Table 1 demonstrates that the total number of participants was 130. The mean age of the participants was 29.32 with a standard deviation of 7.94. The quartile ages were 23 years for the lower age, 26 years for the middle age, and 36 years for the upper age. The majority of the participants, i.e, 94 (72.3%) were in the age group between 18 to 35 years, followed by the age group between 36 to 45 years, i.e, 34 (26.2%) participants. More than half, i.e, 73 (56.2%) of the participants were single. The majority of the participants, i.e, 74 (56.9%) had a secondary education status, followed by those with tertiary education, i.e, 49 (37.7%) participants. The number of participants who were employed, i.e, 62 (48.1%) was almost equally proportionate to those unemployed, i.e, 65 (50.4%). Among the participants, 35 (26.9%) participants were alcohol users.

Table 2 indicates that 123 (94.6%) participants were knowledgeable about STIs other than HIV that can be acquired through sexual intercourse. However, 32 (24.6%) and 41 (31.5%) participants did not know about the possibility that female or male persons, respectively, can have an STI other than HIV without having symptoms. The table also demonstrates that 89 (68.5%) and 82 (63.1%) participants were knowledgeable about the possibility of contracting STIs when having sex soon after delivery and during menses, respectively. Sixty-seven (51.5%) participants were knowledgeable about blood transfusion as a possible cause for STI. The most known STIs were HIV, i.e. by 117 (90%) participants, syphilis, i.e, 95 (73.1%) participants, and gonorrhoea, i.e, by 59 (45.4%) participants.

As shown in Table 3, the majority of participants, i.e, 126 (96.9%) knew that sexual intercourse is the route of transmission of STIs. Fifty-eight (44.6%) participants knew about the transmission of STI from mother to child, while 51 (39.2%) and 34 (26.2%) participants knew about blood transmission and the sharing of needles, respectively, as routes of STI transmission. Furthermore, the majority of participants, i.e, 108(83.1%) knew about discharge from vagina/penis as symptoms of STIs, while 79 (60.8%) participants knew as much about abdominal pains. A low number of participants, i.e, 24 (18.5%) knew about itching in genital areas, 35 (26.9%) about pain during intercourse, and 38 (29.9%) about burning in urination as symptoms of STIs. Regarding complications of STIs, miscarriage by 107 (82.3%) participants, cervical cancer by 88 (67.7%) participants, and ectopic pregnancy were the highest known complications.

Regarding attitudes, Table 4 demonstrates that a high proportion of participants, i.e, 127 (98.4%) regarded condom use as a preventative measure for STIs, an individual with an STI should be treated, as regarded by 125 (97.7%) participants, and that an individual who is not sure about symptoms of STIs must contact health care personnel by 100 (77.5%) participants. 74 (57.3%) participants regarded STIs as not dangerous because they are curable. The table also demonstrates participants’ beliefs that STIs can be cured, regarded by 128 (99.2%) participants and prevented, according to 124 (95.4%) participants, and also that women were at a high risk to acquire STIs as regarded by 77 (59.2%) participants.

Table 5 shows that there was a statistically significant association between participants’ knowledge of occurrence of STIs without symptoms and alcohol consumption among women (21; 60.0% versus 77; 81.1%; p = 0.021) and among men (18; 51.4% versus 71; 74.7%; p = 0.018). There was also a pointer towards a significant association between the participants’ knowledge that blood transfusion can transmit STIs and their alcohol consumption (13; 37.1% versus 54; 56.8%; p = 0.051).

Table 6 indicates that there was a significant association between the women’s knowledge of STIs and their level of education with respect to knowledge of symptoms occurring in females and males who have acquired STIs (p = 0.002 and p = 0.000), respectively; chlamydia as an STI (p = 0.005), genital herpes as an STI (p = 0.000), and that infertility can be a complication of STIs. There was a high proportion of women who did not know that Hepatitis B can be an STI, regardless of their level of education (4; 3.1% versus 126; 96.9%).

The majority (72%) of the participants in this study were in the age group between 18 to 35 years, in keeping with most studies conducted on knowledge, attitudes, and beliefs regarding STIs [1-32]. Young adults have been found to be at high risk for acquiring STIs as they move away from families and attend learning institutions where they are at high risk of having multiple sexual partners and practice unsafe sex [21]. There has been much emphasis on HIV/AIDS as the dreaded infection in communities [22, 23], such that inquiry on other STIs among patients may be downplayed. In this study, the participants were asked about their knowledge on other STIs other than HIV/AIDS and their responses indicated that almost all of them (95%) were well-informed. Furthermore, their knowledge that STIs can occur without symptoms in males and females (e.g. chlamydia, gonorrhoea, and genital herpes) [24] was also inquired. Again, their response indicated high proportions of knowledge (> 68%) in this regard.

In this study, the main possible risk factors of STIs were identified as having sex soon after delivery (69%), sexual intercourse during menstruation (63%), and blood transfusion (52%). A study on postpartum sexually transmitted infections found that 27% of women were diagnosed with STIs postpartum. However, the study also showed that the incidence of postpartum infection was higher among the women who had contracted an STI during pregnancy (43%) [25]. There is evidence that sexual intercourse during menstruation can be a risk factor for STI [26], particularly, candidiasis and bacterial vaginosis as a result of the hormonal change in the woman’s body during this period [27], and indeed, a study found self-reported STI history among women who had engaged in sexual intercourse during menstruation [28, 29]. A systematic study on knowledge gaps of STIs in Africa quoted a study conducted in Nigeria which reported a 73% prevalence of knowledge that blood and blood products can be modes of STIs transmission [30]. The difference could be ascribable to the difference in the level of education in the two studies: most of the participants (62%) in our study had primary and secondary education, compared to the Nigerian study all of whom were secondary school adolescents [30].

Regarding knowledge about types of STIs, the majority (95%) of the participants in this study were knowledgeable about infections other than HIV/AIDS that can be acquired through sexual intercourse. A study conducted among dermatology patients in an urban city of Vietnam indicated a much lower percentage (57.4%) of patients who knew that HIV/AIDS was an STI [31]. The authors of this study are not able to give possible reasons for this difference, as they would have expected a similarly high proportion in the Vietnam study, given the long history and pandemic nature of HIV/AIDS [32]. However, a study conducted in India on the knowledge and attitude about STIs other than HIV/AIDS among college students found a similar proportion (99%) to ours [21]. Our study reported that 73.1% of participants knew that syphilis was an STI, and a comparable proportion (68.3%) was found in a study conducted in Italy among similar age-group participants [33]. The finding that very low proportions (below 10%) of participants displayed very poor knowledge that hepatitis B and C can be sexually transmitted [34, 35], points towards a gap in patient knowledge on STIs.

Regarding the routes of infection, most participants in this study indicated sexual intercourse (97%), mother to child (46%), blood transfusion (39%), and sharing of needles (26%) as the most known routes. These routes of transmission have been reported in other studies as well [36-38]. The level of misconceptions (transmission through sharing of clothes and food items) was significantly low (less than 5%) among the participants of the current study, which was a positive finding for women’s health. Symptoms mainly identified in this study were: discharge from the penis/vagina (83%), abdominal pain (61%), swelling (57%), and sores (49%) in the genital area. Other studies have listed similar symptoms albeit with differing proportions to our study [39-41].

Complications of STIs predominantly known by the participants in this study were miscarriage (82%), cervical cancer (68%), ectopic pregnancy (47%), and infertility (42%). These have been listed in other literature [42, 43]. In Italy, high school and university students were reported to have poor knowledge of the complications of STIs, making them vulnerable to unprotected sex [44], as confirmed by a study conducted in rural Kilimanjaro, which demonstrated that low knowledge of STI complications correlated “significantly with recent (past 4 weeks) practice of multiple sexual partners and not using condoms with casual (sexual) partners.” [45].

Almost 60% of the respondents agreed with the statement that STIs are not dangerous because they can be cured. This was higher than the 24.5% that was reported in a study conducted among university students in Thailand [46]. The authors of this study, again thought that the explanation of this difference is the difference in the levels of education between the women in the current study, most of whom (62.3%) had a secondary level of education and below, compared to the university students in the Thai study. The high proportion of women who regarded STIs as not dangerous is a cause for concern as it could lead to a lack of prevention against STIs. However, there were high proportions of participants in this study who agreed with the statements that unprotected sexual intercourse with STI-infected individuals should be avoided to prevent being infected, condoms should be used to prevent STIs, persons infected with STIs should receive treatment, and that persons who are not sure about STI symptoms should contact health care personnel for assistance. These latter responses are an indication that the participants, on average, had a positive attitude in their health-seeking behaviour [47, 48]. The authors of this study are of the view that the positive attitudes were influenced by their reasonable knowledge of the routes of infection, symptoms, and complications of STIs since one’s knowledge tends to influence one’s attitude [46].

A high proportion of participants had a belief that STIs can be cured (99%) which corresponded to their attitude that STIs are not dangerous (60%). It is a misconception that all STIs are curable since some are amenable to cure, e.g. syphilis, gonorrhoea, and chlamydia, and some are incurable e.g. HIV/AIDS, hepatitis B, human papillomavirus (HPV), and genital herpes (HSV) [49, 50]. This belief carries the risk of infection as the women could neglect protective measures against STIs. However, their beliefs that women are at a higher risk to acquire STIs, and that STIs can be prevented, were not contradictory to available scientific evidence [40, 51, 52].

Although slightly above one in four (27%) of the participants were alcohol users, our study did not demonstrate a clear correlation between alcohol consumption and knowledge of STIs. In a systematic study on alcohol consumption and STIs, eight studies reported a significant association between excessive alcohol consumption and at least one STI [53]. The authors of the current study concede that the absence of the correlation of these two variables may have come as a result of the non-specific enquiry on ‘excessive alcohol consumption, the current study simply required the participants to indicate if they used alcohol or not. However, the study also demonstrated that there was a significantly large proportion of non-alcohol users who knew that a woman or a man can have symptom-free STIs (p < 0.05). We did not find studies that reported the effect of alcohol use in association with knowledge of symptoms-free STIs. The closest study to the subject was conducted in England, which showed that 59.7% of the participants knew that STIs, in general, can be symptom-free [54], and a Brazilian study which addressed the effect of alcohol consumption by women before or during sexual intercourse, rendering them vulnerable to STIs [55].

The study revealed a significant association between the women’s knowledge of STIs and their level of education with respect to knowledge of symptoms occurring in females and males, chlamydia and genital herpes is STIs and that infertility can be a complication of STIs. This meant that the higher the education level, the better the knowledge on STIs on the indicated parameters. A similar finding has been reported in a study on patient’s awareness of STIs at a public hospital in Malaysia. However, the study, unlike our study, comprised both male and female patients. The current study also showed a high proportion of women who did not know that Hepatitis B can be an STI, regardless of their level of education, in keeping with a study conducted in Nigeria, where secondary school adolescents never mentioned hepatitis B at all in their list of known STIs [36].

The results of this study are based on the self-reported account of the participants, which may be subjected to social desirability bias. The participants were not asked if they consumed alcohol excessively or not, as it is excessive alcohol consumption that is deleterious to health [40]. Therefore, the study is limited in terms of the association of alcohol and patient knowledge on STIs. In the literature review that we conducted, there was a scarcity of studies on knowledge, attitude, and beliefs particularly among patients, and most studies were conducted on college and university students. This limited the comparison of the current study findings to similar studies, but it also highlighted the gap in studies conducted on knowledge, attitudes, and beliefs in the various settings.