Prevalence of sexually transmitted infections among sexually active Jordanian females

OBJECTIVES: To determine the prevalence of the most important sexually transmitted infections among women of child bearing age in Jordan. GOAL: To assess the need for screening programs to detect sexually transmitted infections. STUDY DESIGN: This is a cross-sectional study wherein consecutive symptomatic and asymptomatic women presenting to gynecology and family planning clinics from different areas in Jordan were tested for reproductive tract infections caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, and Trichomonas vaginalis. RESULTS: The prevalence of C. trachomatis infection was 0.6% and 0.5%, among symptomatic and asymptomatic women respectively, that of N. gonorrhoeae was 0.9% and 2.2%, that of T. pallidum 0.0% and 0.0%, and that of Tr. vaginalis was 0.7% and 0.5%. These prevalence rates did not differ significantly between symptomatic and asymptomatic women. CONCLUSIONS: Based on the low prevalence of sexually transmitted infections detected in this study among Jordanian women, the need for screening programs for such infections is questioned.     

Screening of Chlamydia trachomatis urogenital infections among the male and female population of the Republic of Macedonia

BACKGROUND: Noninvasive urine screening for Chlamydia trachomatis infections offers a valuable public health tool, that could be of vast importance in Chlamydia control programs. OBJECTIVE: The goal was to determine the prevalence of C. trachomatis infections among a sexually active population, to define the epidemiological factors associated with it, and to develop potential selective screening strategies among asymptomatic individuals in the Republic of Macedonia, using a highly sensitive and specific DNA amplification method for C. trachomatis. STUDY DESIGN: A total of 1435 urine samples, divided into two main groups: asymptomatic individuals (n = 1210) and symptomatic patients (n = 225), were tested. Samples from the asymptomatic group were collected during routine screening programs, while the symptomatic group consisted of patients with symptoms of urogenital tract infection, attending sexually transmitted diseases (STD) clinics. The presence of C. trachomatis was determined using commercial AMPLICOR C. trachomatis Assay (Roche Diagnostic Systems, Inc., Branchburg, NJ, USA). RESULTS: The prevalence of C. trachomatis infections among different groups was: recruits 0%, soldiers 0.4%, policemen 3.5%, clerks 4.6%, pregnant women 4%, and students 4.4%. The average prevalence for both groups (asymptomatic and symptomatic) was 2.3%[95% confidence interval (CI): 1.5-3.1%]. The average prevalence for the asymptomatic group was 1.6% (95% CI: 0.8-2.4%), while the average prevalence for the symptomatic group was 6.2% (95% CI: 3.1-9.3%) which were significantly different (P = 0.00003). CONCLUSION: Testing first void urine specimens by AMPLICOR C. trachomatis assay is a highly sensitive and specific method for diagnosing C. trachomatis infections in men and women. This method provides health care workers and public health officials with a new molecular amplification assay that uses noninvasive urine specimens for population-based screening purposes. The prevalence of C. trachomatis was relatively low among asymptomatic individuals. However, selective screening strategies are highly recommended for testing the student population in the Republic of Macedonia.     

High prevalence of trichomoniasis in rural men in Mwanza, Tanzania: results from a population based study

OBJECTIVES: To measure the prevalence of urethral infections including trichomoniasis in rural Tanzanian men, to assess the prevalence of symptoms and signs among men with Trichomonas vaginalis, and to analyse the risk factors for trichomoniasis. DESIGN: A cross sectional study of 1004 men aged 15-54 years in a rural community in north west Tanzania. METHODS: Participants were interviewed about sexual behaviour and symptoms of sexually transmitted diseases. First fraction urine samples and urethral swabs were collected and used to test for T vaginalis by wet preparation and culture, Neisseria gonorrhoeae by culture, Chlamydia trachomatis by ligase chain reaction and non-specific urethritis by Gram stain. Urine was also tested for the presence of leucocytes using a leucocyte esterase dipstick. Men were re-interviewed 2 weeks later to document new symptoms and signs of urethritis. RESULTS: Complete laboratory results were available on 980 men. One in four men had laboratory evidence of urethritis. T vaginalis was found in 109 individuals (11%), gonorrhoea in eight (0.8%), and chlamydial infection in 15 (1.5%). Over 50% of men with urethritis were asymptomatic. The prevalence of signs and symptoms was similar among men with T vaginalis alone compared with men with other urethral infections. The sensitivity and specificity of the leucocyte esterase dipstick (LED) test for detecting T vaginalis were 80% and 48% respectively in symptomatic men and 60% and 68% in asymptomatic men. Factors associated with trichomoniasis included religion, type of employment, and marital status. CONCLUSIONS: A high prevalence of urethritis was found in men in this community based study. More than half of the urethral infections detected were asymptomatic. The most prevalent pathogen was T vaginalis. Studies are needed on the prevalence of trichomoniasis in men presenting to health services with complaints suggestive of urethritis since treatment for T vaginalis is not included in the syndromic management of urethritis in most countries. The performance of the LED test as a screening test for trichomoniasis was unsatisfactory in both symptomatic and asymptomatic men. Improved screening tests are urgently needed to identify urethral infections that are asymptomatic and which are not covered by current syndromic management algorithms.     

Prevalence of Neisseria Gonorrhoeae among men screened for Chlamydia Trachomatis in four United States cities, 1999-2003

OBJECTIVES: Neisseria gonorrhoeae infections are the second most commonly reported disease in the United States and cause significant morbidity. We describe the prevalence of gonorrhea in a large sample of men tested for gonorrhea and Chlamydia trachomatis in Baltimore, Denver, San Francisco, and Seattle. METHODS: Gonorrhea prevalence was measured among 17,712 men tested in a variety of non-sexually transmitted disease (STD) clinic venues using urine-based nucleic acid amplification tests. RESULTS: Among 16,850 asymptomatic men, prevalence ranged from 0% to 1.5% by city (P=0.20): Baltimore 1.3%, Denver 1.5%, San Francisco 1.5%, and Seattle 0%. Among 862 symptomatic men, the gonorrhea prevalence varied from 0.0% to 28.3% by city (P<0.01). CONCLUSIONS: The high prevalence of gonorrhea in symptomatic men supports the importance of testing for symptomatic men. The prevalence of gonorrhea among asymptomatic men is low, and routine screening cannot be recommended when screening is performed for chlamydia, unless a substantial local prevalence of gonorrhea can be documented in specific targeted venues or population groups.     

Evaluation of chlamydia and gonorrhea screening criteria: San Francisco sexually transmitted disease clinic: 1997 to 1998

BACKGROUND AND OBJECTIVES: The advent of more sensitive diagnostic testing technologies and competition in public healthcare spending have resulted in a reevaluation of sexually transmitted disease (STD) screening practices in an attempt to target populations at greatest risk. Screening among populations with a < 2% prevalence of chlamydia and a < 1% prevalence of gonorrhea may not be cost-effective. GOAL: To identify subpopulations with a low prevalence of chlamydia or gonorrhea. STUDY DESIGN: The prevalence of genital chlamydia and gonorrhea among asymptomatic STD patients screened from 1997 to 1998 at San Francisco City Clinic was stratified by demographic and behavioral risk factors. RESULTS: The prevalence of chlamydia and gonorrhea was 3.4% and 1.1% among asymptomatic women and 4.0% and 1.0% among asymptomatic men, respectively. Two low-prevalence subpopulations identified among asymptomatic patients were women older than 29 years (chlamydia, 1.2%) and men who have sex with women (gonorrhea, 0.8%). CONCLUSIONS: These data identified low-prevalence subpopulations among asymptomatic STD patients. As a result, the STD screening criteria at San Francisco City Clinic were changed accordingly.     

Screening for Chlamydia trachomatis in asymptomatic women attending outpatient clinics in a large maternity hospital in Dublin, Ireland

BACKGROUND: Chlamydia trachomatis can cause a sexually transmitted infection, which, untreated, may result in considerable morbidity. METHODS: A prevalence study was conducted for C trachomatis using nucleic acid amplification technology in asymptomatic women, and certain risk factors that may be used to direct future screening strategies were assessed. RESULTS: The study population comprised 945 asymptomatic women, of whom 783 were attending antenatal clinics, 91 were attending infertility clinics and 71 were attending family planning clinics. An overall C trachomatis prevalence of 3.7% (35/945) was found, with the highest prevalence of 11.2% (22/196) in Irish single women aged <25 years. Logistic regression analysis showed that single status and age <25 years were independent, statistically significant predictors of C trachomatis infection. CONCLUSION: These results support routine screening of asymptomatic women who are sexually active and aged <25 years. An opportunist active screening of all sexually active women independent of age should be additionally considered if resources permit.     

Urine-based screening for Chlamydia trachomatis in men attending sexually transmitted disease clinics

BACKGROUND: Nucleic acid-amplified tests for Chlamydia trachomatis are accurate but costly. Screening strategies for asymptomatic men are needed. GOAL: To assess C trachomatis screening strategies for asymptomatic males. STUDY DESIGN: Men attending a sexually transmitted disease clinic were tested for C trachomatis with ligase chain reaction and culture, and for urethral inflammation with urine leukocyte esterase and urethral Gram stain. RESULTS: C trachomatis prevalence was 5.5% among 1,625 asymptomatic men. Ligase chain reaction increased detection by 49% among men without urethral inflammation. An age of younger than 25 years and urethral inflammation were associated with positive ligase chain reaction results. The negative predictive value of urine leukocyte esterase was highest among older men, but urethral Gram stain was equally sensitive in predicting infection regardless of age. An age of younger than 30 years or urethral inflammation identified the highest proportion of infections (92%) and reduced the percentage of men screened by 43%. CONCLUSIONS: Urine ligase chain reaction increased C trachomatis detection, particularly among men without urethral inflammation. Testing all asymptomatic men younger than 30 years is optimal, whereas negative urine leukocyte esterase or urethral Gram stain results in men 30 years or older support no testing.     

Prevalence of chlamydia and gonorrhoea among a population of men who have sex with men

OBJECTIVES: Few data are available on the prevalence of sexually transmitted diseases (STDs) in men who have sex with men (MSM), making it difficult to develop STD screening guidelines for this population. The objective of the study was to determine the prevalence of urethral infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae within a large, community based population of MSM, and to assess the feasibility of rectal screening in this population. METHODS: This was a cross sectional study of 566 MSM, who were predominantly middle aged, white, asymptomatic, and engaged in sex with multiple partners. All provided a urine sample to screen for chlamydial and gonorrhoea infections using a PCR assay; rectal screening was performed on 48 participants. RESULTS: Urethral C. trachomatis infections were detected in 1/566 participants (prevalence 0.2%, 95% CI 0.004% to 1.0%), and rectal C. trachomatis infections were detected in 2/48 men (prevalence 4.2%, 95% CI 0.5% to 14.2%). No gonorrhoea infections were detected, and none of the 117 HIV positive men had either infection. CONCLUSIONS: Chlamydial and gonorrhoea infections were uncommon in this sample of MSM, even among those with multiple sexual partners or HIV infection. These data call into question recommendations to screen all MSM based on their individual sexual behaviours or HIV. Additional data are needed on the prevalence of these infections in MSM from different settings.     

Curable sexually transmitted infections among the clientele of a family planning clinic in Istanbul, Turkey

BACKGROUND: Integrating screening and treatment of sexually transmitted infections into existing family planning programs can be a good way to fight this problem. Also, the number of studies on the prevalence of certain sexually transmitted infections in this population in Turkey is limited. GOAL: To find out the prevalence of the most common sexually transmitted infections among the clients of an urban family planning clinic and to evaluate demographic characteristics and clinical signs related to sexually transmitted infections. STUDY DESIGN: Samples for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis were collected from 569 women who attended the clinic from December 15, 1997 to March 31, 1998. RESULTS: No case of N gonorrhoeae was found among the samples. The prevalence of C trachomatis infection was 1.9%, whereas the prevalence of of T vaginalis was 2.6%. None of the demographic characteristics or clinical signs was related to these infections. CONCLUSION: Larger studies using more sensitive laboratory tests are needed to determine the prevalence of chlamydial infections in family planning clinics in Turkey.     

Infections missed by urethral-only screening for chlamydia or gonorrhea detection among men who have sex with men

In a retrospective analysis of asymptomatic men who have sex with men visiting an urban municipal sexually transmitted disease clinic, 83.8% of chlamydial and gonococcal infections would have been missed by urethral screening, compared with 9.8% by screening the rectum and pharynx. Extragenital screening is critical to the provision of comprehensive sexual health services for men who have sex with men.     

Sexually transmitted infections among brothel-based sex workers in bangladesh: high prevalence of asymptomatic infection

OBJECTIVE AND GOAL: The goal of this study was to study the prevalence of sexually transmitted infections (STIs)/reproductive tract infections (RTIs) among brothel-based sex workers (SWs) in Bangladesh. STUDY: A cross-sectional study was conducted among SWs in 4 randomly selected brothels. A sociodemographic and behavioral survey and pelvic examination was conducted. Specimens including endocervical swab, high vaginal swab, and blood were collected and were examined for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, bacterial vaginosis candidiasis, and syphilis. RESULTS: A total of 439 SWs were enrolled and 49.6% had genital symptoms. Among all SWs, 17.5% were positive for N. gonorrhoeae; 15.5% for C. trachomatis; 7.5% for T. vaginalis, and 6.6% had active syphilis. A total of 67.4% SWs were positive for at least 1 cervical and/or vaginal infection. CONCLUSION: The prevalence of STIs/RTIs among SWs in brothels in Bangladesh is high. An intervention strategy addressing both symptomatic and asymptomatic infections and periodic screening of SWs for RTIs/STIs is essential for successful HIV and STIs prevention programs.     

Prevalence of asymptomatic sexually transmitted infections among high-risk patients attending a free anonymous HIV-screening center

INTRODUCTION: The aim of this study was to assess the prevalence of sexually transmitted infections among patients attending an anonymous HIV Screening Center. PATIENTS AND METHODS: This prospective study was performed in the HIV Screening Center of University hospital in Reims (France) from May 1997 to December 1997. The inclusion criteria were the asymptomatic clinical presentation and the presence of risk factors for sexually transmitted infections referring to WHO criteria. The methods included clinical examination after application of acetic acid and urethral and endocervical swabs to identify:Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Gardnerella vaginalis, Trichomonas vaginalis in specific culture. Treponema pallidum and HIV-1 infection were both detected by Enzym Linked Immuno Sorbent Assay (ELISA). RESULTS: One hundred and one patients (62 men and 39 women) were included in the study. Their mean age was 27 +/- 4 Years. Risk factors for sexually transmitted infections were: multiple sexual partners 81 p. 100; homo or bisexuality 16 p. 100; intravenous drug use 3 p. 100. The sexually transmitted infections were: HIV-1 infection 1 p. 100;Ureaplasma urealyticum 25 p. 100; genital warts 5 p. 100;Chlamydia trachomatis 3 p. 100; Gardnerella vaginalis 3 p. 100; Mycoplasma hominis 2 p. 100; Treponema pallidum 0 p. 100; Neisseria gonorrhoeae 0 p. 100; Trichomonas vaginalis 0 p. 100. The prevalence of sexually transmitted infections was significantly higher among women (p<0.05). DISCUSSION: Classical sexually transmitted infections and HIV infection were rarely detected in this study; but prevalence of other sexually transmitted infections (genital warts, Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum) was high. Ureaplasma urealyticum is considered as a possible pathogenic agent in pregnant women (preterm delivery, decrease of birth weight, chorioamniotitis). These results suggest that other than sexually transmitted infections in high risk patients attending a HIV Screening Center other sexually transmitted infections should also be systematically screened for.     

Problem-orientated categorisation of "other conditions" seen in a genitourinary medicine clinic.

The case sheets of patients coded as D2 (other conditions requiring treatment) and D3 (other conditions not requiring treatment) in 1981 were reclassified on a problem-orientated basis. Ten discreet categories were delineated with ease. Women with non-specific vaginitis and men with Gardnerella vaginalis urogenital infection, usually coded D2 or C4, should be reclassified under the C group of conditions as, for example, "Gardnerella or other bacterial genital infections." It is suggested that codes D2 and D3 be replaced by the following nine categories: genital skin lesions or rashes; genitourinary symptoms; enteric conditions; other sexually transmitted infections; normal genital architecture, congenital conditions, or unconfirmed genital discharges; asymptomatic patients attending for routine examination; uninfected contacts of patients with sexually transmitted diseases; psychosexual problems; and others.     

Problem-orientated categorisation of "other conditions" seen in a genitourinary medicine clinic

The case sheets of patients coded as D2 (other conditions requiring treatment) and D3 (other conditions not requiring treatment) in 1981 were reclassified on a problem-orientated basis. Ten discreet categories were delineated with ease. Women with non-specific vaginitis and men with Gardnerella vaginalis urogenital infection, usually coded D2 or C4, should be reclassified under the C group of conditions as, for example, "Gardnerella or other bacterial genital infections." It is suggested that codes D2 and D3 be replaced by the following nine categories: genital skin lesions or rashes; genitourinary symptoms; enteric conditions; other sexually transmitted infections; normal genital architecture, congenital conditions, or unconfirmed genital discharges; asymptomatic patients attending for routine examination; uninfected contacts of patients with sexually transmitted diseases; psychosexual problems; and others.     

Chlamydia trachomatis testing in the second British national survey of sexual attitudes and lifestyles: respondent uptake and treatment outcomes

BACKGROUND: Noninvasive molecular tests for bacterial sexually transmitted infections (STIs) provide new opportunities for testing in nonclinical settings. Little information is available on the outcomes when applied to asymptomatic sex survey participants. OBJECTIVE: The objective of this study was to examine patient treatment preferences and partner notification outcomes among Chlamydia trachomatis-positive cases identified in the 2000 national survey of sexual attitudes and lifestyles (Natsal 2000), and factors associated with providing a urine sample. METHODS: The authors conducted a stratified probability sample survey of 11,161 men and women aged 16 to 44 years residing in Britain using computer-assisted self-interviews. Urine testing was performed for C. trachomatis offered to a random half of sexually active respondents aged 18 to 44 using ligase chain reaction. Notification, treatment, and follow up of ligase chain reaction-positive respondents were undertaken. RESULTS: A total of 5105 respondents were invited to provide a urine sample. A total of 3628 (71%) agreed and 3608 samples were successfully tested. Willingness to provide a urine sample was significantly higher among those reporting previous homosexual experience, heterosexual anal sex, and STI diagnosis. Seventy-three respondents (31 men and 42 women) were diagnosed with genital chlamydial infection. Sixty-five (89%) responded to notification of their infection and were recommended for treatment and partner notification. Fifty (77%) respondents preferred to be seen by their general practitioner and 15 (23%) by their local genitourinary medicine clinic. Although physician feedback on treatment and partner notification outcomes was obtained for only half (n = 34) of respondents, follow-up respondent interviews confirmed that a total of 49 (75%) respondents underwent this process. INTERPRETATION: In this community-based survey, the rate of provision of urine samples was high, and those who provided samples were found to be at somewhat greater risk of infection on average. This was accounted for in estimating population chlamydia prevalence. The authors found that treatment and partner notification of newly diagnosed infections can be successfully achieved in STI prevalence studies.     

Epidemiological correlates of asymptomatic gonorrhea

OBJECTIVES: To assess correlates of asymptomatic gonorrhea among patients attending Genitourinary Medicine Clinics participating in the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in England for 2001-2003. STUDY DESIGN: GRASP is a sentinel surveillance program that monitors antimicrobial resistance to Neisseria gonorrhoeae. Data collection occurs annually in June to August each year. RESULTS: Women with previously diagnosed gonorrhea had decreased odds of asymptomatic gonococcal infection, as did women diagnosed with other sexually transmitted infections (all except chlamydia, syphilis, herpes, and warts). Heterosexual men, but not women, coinfected with chlamydia had significantly higher likelihood of being diagnosed with asymptomatic gonorrhea, as did homosexual men coinfected with syphilis and warts. CONCLUSION: The heterogeneity in correlates of asymptomatic gonorrhea has implications for screening in clinical settings. Such findings also depend on the extent of testing on sexually transmitted infections from different sites of infection, which has particular relevance in homosexual men and would thus need to be investigated in other studies.     

Trichomonas vaginalis as a cause of urethritis in Malawian men.

BACKGROUND AND OBJECTIVES: Trichomonas vaginalis is one of the most common sexually transmitted infections. In Malawi, rates of trichomoniasis in women are high. The prevalence of T. vaginalis infection in men is expected to be high but has not previously been documented. GOALS: We sought to determine the prevalence of trichomoniasis in Malawian men with and without urethritis, to evaluate a polymerase chain reaction detection assay for T. vaginalis in urethral swabs and to examine the effect of T. vaginalis infection on excretion of human immunodeficiency virus (HIV) in semen. STUDY DESIGN: Men presenting at the Sexually Transmitted Diseases (STD) and Dermatology Clinics in Malawi were enrolled in a cross-sectional study. We compared a polymerase chain reaction-based test for T. vaginalis detection with wet-mount microscopy and culture of urethral swabs. HIV serology was determined by enzyme-linked immunosorbent assay (ELISA), and HIV-1 RNA concentrations in semen were measured by quantitative nucleic acid sequence-based analysis. RESULTS: T. vaginalis was detected in 51 of 293 men. The estimated prevalence among symptomatic men was 20.8% and among asymptomatic men, 12.2%. Polymerase chain reaction performed with a sensitivity of 0.82 (95% CI: 0.66-0.92) and specificity of 0.95 (95% CI: 0.91-0.97) compared to wet-mount microscopy and culture. There was no difference in the rate of HIV seropositivity in men with and without T. vaginalis infection. However, in men with symptomatic urethritis, the median HIV RNA concentration in seminal plasma from men with T. vaginalis was significantly higher that in seminal plasma from HIV-positive men without trichomonas.     

Screening and genotyping of genital Chlamydia trachomatis in urine specimens from male and female clients of youth-health centers in Stockholm County

BACKGROUND: The current study was conducted in the context of the current increase in cases of Chlamydia trachomatis infections, the development of new diagnostic strategies, and an outreach to community-based youth center screening sites. GOAL: The goal was to define the prevalence of genital C trachomatis infection among clients of youth-health clinics and to evaluate the feasibility of implementing genotyping as a tool for epidemiologic studies with use of urine specimens. STUDY DESIGN: This was a prospective pilot study at two community-based youth-health clinics for teenagers and adolescents. Enrollment followed a high school educational program and public advertising campaign on the common occurrence of nonsymptomatic or only mildly symptomatic chlamydial infection among sexually active young people. Voluntary, confidential, free screening of first-void urine was provided, and the samples were tested by polymerase chain reaction (PCR). Demographic and behavioral data were obtained. Positive samples were differentiated into genovars by genotyping with restriction fragment length polymorphism analysis of the PCR-amplified omp1 gene. RESULTS: The prevalence of nonsymptomatic or mildly symptomatic chlamydial infection was 6.0% among women and 9.3% among men. A significant increase in the risk of infection was associated with a history of sexually transmitted disease (STD) (P < 0.01). There was no statistical risk correlating with partner change during the past year, infrequent or inconsistent condom use during the past year, present use of contraceptive pills, smoking habits, or recent alcohol consumption. Genotype E was most common (60%) among both sexes. Genotypes F and K were second most prevalent for men (20%), and genotype D was second most prevalent for women (15%). Genotype K or F was found in 23% of cases. CONCLUSION: Screening programs targeting sexually active adolescents attending youth-health clinics are important for detection of C trachomatis. Genotyping might become an efficient tool in epidemiologic studies. The impact of educational school- and community-based programs on STD among young people needs further evaluation.     

Phase specific strategies for the prevention,control, and elimination of sexually transmitted infections: case study in Lambeth,Southwark, and Lewisham,London, UK

Lambeth, Southwark, and Lewisham are three London boroughs that probably have the worst set of indicators of sexual health in the United Kingdom. This area is used to illustrate an urban epidemic of bacterial sexually transmitted infections in an industrialised country with well developed public health infrastructure, and the generalisability of the phase specific model for prevention and control of sexually trasmitted infections. The results show that national strategies for preventing and controlling sexually transmitted infections comprise a limited repertoire of activities that fit with those suggested by the phase specific model. Specific strategies for men and for young black heterosexuals in the most heavily affected areas should be developed. There is, however, insufficient empirical evidence about whether particular interventions introduced at different epidemic stages are effective.     

Investigating ethnic differences in sexual health: focus groups with young people

OBJECTIVES: To compare normative beliefs about sexual health in young men and women from black Caribbean, black African, and white ethnic groups in order to better understand ethnic inequalities in sexual health. METHODS: Focus group discussions with young people living in an area with known high prevalence of gonorrhoea and chlamydia. Groups were stratified by sex and self defined ethnicity. RESULTS: 22 male and 20 female 16-25 year olds of black Caribbean, black African, and white ethnicity took part in eight discussions. Participants from black ethnic groups were more aware of gonorrhoea than white participants but all ethnic groups regarded these as being less important than unplanned pregnancy or HIV/AIDS. Most participants believed that they would have obvious symptoms if they had a sexually transmitted infection and could determine the cleanliness of sexual partners by visual or behavioural cues. Black Caribbean women were alone in acknowledging the likelihood of their partners having concurrent sexual relationships. Some black Caribbean women described negative attitudes of staff in genitourinary medicine clinics who were from the same ethnic background. CONCLUSION: In this focus group study we identified ethnic differences in terminology, awareness of sexually transmitted infections, non-exclusive sexual relationships, and experience of sexual health services but gender had a greater influence on normative beliefs. The similarities in norms for all ethnic groups might reflect common social and cultural exposures. The low priority given to sexually transmitted infections by young people from all ethnic groups needs to be addressed if they are to be tackled successfully.