe sexual practices.[9,10]
When asked about prevention and containment of STI, more than 50% of the participants felt isolation of patient with STI and banning prostitution as an option to prevent spread of STI. Furthermore, almost one-third of the students thought emergency contraceptive pills can prevent STI and one-third did not know if it could prevent STI. Although most of the students knew about the mode of spread of STIs, many of them still had misconceptions about the prevention of spread of STIs. The main problem we felt was almost one-third of students felt emergency contraceptive pills can prevent STI. This point has not been discussed much in earlier studies.[8,14]
Most importantly, only 30% of the students knew that there was no cure for HIV/AIDS, 31.4% thought HIV infection can be cured, and 30% did not know if it can be cured.
Almost 90% of the students agreed about the need for sex education to be included in the curriculum. Probably, they felt they would have had a better knowledge if they had been educated about the issues at a younger age. Similar findings have been reported in other studies.
On review of literature, not many studies have been done in India, to assess the knowledge and attitude of college students about STIs. Most of the times, sexual health is not discussed by parents/relatives with children as it is still considered a taboo by many people. Even in our study, parents/relatives as a source of information about STIs are very less (11%). Our study shows that teachers, internet, and media are the main source of information for students.
The studies which have been done earlier are mainly among school students. Although few studies have been done in general population[15,16,17] and among university students,[4,5] it is from a different sociocultural background. Hence, our study has aimed at assessing knowledge and attitude of students from professional course (engineering) about STI and AIDS. The findings of our study show that it is important to orient the students about sexual health and safe sexual practices as it will go a long way in prevention and control of STIs. Furthermore, the morbidities and complications associated with STIs can be prevented.
There are no conflicts of interest.
We acknowledge the help and support provided by Dr. Jayanthi V, Dr. Savitha AS, Dr. Priyadarshini M, and Dr. Reshma Abraham in the conduct of the study and preparation of the manuscript.