Sex History Doesn't Always Match STD Status

A new study finds significant discrepancy between young people's self-reported sexual experience and their STD status, potentially suggesting changes in how this population is screened for the infections.

Jessica McDermott Sales, PhD, of Emory University, and colleagues examined wave three of the National Longitudinal Study of Adolescent Health, which occurred in 2002, limiting their analysis to 14,012 young adults (mean age 22) who completed an audio computer-assisted survey and provided a urine sample for STD testing. NLSAH began in 1994 when the participants were in grades seven through 12.

Nucleic acid amplification testing was used to detect the presence of chlamydia, gonorrhea, and trichomoniasis. Of participants, 79.7 percent reported having had sex in the previous year, and 6 percent tested positive for one of the STDs. Among those with a positive test, 10.5 percent reported being sexually abstinent in the past year, with half of those reporting never having had penile/vaginal contact.

The study's limitations included the absence of a baseline measure of STD status, the use of only urine samples, the possibility of false-positives and false-negatives in testing, and the chance of recall bias. "Singly, or more likely, a combination of limitations may partly account for the observed discrepancy between young adults' positive STD status and self-reported abstinence," the team noted.

According to the study, "Acquiring an STD is not only a function of unprotected sexual intercourse, but also reflects the prevalence of STDs in young adults' sociosexual network, risk of sex partners (i.e., currency), and frequency and proficiency of correct condom use."

"From a clinical standpoint, the discrepancies between STD positivity and self-reported sexual behavior observed in this nationally representative sample suggest that routine STD screening may be beneficial and necessary to reduce STD morbidity among young adults," said the researchers.

"Our findings reveal that if pediatricians and adolescent medicine physicians do not test all young people, there are likely a substantial number of missed cases of STDs that will go undiagnosed, untreated, and spread to future sex partners," Sales and colleagues concluded.

The study, "Association Between Sexually Transmitted Diseases and Young Adults' Self-Reported Abstinence," was published early online in Pediatrics (2011;doi:10.1542/peds.2009-0892).