Reports reveal misconceptions about STIs among patients, clinicians

Issue: June 2018

Recent survey data showed that most young, sexually active women do not undergo routine screening for sexually transmitted infections because they do not see themselves at risk, even though less than half reported using a condom the last time they had sexual intercourse.

The reports — conducted by Quest Diagnostics and Analyte Health — further showed that physicians often feel uncomfortable discussing STI risks with their patients, and many do not offer testing.

“Our findings suggest that discomfort with frank conversations about sexual activity and false beliefs about risk are key barriers to STD testing and could be driving some of the increase in STD cases of young women,” Damian P. Alagia III, MD, FACOG, FACS, medical director of woman’s health at Quest Diagnostics, said in a press release. “Our hope in sharing this survey’s findings with clinicians and the general public is that it prompts open dialogue about reproductive health and STD risk, which is absolutely critical to reversing the trajectory of high STD rates in the United States.”

Gaps in STI awareness

Recent CDC data show that all three nationally reportable bacterial STDs in the United States are on the rise. In 2016, there were 1.6 million chlamydia cases, 468,518 gonorrhea cases and 27, 814 syphilis cases, representing a 4.7%, 18.5% and 17.6% increase since 2015. Half of all new STIs occur among young people aged 15 to 24 years. Moreover, one in four sexually active adolescent females — whose behavior and biological factors, such as increased cervical ectopy, predisposes them to infection — has an STI, according to the CDC.

To investigate the rising trends in STIs among young women, Quest Diagnostics surveyed 3,314 young women aged 15 to 24 years and 312 health care providers about sexual activity, sexual health, STI awareness and testing.

Data showed that more than half (56%) of young women reported being sexually active, but only 39% used a condom during their last sexual encounter. Although the CDC recommends annual testing among all young, sexually active women, only 56% of those surveyed said they have been tested. Sixty-two percent of sexually active women who were not tested said it was because they did not feel at risk, and 55% said it was because they did not have symptoms. However, the CDC warns that STIs in women are often asymptomatic.

Other key findings among young women showed that:

86% and 88% do not see themselves at risk for chlamydia and gonorrhea, respectively;
51% do not want to bring up sex or STIs to their health care provider;
27% overall and 43% of those 15 to 17 years of age are not completely honest with their health care provider about sexual history; and
49% were not offered STI testing by their health care provider.

According to survey results from health care providers:

24% agreed they are uncomfortable discussing STI risks with their female patients;
27% said they can accurately diagnose an STI based on patients’ symptoms; and
74% would order chlamydia testing and 72% would order gonorrhea testing for an asymptomatic, sexually active female patient.

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“We know that people often think of STIs as something that happens ‘to others’ and, frequently, health care providers have similar beliefs and don’t view their patients as being at risk,” Lynn Barclay, president and CEO of the American Sexual Health Association, said in the release. “Testing is crucial in young women because STIs are very common, often without symptoms, and undetected infections like chlamydia can lead to problems, including infertility.”

Many patients prefer online-based STI testing

In a separate survey, experts with Analyte Health, a company that provides health care diagnostic information to patients, also identified gaps in STI knowledge and testing. Of the 1,030 adults surveyed, only 40% who reported being sexually active were tested in the past year, and half discussed STI testing with their health care provider.

Among sexually active adults who were not tested:

49% said they do not need routine STI testing;
33% said testing was too expensive,
26% said they had no time;
19% were worried about confidentiality;
17% were not offered testing; and
16% were not sure where they could get tested.

In other results, more than 40% of survey respondents said they would prefer an online-based STI testing solution. Online testing, according to Analyte Health, is a physician-ordered test that is facilitated online or through a call center. Patients can take their test samples to a walk-in laboratory or send it in the mail to a physician who reviews the results and delivers them through a secure website. Physician consultations are also available, when needed.

“It’s imperative that we understand how to meet Americans where they are and provide them with their preferred method of access to testing,” Kevin Weinstein, CEO of Analyte Health, said in a press release. “We’re very pleased to make this survey available to the public, policymakers and providers to help address this public health crisis, especially during STD Awareness Month.” – by Stephanie Viguers

References:

Analyte Health. Americans’ Attitudes Towards Sexually Transmitted Infections (STI) Testing. https://www.stdtestexpress.com/blog/wp-content/uploads/2018/04/AH-STI-White-Paper-v4.pdf. Accessed April 20, 2018.

CDC. STD Awareness Month. https://www.cdc.gov/std/sam/index.htm. Accessed April 23, 2018.

Quest Diagnostics. Young women and STDS: Are physicians doing enough to empower their patients and protect their health? https://mma.prnewswire.com/media/662641/Young_Women_and_STDs_Physicians_Report.pdf. Accessed April 20, 2018.

Disclosures: Alagia is an employee of Quest Diagnostics. Infectious Disease News was unable to confirm Barclay’s relevant financial disclosures at the time of publication. Weinstein is an employee of Analyte Health.