RESEARCH ARTICLE


Investigating the Knowledge of Sexually Transmitted Diseases in University Students of Iran



Katayon Vakilian1, *
iD

1 Medical School, Arak University of Medical Sciences, Shahroud, Iran


Article Metrics

CrossRef Citations:
0
Total Statistics:

Full-Text HTML Views: 59
Abstract HTML Views: 19
PDF Downloads: 0
Total Views/Downloads: 78
Unique Statistics:

Full-Text HTML Views: 45
Abstract HTML Views: 14
PDF Downloads: 0
Total Views/Downloads: 59



Creative Commons License
© 2021 Katayon Vakilian.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Medical School, Arak University of Medical Sciences, Shahroud, Iran; E-mail: dr.kvakilian@arakmu.ac.ir


Abstract

Background:

Unprotected sex, multi partnership, no or inconsistent use of the condom can be mentioned as risk behaviors putting youth at high risk to Sexually Transmitted Diseases (STDs). The present study aimed to investigate the knowledge of sexually transmitted diseases in the university students of Shahroud in Iran.

Methods:

This cross-sectional study was conducted in Shahroud city of Iran. 1500 female and male students in the age bracket of 18-24 were included in the study. Multistage sampling was employed. After stating the objective of the study, the questionnaire was distributed to students during the end of lecture time upon the agreement of the education officials and collected after 15 minutes. To ensure that the information provided will be kept confidential, the students were asked not to write down their names and fields of study. Data were described using descriptive statistics by SPSS software, version 20.

Results:

The answers showed that the female and male students have heard more about HIV (94.9% vs. 93.1%), gonorrhea (47.2% vs. 50.2%), genital herpes (45.6% vs. 33.1%), and genital warts (31.4% vs. 18.1%), in the order of frequency. 35.9% of females had no knowledge about the symptoms of diseases in women and 53% of males had no knowledge about the symptoms of the diseases in men. 26.6% of female students and 16% of male students knew regarding at least three symptoms of diseases.

Conclusion:

The present study showed that the university students' knowledge is far distant from the desired situation. This study succeeded in identifying the educational needs of the youth.

Keywords: HIV, Sexually transmitted diseases, Iran, Reproductive health, Adolescents, Youth.



1. INTRODUCTION

12.7% of youth in the age range of 15-17 years old experience sexual behaviors [1]. Unprotected sex, multi partnership, no or inconsistent use of the condom and drug abuse can be mentioned as risk behaviors putting adolescents and young adults at high risk to HIV/AIDS and other Sexually Transmitted Diseases (STDs) [2].

Sexually transmitted diseases (STDs) include a variety of clinical syndromes and infections that are caused by pathogens. These pathogens can be acquired and transmitted through sexual activity [3]. The majority of young people under the age 25 years old in the US suffer from sexually transmitted diseases especially HIV/AIDS [2]. According to CDC, 0.44 and 0.55 per 100 females at the age range of 14 to 19 years old and 20 to 24 years old are infected by gonorrhea, respectively. It was also found that the chlamydia rate among 15-19 years old females was 3.0 cases per 100 and among 20-24-year-old females, it was 3.7 cases per 100 females [4]. Concerning the prevalence rate of infection with HPV from 2009–2012, the estimations showed that 29.0% of females aged 14–19 years old and 58.7% of females aged 20–24 years old suffered from HPV [5].

Studies in Iran have shown that 40% of 18-24-year-old youth have sexual relations [6], of which 16% of females and 27% of males use condoms [7]. Moreover, the adolescent reproductive health indicators show that their knowledge about reproductive and sexual health is not sufficient and all of these factors can put them at risk for sexually transmitted diseases [8].

Since most STDs can occur with no symptoms, they are likely to be passed on during unprotected sexual intercourse.

Insufficient knowledge regarding the consequences of unprotected premarital sex can put the youth at risk for unwanted pregnancies, unsafe abortion and its complications, as well as sexually transmitted diseases [9]. According to the results of numerous studies, young people in developing countries have low awareness about STDs and how to prevent infection with HIV [2, 10].

On the other hand, factors such as lack of teen-friendly clinics, the taboo of talking about sexual issues with health workers, inconsistent use of condom in sexual intercourses, lack of education by families, drug use and smoking, as well as the cost of treatment are barriers that expose adolescents to the complications of sexually transmitted diseases [7, 11-14]. In this context, the present study aimed to investigate the knowledge of sexually transmitted diseases in university students of Shahroud, Iran.

2. METHODS

This crosssectional study was conducted in Shahroud city of Iran. 1500 female and male students in the age bracket of 18-24 were included in the study. Multistage sampling was employed. Each university and class was initially considered a single stratum and cluster, respectively. After obtaining written informed consent from the students and stating the objective of the study, the questionnaires were distributed to students during the end of lecture time upon the agreement of the education officials and collected after 15 minutes. To ensure that the information provided will be kept confidential, the students were asked not to write down their names and fields of study. Data were analyzed using SPSS software version 20, and descriptive-analytical statistics such as percentage, mean scores, t-test Spearman, and chi-squared test. The questionnaire was administered in one of the universities in Shahroud, Iran, by one of the researchers. This questionnaire, consisting of demographic characteristics and the CDC questionnaire, was used to collect data regarding the knowledge of sexually transmitted diseases and the signs and symptoms (“yes” option was used for the answer “I Know” and “no” option was used for the wrong answer or “I don't know”). Also, the part of the questionnaire that students were asked to number the sign and symptoms of STIs they have experienced during life was in the form of self-report [15]. The validity and reliability of the questionnaire had been previously determined by Mousavi et al. [16]. Data were described using descriptive statistics by SPSS software, version 20.

3. RESULTS

The results showed that 919 (61.2%) university students were females and 539 (36.1%) were males. The mean age of females and males was 20.26 ± 91.49 and 20.32±1.57 years old, respectively (P=0.437).

Regarding the item “Which of the following diseases have you heard of?”, the answers showed that the female and male students have heard more about HIV (94.9% vs. 93.1%), hepatitis (56.7% vs. 44.1%), gonorrhea (47.2% vs. 50.2%), genital herpes (45.6% vs. 33.1%), and genital warts (31.4% vs. 18.1%), in order of frequency.

Table 1. Knowledge of male and female students regarding STIs.
- - - Boys Girls
- - - N % N %
Which STIs disease do you know? HIV Yes 483 93.1 861 94.9
No 36 6.9 46 5.1
Syphilis Yes 106 20.1 301 32.9
No 422 79.9 615 67.1
Gonorrhea Yes 267 50.2 433 47.2
No 265 49.8 485 52.8
Hepatitis B Yes 235 44.1 521 56.7
No 298 55.9 398 43.3
Chlamydia Yes 21 3.9 103 11.2
No 513 96.1 816 88.8
Human papilloma vinous Yes 96 18.1 288 31.4
No 435 81.9 630 68.6
Trichomonas vaginitis Yes 21 3.9 108 11.8
No 513 96.1 808 88.2
Herpes simplex virus Yes 174 33.1 414 45.6
352 66.9 494 54.4
Knowledge of STIs Signs in Men. Discharge 39 7.3 47 5.1
Pain during urination 44 8.2 41 4.5
Sore 20 3.7 38 4.1
I don’t know any sign 175 32.7 379 41.2
Other sign 4 0.7 2 0.2
2 signs 166 31.0 284 30.9
3 signs 87 16.3 129 14.0
Knowledge of STIs Signs in Women. - Discharge 33 7.7 73 8.9
Pain during urination 12 2.8 20 2.4
Sore 31 7.2 40 4.9
I don’t know any sign 230 53.5 295 35.9
Other signs 4 0.9 4 0.5
2 signs 51 11.9 171 20.8
3 signs 69 16.0 218 26.6
Table 2. Frequency of signs and symptoms of STIs in male and female students.
- - Boys Girls
N % N %
Discharge Yes 105 20.5 379 42.4
No 369 72.1 417 46.6
Don't remember 38 7.4 98 11.0
Dysuria Yes 135 26.6 186 20.9
No 338 66.5 647 72.7
Don't remember 35 6.9 57 6.4
Itching Yes 181 35.8 511 57.1
No 283 56.0 326 36.4
Don't remember 41 8.1% 58 6.5%
Edema in genitalia Yes 52 10.3 59 6.7
No 423 83.8 772 87.1
Don't remember 30 5.9 55 6.2
Bleeding Yes 22 4.4 81 9.2
No 444 89.7 759 86.2
Don't remember 29 5.9 40 4.5
Sore or papilloma Yes 39 7.8% 51 5.9%
No 434 86.5 758 87.6
Don't remember 29 5.8 56 6.5

However, they have heard less about chlamydia and trichomonas vaginalization. Concerning knowledge of signs and symptoms of sexually transmitted diseases in men, 41.2% of females and 32.7% of males had no information about the symptoms. 30.9% of females and 30% of males had knowledge about at least two symptoms of diseases. 35.9% of females had no knowledge about the symptoms of diseases in women and 53% of males had no knowledge about the symptoms of the diseases in men. 26.6% of female students and 16% of male students knew at least three symptoms of diseases (Table 1). The results showed that the most common symptoms of sexually transmitted diseases in males were, in order, itching (35.8% (181 students)), dysuria (26.6% (135 students)), and discharge (20.5% (105 students)). These symptoms in females were itching (57.1% (511 students)) and discharge (42.4% (379 students)). Warts and sores were the least common reported symptoms (Table 2).

4. DISCUSSION

Youth is a period of life in which sexual behaviors can expose individuals to sexually transmitted diseases [17]. The results showed that less than half of the students have heard of common diseases such as chlamydia, genital herpes and warts. A random sample of 500 university students, regarding their knowledge of HPV, showed that only 37% of respondents had heard of HPV. They said they had the least knowledge about HPV and found that the training efforts for these diseases have been insufficient. Therefore, despite the high prevalence of HPV among young adults, the majority of students had low knowledge of this type of infection [18]. In the present study, only 33% of male students and 45% of female students had heard of the disease. However, it is speading all over the world, especially among young people. A systematic review study in Iran has reported its prevalence as 6.5%, half the rate reported in 2012 in the world [19, 20]. The students who participated in this study had insufficient knowledge about genital warts and trichomonas; however, more than 90% were aware of AIDS. Dehqani et al. showed that the university students' knowledge about AIDS was sufficient but insufficient about HBV, which was in line with the results found in this study [21]. Considering the fact that some sexually transmitted diseases such as genital warts can be prevented with a vaccine, knowledge about sexually transmitted warts can protect people against the disease. A study in Iran showed that the awareness of young people, parents, and families about the HPV vaccine was very low, but they had a good attitude towards it. Thus, the training programs should focus on encouraging young people and parents to prevent the disease by taking the vaccine [22].

Another result of the present study showed that 32.7% of males and 41.2% of females had no knowledge about the symptoms of sexually transmitted diseases, and less than 20% of female and male university students had knowledge about three symptoms of the disease. A study in Nigeria on 550 adolescents studying in public and private high schools using a multi-stage sampling method showed that 499 (92.4%) of students had previously heard of sexually transmitted infections. 80% of respondents had knowledge about only one STI disease and the two diseases mostly mentioned by students were AIDS (78.0%) and gonorrhea (23.0%). The most important symptoms were weight loss (77.4%), painful abortion (68.9%), and genital sores (54.1%). Overall, only 6.9% of respondents had enough knowledge about STIs while others had moderate and low knowledge [23]. A study in Turkey on knowledge of 888 freshman university students about sexually transmitted diseases indicated that 55% of students had knowledge about “vaginal discharge”, 48.1% about genital warts/sores/genital sores”, and 28.9% of students were aware that the diseases may “be asymptomatic”, and 15.7% were aware of “pain in the abdomen” [24].

Other results of the present study showed that university students had experienced the symptoms of sexually transmitted diseases in their life and the most common symptoms in these students were itching and discharge.

Discharge is a common symptom of trichomonas. The present study showed that a small number of students had heard of the disease. The studies have revealed that the prevalence of trichomonas in Iran varies from 2.9% to 17%, whose most common symptom is discharge, though this symptom is observed in other sexually transmitted diseases as well [25, 26]. The studies on different age groups of females have indicated that it is more prevalent among 2.3 of adolescents, 4% of adults aged over 25 years old, and 3.1% of 14-49-year-old females [27]. The present study showed that 5.8% [7, 9] of male and female students had genital sores or warts, which could be a sign of diseases such as warts, genital herpes, canker, or syphilis. Studies in Iran have shown that the rate of genital warts is on the rise in this country like other developing countries [28, 29]. A study on 447 women showed a rate of 3.5% of genital warts in Iranian women [30]. Considering the fact that sexually transmitted diseases affect the quality of reproduction and male and females' life, the adolescents at the beginning of the reproductive period need to receive the required trainings [31]. Since adolescents are influenced by friends, the trainings should be performed in schools and learning centers such as universities [17].

CONCLUSION

The present study showed that the university students' knowledge is far distant from the desired situation. This study succeeded in identifying the educational needs, and in other words, the educational gaps of the respondents in this study, which should be considered in further studies in the future, i.e. designing the content and educational interventions. According to the results of the study, it is suggested to include the prevention methods of sexually transmitted diseases as a part of the educational programs. Training the university students not only increases their awareness, improves attitudes, and develops the skills required to prevent sexually transmitted diseases, but also transmits these abilities to other members of the society, reducing infection with these diseases and improving the reproductive health in the society through considering the students' social status and their role model in the society. This study has some limitations; it cannot be generalized to youth in other countries.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

The present study has been conducted in Shahroud University of Medical Sciences, Iran, under the ethics code (code 890/08).

HUMAN AND ANIMAL RIGHTS

All procedures followed were in accordance with the ethical standards of the research committee responsible and with the 1964 Helsinki Declaration and its later amendments.

CONSENT FOR PUBLICATION

Informed consent was obtained from all the participants.

AVAILABILITY OF DATA AND MATERIALS

The datasets generated and/or analyzed during the current study are not publicly available due to the moral rules of Shahroud University of Medical Sciences, but are available from the corresponding author [K.V] on reasonable request.

FUNDING

This research was funded by Shahroud University of Medical Sciences under the financial code of 9664.

CONFLICT OF INTEREST

The authors declare no conflicts of interest, financial or otherwise.

ACKNOWLEDGEMENTS

This study was extracted from a PhD. thesis performed at Shahroud University of Medical Sciences, Shahroud, Iran. Hereby, we extend our gratitude to the Research Deputy of the university and all the participants for their cooperation in this study.

REFERENCES

[1] Leichliter JS, Copen C, Dittus PJ. Confidentiality issues and use of sexually transmitted disease services among sexually experienced persons aged 15–25 years—United States, 2013–2015. MMWR Morb Mortal Wkly Rep 2017; 66(9): 237-41.
[2] Shiferaw Y, Alemu A, Girma A, et al. Assessment of knowledge, attitude and risk behaviors towards HIV/AIDS and other sexual transmitted infection among preparatory students of Gondar town, north west Ethiopia. BMC Res Notes 2011; 4(1): 505.
[3] Mark H, Dhir A, Roth C. CE: sexually transmitted infections in the United States: Overview and update. Am J Nurs 2015; 115(9): 34-44.
[4] Risser WL, Risser JM, Risser AL. Current perspectives in the USA on the diagnosis and treatment of pelvic inflammatory disease in adolescents. Adolesc Health Med Ther 2017; 8: 87-94.
[5] Shannon CL, Klausner JD. The growing epidemic of sexually transmitted infections in adolescents: A neglected population. Curr Opin Pediatr 2018; 30(1): 137-43.
[6] Vakilian K, Mousavi SA, Keramat A. Estimation of sexual behavior in the 18-to-24-years-old Iranian youth based on a crosswise model study. BMC Res Notes 2014; 7(1): 28.
[7] Vakilian K, Abbas Mousavi S, Keramat A, Chaman R. Knowledge, attitude, self-efficacy and estimation of frequency of condom use among Iranian students based on a crosswise model. Int J Adolesc Med Health 2016; 30(1): /j/ijamh.2018.30.issue-1/ ijamh-2016-0010/ijamh-2016-0010.xml.
[8] Vakilian K, Keramat A, Seyyed Abbas M. The necessity of developing AIDS and reproductive health indicators for Iranian adolescents in the national health system; The evaluation of indicators among 18-24 year old university students of shahroud, Iran: A cross-sectional study. Open Public Health J 2018; 11(1)
[9] Kyilleh JM, Tabong PT-N, Konlaan BB. Adolescents’ reproductive health knowledge, choices and factors affecting reproductive health choices: A qualitative study in the West Gonja District in Northern region, Ghana. BMC Int Health Hum Rights 2018; 18(1): 6.
[10] Samkange-Zeeb FN, Spallek L, Zeeb H. Awareness and knowledge of sexually transmitted diseases (STDs) among school-going adolescents in Europe: A systematic review of published literature. BMC Public Health 2011; 11(1): 727.
[11] Keramat A, Vakilian K, Mousavi S. Barriers to youths’ use of reproductive health services in Iran. Life Sci J 2013; 10: 943-9.
[12] Mousavi SA, Keramat A, Vakilian K, Chaman R. Interpretation of opposite-sex friendship based on social ecology model in Iranian females. Iran J Psychiatry Behav Sci 2012; 6(2): 69-78.
[13] Keramatm Afsaneh, Katayon K, Mousavi Seyed. AM: Barriers to youths’ use of reproductive health services in Iran. Life Sci J 2013; 10(2): 943-9.
[14] Vakilian K, Keramat A, Mousavi SA, Chaman R. Experience assessment of tobacco smoking, alcohol drinking, and substance use among shahroud university students by crosswise model estimation–the alarm to families. Open Public Health J 2019; 12(1)
[15] Pophan JW, Hall EA. Assesment instrument for measuring student outcomes (Grade 7-12). CDC 1999.
[16] Mousavi A, Keramat A, Vakilian K, Esmaeili Vardanjani SA. Development and adaptation of Iranian youth reproductive health questionnaire. International Scholarly Research Notices 2013; 2013
[17] Vakilian K, Keramat A. The correlation between perceived peer norms in attitude and self-efficacy premarital sexual behavior. The open public health 2020; 4(13): 3-6.
[18] Yacobi E, Tennant C, Ferrante J, Pal N, Roetzheim R. University students’ knowledge and awareness of HPV. Prev Med 1999; 28(6): 535-41.
[19] Malary M, Abedi G, Hamzehgardeshi Z, Afshari M, Moosazadeh M. The prevalence of herpes simplex virus type 1 and 2 infection in Iran: A meta-analysis. Int J Reprod Biomed (Yazd) 2016; 14(10): 615-24.
[20] Looker KJ, Magaret AS, Turner KM, Vickerman P, Gottlieb SL, Newman LM. Global estimates of prevalent and incident herpes simplex virus type 2 infections in 2012. PLoS One 2015; 10(1): e114989.
[21] Dehghani B, Dehghani A, Sarvari J. Knowledge and awareness regarding hepatitis B, hepatitis C, and human immunodeficiency viruses among college students: A report from Iran. Int Q Community Health Educ 2020; 41(1): 15-23.
[22] Taebi M, Riazi H, Keshavarz Z, Afrakhteh M. Knowledge and attitude toward human papillomavirus and HPV vaccination in Iranian population: A systematic review. Asian Pac J Cancer Prev 2019; 20(7): 1945-9.
[23] Amu E, Adegun P. Awareness and knowledge of sexually transmitted infections among secondary school adolescents in Ado Ekiti, South Western Nigeria. J Sex Transm Dis 2015; 2015: 1-7.
[24] Ekşi Z, Kömürcü N. Knowledge level of university students about sexually transmitted diseases. Procedia Soc Behav Sci 2014; 122: 465-72.
[25] Rabiee S, Fallah M, Zahabi F. Frequency of trichomoniasis in patients admitted to outpatient clinics in hamadan (2007) and relationship between clinical diag-nosis and laboratory findings. J Res Health Sci 2010; 10(1): 31-5.
[26] Arbabi M, Fakhrieh Z, Delavari M, Abdoli A. Prevalence of Trichomonas vaginalis infection in Kashan city, Iran (2012-2013). Iran J Reprod Med 2014; 12(7): 507-12.
[27] Poole DN, McClelland RS. Global epidemiology of Trichomonas vaginalis. Sex Transm Infect 2013; 89(6): 418-22.
[28] Seifi S, Asvadi Kermani I, Dolatkhah R, et al. Prevalence of oral human papilloma virus in healthy individuals in East azerbaijan province of iran. Iran J Public Health 2013; 42(1): 79-85.
[29] Jahdi F, Khademi K, Khoei EM, Haghani H, Yarandi F. Reproductive factors associated to human papillomavirus infection in Iranian woman. J Family Reprod Health 2013; 7(3): 145-9.
[30] Rezaei-Chaparpordi S, Assmar M, Amirmozafari N, et al. Seroepidemiology of herpes simplex virus type 1 and 2 in northern iran. Iran J Public Health 2012; 41(8): 75-9.
[31] Solikhah SN. Knowledge and behaviour about adolescent reproductive health in Yogyakarta, Indonesia. Int J Public Health 2015; 4(4): 326-31.