High School Dropouts and Sexually Transmitted Infections

Regional and Country Prevalence Estimates of Unsafe Sex Among Adolescents in 68 Low-Income and Middle-Income Countries

Prioritizing adolescent health is a public health priority to achieve the sustainable development goals, including reducing the risk of unsafe sex. Data on unsafe sex have remained scarce among adolescents in low-and middle-income countries (LMICs). To estimate the prevalence of unsafe sex in LMICs, we conducted secondary data analysis on the Global School-based Student Health Surveys among 244,863 students aged 13-17 years from 68 countries across five World Health Organization regions. The overall prevalence of ever had sex was 16.2%. The highest to lowest regional prevalence estimation of ever had sex was 30.5% (28.9-32.1) in the Americas, 28.6% (26.8-30.4) in Africa, 10.9% (9.2-12.6) in the Eastern Mediterranean, 9.6% (8.8-10.5) in South-East Asia, and 8.0% (6.8-9.1) in the Western Pacific. The highest prevalence of sexual intercourse before age 14 and practicing sexual intercourse without condom use were 36.5% (34.5-38.5) and 32.2% (30.1-34.3) in Africa, respectively. Findings suggest that current interventions are inadequate in promoting the uptake of safe sexual behaviors and an urgent intervention is needed.

Condom Use at Last Sex and Sexual Negotiation Among Young African American Women in North Carolina: Context or Personal Agency

African American women are 10.8 times more likely to be diagnosed with HIV compared with White women. This descriptive study fills a gap by examining associations among social and contextual factors and sexual communication, condom use, and safer sex negotiation among African American women. Study participants between 18 and 25 years of age and who reported recent substance use were recruited from three North Carolina counties. A risk behavior survey was administered via audio computer-assisted self-interview, and logistic regression analyses were conducted to assess associations between social and contextual variables and condom use at last sex with a main partner. Education (AOR: 2.078; 95% CI: 1.214, 3.556), sexual communication with a main partner (AOR: 1.079; 95% CI: 1.050, 1.109), and condom use relationship scale (AOR: 1.059; 95% CI: 1.023, 1.098) were positively associated with condom use at last sex, whereas living with a main partner (AOR: 0.447; 95% CI: 0.210, 0.950) and the alcohol and drug problem scale (AOR: 0.971; 95% CI: 0.944, 0.998) were negatively associated with condom use (p < 0.05). The study findings show that among young African American women at risk for HIV, contextual and personal factors may influence condom use. A socio-ecological approach combining personal empowerment, interpersonal, structural, and biobehavioral strategies is necessary in implementing holistic gender-focused HIV prevention programs.

High prevalence of rectal chlamydia among pregnant adolescents in La Romana, Dominican Republic warrants extragenital STI testing

To our knowledge, there are no studies estimating the prevalence of extragenital sexually transmitted infections (STIs) among pregnant adolescents in the Caribbean. This study sought to fill this gap by assessing the prevalence and correlates of oral, genital, and rectal chlamydia (CT) among a sample of pregnant adolescents in La Romana, Dominican Republic. Two hundred pregnant youths, aged 15-24 years, were recruited by systematic sampling during their first prenatal visit to a maternal care unit. A sociodemographic and behavioral questionnaire was administered and urine and oral/anal swabs were collected and tested for CT. Descriptive analyses and Fisher's exact tests were performed. The prevalence of oral, genital, and rectal CT was 6%, 15%, and 23%, respectively, although less than 5% of participants reported ever engaging in receptive anal intercourse. This discrepancy could be explained by autoinoculation, concurrent transmission during sex, undertreatment of rectal CT, or underreporting of anal sex. Almost half of CT infections would have been missed if only genital samples were collected, as current protocol dictates. More research is needed to understand sexual behaviors and rectal STI risk factors among heterosexual adolescent women. STI screening procedures for pregnant and sexually active adolescents should include routine testing of extragenital sites.

Incidence of Nongonococcal Urethritis in Men Who Have Sex With Women and Associated Risk Factors

BACKGROUND

Incidence and risk factors for nongonococcal urethritis (NGU) remain poorly defined. We conducted a cohort study to estimate the incidence of NGU and identify risk factors in men who have sex with women.

METHODS

We enrolled cisgender male sexually transmitted disease clinic attendees 16 years or older who reported exclusively female partners. At enrollment and 6 monthly follow-up visits, men underwent a clinical examination, provided urethral swab and urine specimens, completed a sexual behavior survey and biweekly diaries, and were tested for Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG) using Aptima assays (Hologic, Inc). Nongonococcal urethritis was defined as ≥5 polymorphonuclear leukocytes per high-power field plus either urethral symptoms or visible discharge. We estimated the incidence of NGU overall, asymptomatic and symptomatic NGU, non-CT/non-MG NGU, and CT/MG-associated NGU using Poisson regression for clustered outcomes. We performed relative risk binomial regression for clustered data to identify characteristics associated with incident NGU.

RESULTS

From August 2014 to July 2018, 307 participants at risk for NGU contributed 109.4 person-years. Median age was 32 years, and 52% were White. At enrollment, 107 men had NGU; of these, 88% were symptomatic, 27% had CT, and 22% had MG. Fifty men had 60 cases of incident NGU (incidence rate, 56 per 100 person-years; 95% confidence interval, 43-74). Unlike prevalent NGU at enrollment, CT/MG-associated incident NGU was rare (incidence rate, 7; 95% confidence interval [CI], 4-15), and most (78%) incident NGU was asymptomatic. Risk factors for incident NGU were ≤ high school education (adjusted rate ratio [ARR], 2.45; 95% CI, 1.19-5.00), history of CT (ARR, 2.15; 95% CI, 1.08-4.27), history of NGU (ARR, 2.67; 95% CI, 1.27-5.62), and NGU at enrollment (ARR, 2.03; 95% CI, 1.04-3.98). Neither condom use nor having a new partner was associated with incident NGU; Black race was only associated with incident symptomatic and non-CT/non-MG NGU.

CONCLUSIONS

Incidence of NGU was high, predominantly non-CT/non-MG and asymptomatic. Future studies should investigate the etiology and clinical significance of asymptomatic NGU.

[Adolescents and teachers´ knowledge, attitude and practice towards contraception: results from a qualitative study conducted in the Democratic Republic of the Congo]

Introduction

the purpose of this study was to assess adolescents and teachers´ knowledge, attitude and practices towards family planning (FP).

Methods

in 2018, a qualitative study was conducted among seven teachers and 62 teenagers aged 15-19 years based on the Theory of Reasoned Action published by Fishbein and Ajzen in 2011. Data were collected from six focus group (FG) with adolescents and seven semi-structured interviews of teachers. They were analyzed using Atlas Ti software on the basis of a deductive approach.

Results

periodic abstinence, male condoms and pills were the only contraceptive methods reported. Adolescents and teachers were apprehensive about using artificial contraceptive methods other than irregularly used male condom. Girls prefer natural methods fearing side effects. The majority of adolescents wanted to be informed about FP in school; however, they felt that the content of the Life Education Course (EVIE) was insufficient and that teachers lacked of openness. Peers, brothers, sisters and internet were the main sources of information. Mothers were an important source of information especially for girls, unlike fathers who were generally less appreciated.

Conclusion

knowledge about FP is weak. Misconceptions about contraception lead to the use of ineffective practices to prevent unintended pregnancies. Training programs to improve teachers´ knowledge should be developed and the content of the EVIE course should be formalized and regulated.

Association between number of sexual partners and utilization of family planning and sexually transmitted infection services by men aged 15-44 in the United States

Unintended pregnancy and sexually transmitted infections (STIs) pose a huge public health problem in the United States. Efforts towards reducing unintended pregnancies have previously focused on women, but the role of men in family planning and preventing unwanted pregnancy is becoming clearer. The primary objective of the study was to fully examine the utilization of family planning services by men in the US, and to determine whether factors such as race, health insurance type and number of sexual partners influenced their utilization and receipt of family planning services and STI-related health services. Data were from the 2006-2010 National Survey on Family Growth (NSFG) study conducted in the US. The study sample comprised 7686 men aged 14-44 who ever had sex with women, and who had had at least one sexual partner in the 12 months before the survey. The receipt of family planning and STI-related health services by this group of men was estimated. The results showed that non-Hispanic Black men were more likely to receive family planning and STI-related services than Hispanic and non-Hispanic White males. Given that non-Hispanic Black men are disproportionately affected by STIs and are a high-risk group, the finding that this group received more family planning and STI services is a positive step towards reducing the disproportionately high prevalence of STIs in men in this under-privileged population.

Major Depressive Disorder and Condom Use in Young Adult Females

Major Depressive Disorder (MDD) is a leading cause of disability and can contribute to risky sexual behavior, potentially leading to Sexually Transmitted Infections (STIs).Young adult women face unique STI risks, along with gender prevalence for MDD.

Aim

The aim of this study is to assess the association between moderate to severe MDD and inconsistent condom use in U.S women aged 18-25.

Methods

We examined National Health and Nutrition Examination Survey (NHANES) data from 2011-2013 Our study focuses on responses to the depression screener and "sexual behavior" questions.

Results

A total of 302 women, aged 18-25 responded to the depression screener and the "never had sex without a condom question". Of these , 270 had no or mild MDD and 32 had moderate to severe MDD Of the women with moderate-severe MDD, 1 consistently used condoms, and 31 used condoms inconsistently. On both bivariate and multivariate analysis this association between moderate-severe MDD and inconsistent condom use was significant (p = .004, OR 10.260 95% Cl 1-371- 76.801 ) After using the complex samples module, this association remained significant, even after controlling for race (p = 0_032; OR = 7_677, 95% Cl = 1202-49.048).

Conclusion

Moderate-severe MDD is significantly associated with inconsistent condom use in 18-25 year-old women. This suggests a need for further research and interventions geared toward treating MDD, but also in counseling young adult women with MDD regarding healthy sexual behaviors.