The purpose of this cross-sectional descriptive study was to assess knowledge level regarding signs and symptoms, prevention, treatment of STIs among a sample of residents from Southeastern Texas. One hundred and fifty-seven participants age 18 and over responded to the 23 questionnaire items. Questionnaires were distributed to mostly public places such as hair salons, fitness centers, health centers, gas stations, apartments, and stores. Results indicated that 50.3% of participants reported syphilis was not curable; while over 61% reported gonorrhea was incurable. Over 64% of respondents reported they did know the symptoms for syphilis and over 70% believed that syphilis was vaccine preventable. The data collected from this study indicated that some residents from Southeast Texas lack basic information concerning Syphilis, Gonorrhea, and Chlamydia with regard to prevention, signs and symptoms, and treatment. The cost and effort to increase educational programs and educational messages appear to be justified. Implications for practice include increasing funding and efforts to provide more educational programs focusing on sexually transmitted disease prevention, health literary education to dispel the myths and stigma related to STIs and community wide collaboration efforts to increase awareness.
“Sexually Transmitted Infections (STIs) are nowadays a common group of reportable infectious diseases in most countries particularly among ages 15 to 50 years old and in infants” (De Schryver & Meheus (1990), p. 639) [
WHO (2016) estimates that over one million individuals acquire an STI daily. Sexual contacts such as vaginal, oral, and anal are the major modes of transmission. A majority of infected individuals have no symptoms. Estimated new cases of curable STIs, by WHO regions, were as follows: 126 million in the Americas, 128 million in the western pacific region, 93 million in the African region, 26 million in the eastern Mediterranean region, 79 million in the southeastern region, and 47 million individuals in the European region (WHO, 2013) [
Many individuals and communities in the United States and other parts of the world are, in most cases, reluctant to address sexual health issues openly due to the biological and social characteristics of these diseases (Katz, 2014) [
Since all individuals and communities are impacted either directly or indirectly through the medical cost or death toll engendered by these infections, everyone has a vested interest in prevention of STIs (Eng & Butler, 1997 [
In the United States, more than 19.7 million new cases of STIs occur every year (CDC Fact Sheet, 2013 [
In the United States, illicit drug use and sexual conduct have been strongly linked with incidences of STIs (CDC, 2015) [
Nearly 20 million new STIs are reported every year with the cost of 16.4 billion dollars to the healthcare system (CDC, 2013, 2016) [
According to the CDC’s 2016 report on Viral Hepatitis, STD, and TB Prevention, for the three common STIs: chlamydia, gonorrhea, and syphilis, Texas ranked 15th in the nation for chlamydia with 142,952 cases at the rate of 520.4/100,000 population. Regarding gonorrhea, Texas ranked 17 in the nation with 42,472 cases at the rate of 154.6/100,000 population. In terms of primary and secondary syphilis, Texas ranked 16th in the nation, while syphilis at all stages, Texas had 9564 cases in 2016. The infection trend indicates an increase year by year. For instance, the number of syphilis cases from previous years showed: 7057 cases in 2012, 7044 cases in 2013, 7804 in 2014, and 8250 cases in 2015. Specific areas of the state with higher Syphilis cases included Round Rock and Austin with 825 cases in 2016 compared to 478 cases in 2012. Other Metropolitan areas such as Dallas Fort Worth and Arlington showed 2661 cases in 2016 compared to 2141 cases in 2012, The Woodlands and Sugar Land reported 2817 cases in 2016 compared to 2246 in 2012, and San Antonio-New Braunfels had 1126 cases of Syphilis in 2016 compared to 983 in 2012.
In the Southeastern Texas region, particularly the Golden Triangle area, the number of syphilis cases grew from 24 in 2006 to over 300 in 2008; by 2015 the number had reached 574 cases (Beaumont Enterprise, 2009) [
Following the abrupt increase in syphilis cases, health officials in Southeast Texas launched a “Stomp Out Syphilis” campaign to educate people about syphilis and the importance of getting tested. This program was sponsored by the Texas Department of State Health Services in collaboration with officials from local Health Departments as well as other community professionals in the area. This campaign involved radio and television advertisements as well as community outreach.
The purpose of the survey was to determine knowledge level concerning signs and symptoms, prevention and treatment of STIs. Du, Thomas, McNutt, and Coles (2008) [
The study sought to answer two questions:
1) To what extent do participants know the various kinds of STIs?
2) To what extent do participants know the cause, signs, symptoms, and treatment of STIs?
This cross-sectional study surveyed a diverse group of residents in a southeastern Texas region city with an estimated population of 130,000. The sample contained 157 individuals with an age range of 18 to 55 years of age, both male and female. This sample size was determined to be satisfactory in yielding significant results with a confidence level of 95% and a 7.8% margin of error. The study participants included employed, unemployed, retired, educated as well as uneducated individuals.
Due to the general nature of the topic being explored, a convenient sample (non-probability sampling) with a captive audience approach was utilized in obtaining participants for this study (Abrams, 2010 [
The instrument consisted of 23 questions adopted from the Sexually Transmitted Disease Knowledge Questionnaire [STD-KQ] (Jaworski & Carey, 2007) [
After obtaining approval to conduct the study by a local University's Internal Review Board (IRB), the questionnaires were distributed to individuals in various locations including hair salons, fitness centers, health centers, gas stations, apartments, health meetings as well as workshops, and stores. Questionnaire distribution was performed by two faculty members and four health education trained students from a local university. Participants were presented with a letter which described the purpose of the survey and were asked to complete the questionnaire, if they desired to do so. Participation in the study was voluntary and anonymous. No personal identification information was taken. The number of completed questionnaires totaled 157.
After completing the data collection process, the IBM SPSS program was utilized to enter, process/clean, and analyze the data. The analysis included descriptive statistics such as percentages and frequencies, means and standard deviations which were performed in order to assess the sample characteristics. Another analytical tool that was utilized is the Crass-tabulation analysis. Cross-tabulation was also performed to generating contingency tables by displaying joint frequency of data values in order to compare responses from two or more categorical variables. Cross tabulation helped to determine the frequencies and percentages of a combination of variable categories and determine the relationship between the study variables.
Participants in this study were from Southeastern Texas region. The majority of the participants were between the ages of 18 - 55 (66.9%). Forty-six percent were African American, 32.2% Caucasian, 9.9% Latino, and others (11.9%). Females represented the largest group of participants (83.2%). Sixty-seven percent (n = 103) of the participants were employed. The majority of participants had either a high school diploma (34.2%) or four-year college degree (29.6%). Fifty-eight percent of the participants (n = 90) reported they received medical exams at least once a year, while 19% had physical exams twice per year and 15% had exams only once in three years.
Participants were asked to identify from a list of infectious diseases in the questionnaire whether they were in the category of STIs or not. Over 90% of respondents were able to correctly identified pneumonia, lupus, pertussis and diabetes as not belonging in the group of STIs (see
Interesting results were observed with regard to three specific knowledge level questions concerning the treatment of chlamydia, syphilis, and gonorrhea. Half of the participants (50.3%) considered syphilis to be incurable. Yet still a little over 40% reported chlamydia and 38% reported gonorrhea as incurable STIs. In addition, 27% of participants believed genital wart was curable (see
A cross tabulation was performed in order to examine whether ethnicity or education level variables had an impact on these findings. Two demographic variables, ethnicity and education levels, had to be recoded in order to combine some categories with fewer respondents to allow cross tabulation to be performed. For example, Ethnicity with six categories was recoded into Race to generate two groups (Non-White = 1, White = 2) and Education with five response categories was recoded into education level which generated two groups: those with less than a four-year degree and those with a four-year degree or a graduate degree.
The cross tabulation results indicated that among the majority (n = 103 vs. 49) respondents (Non-White), less than a half of them (43.7%) reported syphilis was
curable while a little over a half (56.3%) reported gonorrhea was curable. In terms of education level, the majority of participants had less than a four-year degree (n = 98 vs. 54). Nearly half of the participants with less than a four-year degree (52%) reported syphilis was not curable, while 40% indicated gonorrhea was not curable.
Participants were asked about general knowledge questions regarding STIs prevention, signs and symptoms as well as mode of transmission.
Item | True | False | ||
---|---|---|---|---|
n | % | n | % | |
STI with greatest increase in S.E. Texas (syphilis) | 123 | 83.1 | 34 | 16.9 |
False statement about STIs (trans. No sympts) | 102 | 69.4 | 55 | 30.2 |
Long-term effects of untreated syphilis (dementia) | 104 | 71.2 | 53 | 28.8 |
Riskiest sexual activity to cause HIV (vaginal or anal) | 131 | 89.1 | 26 | 10.9 |
Common contraction ways (needles, intercourse, etc) | 136 | 89.3 | 21 | 10.7 |
*Chlamydia symptoms (generalized rash) | 77 | 49.0 | 80 | 50.9 |
STIs contracted on toilet sit (None) | 100 | 71.9 | 39 | 28.1 |
*STI linked to Cervical Cancer (HPV infection) | 22 | 15.7 | 135 | 84.3 |
*Characteristics of Primary syphilis (lesion at infect. site) | 44 | 35.2 | 113 | 64.8 |
*Characteristics of Secondary Syphilis (rash on palm) | 47 | 29.9 | 110 | 70.1 |
Vaccine preventable STIs (HPV) | 112 | 71.3 | 45 | 28.7 |
Sexually active person (protect, comm., receive treatment) | 126 | 81.8 | 28 | 18.2 |
Best way to avoid STIs (Use condoms or abstain) | 131 | 86.8 | 20 | 13.3 |
Note: Words in brackets denotes correct answer picked for the questions.
respondents did not know the symptoms for syphilis, including the lesion at the site where the organism enters the body (64.8%). Over half of the participants (70.1%) reported they did not know the rash on the palm of the hand was a secondary stage syphilis symptom. Nearly 15% of participants believed syphilis was vaccine-preventable. Even though a generalized rash is a symptom of syphilis, 50.9% reported that it was one of the symptoms of chlamydia.
Knowledge about STIs is essential in minimizing the prevalence, decreasing infection rates, promoting early diagnosis, and facilitating adherence to treatment (Taylor, Jinabhai, Sathiparsad, & Vries, 2014) [
Although findings of this study may not be generalizable to the entire Southeastern Texas population, these findings suggest existing lack of knowledge about STIs regardless of the availability of information concerning preventive measures.
It can be argued that higher knowledge on STIs can play a role in enhancing healthy practices and protective sexual communication. Assessing the association between knowledge about STIs and sexual behaviors and STIs protection such as use of condoms, Burazeri, Roshi, and Tavanxhi (2004) found an overall association of knowledge about STIs with consistent condom use [
Given the findings of this study, the researchers concluded that the cost and effort of increased educational and intervention programs are justified and, therefore, should be encouraged, supported and expanded where possible.
This study had the following limitations:
1) The sample composed of 83% of women due to convenient sampling approach.
2) Results of this study may not represent the knowledge level of the general population of Southeast Texas. Therefore, findings may not be generalizable to the entire region or state.
Based on the results of this study, the following recommendations and implications are offered:
1) Health promotion and education leaders should continue to offer and expand health education programs in southeast Texas. Such efforts could include seeking more funding in order to provide a community-wide educational program.
2) Health leaders should advocate for comprehensive health literacy in order to dispel myths and stigmas related to STIs.
3) Community leaders in schools, faith-based groups, businesses, and other entities engaged in community health efforts should work in collaboration with health leaders to provide more education on the severity, prevention, and treatment of STIs.
Based on the results of this research, the following recommendations for future studies were made:
1) Investigate the impact of socio-cultural, environmental, and economic factors of sexual behaviors.
2) Explore the best communication tools, which can be used to disseminate the knowledge needed to most individuals regardless of social-demographic factors, such as age, race, income, educational level, and others.
3) Assess knowledge gap among populations similar to the nation’s hardest hit and most vulnerable groups such as those aged 15 to 24 years who comprise the majority of chlamydia and gonorrhea infections nationally. Future studies should also target gay, bisexual, and other men who have sex with men; the literature indicates that these populations face the highest rates of syphilis and HIV co-infection.
4) Additionally, risk factors among women of reproductive age should be assessed. Recent Syphilis data suggest that pregnant women are experiencing severe disparities and severe consequences from untreated STDs, particularly with the recent increase in congenital syphilis.
5) Additional research looking at the factors contributing to knowledge of the STIs in South East Texas is recommended, preferably a quantitative study using random sampling.
Msengi, I.G., Msengi, C., Nikuze, S. and Barton, J. (2018) Sexually Transmitted Infections (STIs) Knowledge Assessment of Adults in a US South Eastern Texas Region. Open Journal of Preventive Medicine, 8, 32-43. https://doi.org/10.4236/ojpm.2018.82004