The Relationship Between Knowledge And Perception Of Young People With The Spread Of Sexually Transmitted Infections

Statistics Regarding the Spread of Sexually Transmitted Infections

Perception can be defined as something detected by the five senses of human or a state of conscious understanding of something. Knowledge is an awareness of a specific factor a condition. The knowledge can as well be defined as a state of having been informed or made aware of something. The researcher was interested to know the cause of an increase of sexually transmitted infections among the young generation (Jones et al 2014).  The statics provided by united nations and Aids showed that about one million young people transmit STDs in each and every year,

By the end of research, the researcher expects to know why sexually transmitted diseases are spread at the high rate, by investigating the knowledge and perception of young people in relation to STDs.The information collected from this research can be used by social health organization and public health in countering the diseases. The healthy educators can as well use the information to create awareness to young people (Alexander et al 2018).

The data collection was done by filling of a short questionnaire in one of the clinics in Washington DC and another in Maryland. Sexually transmitted diseases today are spreading at the high rate because many people are getting more sexually agile especially among young people (Carter et al 2014).  The other cause is the practice of sex with more than one partner among the married people. In the quantitative methodology, patients in one of the in clinics were given a questionnaire with 10 simple question to test their knowledge on STIs. In qualitative methodology, the same patients were to answer a single simple question inform of an essay on their perception and attitudes towards STIs (Drainoni et al 2014).

Sexually transmitted diseases are one of the major problems that have affected many youths globally. This has been contributed to by the insufficient knowledge the young people have about the STDs. Young adults have a common ignorance and disbelieve about the dangers and consequences of sexually transmitted infections (Llata et al 2014).  The problem comes because these sexually transmitted infections (STIs) have comparable symptoms and that makes them difficult to notice (Muzny et al 2014). The signs and symptoms rarely do appear to an infected person, so it is easy to spread the disease without knowing if one is infected with the disease. Another factor that has contributed to the spread of the diseases is the insufficient medical institutions that offer the STIs tests. Private medical institutions are expensive and this limits youth’s interest for tests.  Adequate understanding of STIs to the youths is still low in both developing and developed countries. All other STIs create a high prevalence of contracting HIV/AID, because of their predisposed sex organs due to damage caused by other sexually transmitted diseases.  All STIs are transmitted through either virginal, anal or oral sex. About 60% to 80% of youth who have knowledge of HIV/AIDS have inadequate knowledge about other sexually transmitted diseases (Oster et al 2014).  

According to recent reports Centers for Disease Control and Prevention. (2015) the survey, about 20 million STDs occur in the United States. More than 498 million cases of STDs occur worldwide every year. The involved population that shown better understanding of STIs said they have acquired knowledge about STIs through media, internet, television, brochures and education through public awareness. Casual sex workers have been known to be the most rated group that spread the STIs at a higher rate. These are the workers that use seductive sexy behaviour for money (Liu et al 2015).  Long distance travellers are known to engage in such activities hence about 20% of the spread of these STIs are through casual sex activities. Unprotected sex has remained at the top of the ways of spreading the STIs (Flagg et al 2015).  In some African countries like Nigeria, cultural and religious activities have greatly influenced the mass education of young people about STDs. Islamic religion in Nigeria, it’s a taboo talking about sex with young people. A survey carried out in Albania in the year 2002 showed that large percentage of men had insufficient knowledge on STIs than women (O’Leary et al 2015).  Among the religious background of the young people, the study showed that youth from Islamic religion had poorer knowledge about STIs as compared to youth from (Christians et al 2014).

Factors Contributing to the Spread of Sexually Transmitted Infections

These studies showed that generally there is a lot to be done on the young generations towards educating them about sexually transmitted diseases. Among the infections involved in the study include; gonorrhoea, syphilis, human papillomavirus, genital herpes, chlamydia and HIV/AIDS (Moodley et al 2015).  

Gonorrhea

 Gonorrhoea is a sexually transmitted disease that has been found to affect many of the youth across the world. The causative agent of gonorrhoea is Bacterium gonorrhoea (Park et al 2015).  Many symptoms of this disease are not displayed in majority of the people who have the infection. Though a few symptoms appear. For instance, in women, there is vaginal discharge and lower abdominal pain (Workowski & Bolan,2015).  Men do experience pain during sexual intercourse due to the penile urethra, pain while urinating and penis discharge. In both men and women, one can acquire throat gonorrhoea if he/she practices oral sex with an infected person. The symptoms of throat gonorrhoea are very rare in some cases (Llata et al 2015).  The most common symptom that may appear is a sore in the throat. About 90% of the infected people do not show symptoms. Tiredness and bacterial allergic reaction are among the advanced symptoms of gonorrhoea. The incubation period of gonorrhoea is 2 to 14 days and most symptoms are experienced between 4 and 6 days from the day of infection. These symptoms may appear on the skin as lesions, pain and swelling of joints as the disease travels through the bloodstream. This disease can go deeper and if not treated early may develop to prostate cancer. There is re-infection whereby somebody who is infected comes into sexual contact with another infected person. Due to lack of outer or displayed symptoms, an infected person may infect others repeatedly without his/her knowledge. The percentage risk of a man getting infected after having sex with an infected woman is 20% while that of a woman getting infected after having sex with the infected man is 60% to 80%. This percentage is prone to the young people (Bollerup et al 2016).

The diagnosis of this disease should be taken from samples of vaginal discharge, urine or urethral fluids for screening and testing of the infection. The polymerase chain reaction (PCR) is used to identify the specific gene of species Neisseria gonorrhoea. People who test positive for gonorrhoea are most likely to contract other sexually transmitted diseases (STSs) such as chlamydia syphilis and human papillomavirus (Davey et al 2016).  Recent researchers have shown that 46% to 50% of young people who have chlamydia are likely to have gonorrhoea. The risk of contracting gonorrhoea has a high preference for women of 25 years and below. Men who have sex with other men have high chances of contracting gonorrhoea. Many youths have the ignorance of using condoms during sexual intercourse and this has contributed to the high rate of the spread of the disease. Many of these young men and women include those who have sex for money and those who have sex under influence of drugs like alcohol (Friedman et al 2016). These immoral behaviours are prone to young and middle-aged people. Another factor that has contributed to the spread of the disease is shyness and fear of embarrassment among the youth age-group. To cover this issue of stigmatization in the societies, a need of more education on morals, risk, consequences and the importance of having the test and knowing one’s status is the best ways of fighting these sexually transmitted diseases (Hogben et al 2016).

Specific Types of Sexually Transmitted Infections

Genital herpes

Genital herpes is one of the sexually transmitted diseases that is caused by two types of viruses. These two types of viruses are; herpes simplex virus (HSV-1) type1, herpes simplex virus (HSV-2) type 2. The symptoms of this disease are very rare and this enhances high chances of spreading the infection. HSV-1 causes oral herpes and the symptoms may appear in the mouth as blisters and cold sores. Most people with oral herpes are likely to have the infection with at their childhood age and early adulthood probably from non-sexual fluid contact like saliva. The relationship between genital and oral herpes is HSV-1 can be transmitted from the mouth to the genitals through oral sex. Genital herpes is very common in the United States especially Washington state whereby out of six people more than one among those aged 15 to 50 years are infected (Jordan,2016).

 This disease is spread from one person to another through anal, vaginal or oral sex organs and contact with an infected person. For the contact to be effective, there should be a predisposed due to some sore in genitals, through the saliva or through the skin of an infected person. Contact with objects like towels, silverware, soaps or sharing toilet seats, swimming pools or bedclothes one cannot get infected with genital herpes. The most probable way in which a child can get infected with genital herpes is during delivery. This is dangerous to the baby as it may cause a fatal infection. Pregnant mothers are given antibiotics in hospitals once discovered to have genital herpes to save the baby from contracting the disease.  It is important for pregnant mothers to attend clinics and request for genital herpes test since dangers that genital herpes may cause to the infant can result in miscarriages (Krieger et al 2016).

Some of the signs and symptoms of STIs are mild and general hence not easy for someone to know which is which unless a test is done by a qualified medical officer. Symptoms of genital herpes include; fever, glands swell up and body pain. The outbreak of the symptoms at the second time is short and not as severe as those of the first time of infection. The disease can stay in your body throughout your life. It has no cure but there is medicine for prevention or for shortening the outbreaks. The young generation of youth and middle-aged should be educated on dangers of having unprotected sex to avoid the random spread of this infection. This disease is severe to the people of compromised immune systems. The infected with this disease should be aware they are more predisposed to HIV/AIDS infection and both have no permanent cure (Ward et al 2016).         

Gonorrhoea Symptoms and Diagnosis

Syphilis

Syphilis is a sexually transmitted infection.it is caused by a bacterium called Treponema palladium. There are four stages in which their signs and symptoms vary. They include primary, secondary, latent and tertiary stages. Though the disease is transmitted through sex, it can be transmitted from the mother to the baby during birth or during pregnancy. This is called congenital syphilis (Dean et al 2017).

The first sign of syphilis is some painless sores called chancre that appear on the genital organs or the mouth.  One may be infected with syphilis for years without showing any signs and symptoms. If untreated for long it can cause damage to somebody organs like the brain and the heart.it is spread through direct contact with the syphilis chancres. The primary stage occurs 3-4 weeks after the infection. It begins with a small painless sore that appears where the syphilis bacteria got into contact with the body e.g. rectum, genitals or the mouth.

During the second stage, sore throat and skin rashes may develop. The rashes are mostly found in the soles of the feet and the palms of the hands but they may appear anywhere in the body. These rashes normally don’t itch. During the secondary stage, an individual may also experience headaches, fatigue, fever, swollen lymph nodes, hair loss etc. As time goes on these symptoms disappear with or without treatment though the disease still remains present in the body (Duncan et al 2017).  

Latent stage is the third stage of syphilis.it is also called the hidden stage. Both the primary and secondary symptoms disappear and there are no more noticeable symptoms at this stage though the bacteria is still in the body. Latent stage can last for months or even years before the infection develops to the tertiary stage.

The last stage of syphilis infection is the tertiary stage.it occurs years after contracting the infection. Tertiary syphilis can easily cause death, deafness, memory loss, blindness, heart disease, mental illness and neurosyphilis which affects the brain or the spinal cord. In the year 2015, approximately 45.4 million people had syphilis infection around the globe. Six million of these were the newly reported cases .in the same year syphilis caused an around of 107000 deaths.

A study conducted in china involving 3470 participants revealed that college students were less aware of syphilis infection. The college students had very little knowledge of syphilis compared to all other groups that took part in the study the study also revealed that the young female participant with small levels of education had very little knowledge about syphilis. Lack of knowledge of the infection has in a very great way influenced the rate at which the disease has been spreading among the young people (Kreise et al 2017).

Genital Herpes Symptoms and Diagnosis

HIV/AIDS

HIV stands for human immunodeficiency virus. it causes AIDS which stands for acquired immunodeficiency syndrome. The virus affects the immune system by destroying the white blood cells which fight any infection that tries to get into the body. This makes people vulnerable to diseases and infections. HIV attacks all the tissues in the body.it is found and transmitted through the body fluids of an infected person. (Blood, virginal fluids, semen etc.) It can also be transmitted from the mother to child through breastfeeding or during childbirth.

Some people who are infected with HIV do not show symptoms for some time until after a couple of months or years. After the initial infection, the early symptoms of the HIV infection may include joint pain, muscle aches, sore throat, chills fever, enlarged glands, general body weakness, tiredness etc.in most cases these symptoms appear when the body is dealing with different types of viruses and infections. After the disappearance of the initial symptoms, there may not be any other symptoms for a number of years. At this time the virus continues to increase and damage the body organ and the entire immune system (Pathela et al 2015). In case HIV is left untreated, it destabilizes the ability of the body to fight infection. This is called the stage 3 HIV or AIDS stage. The symptoms of this stage include persistent diarrhoea, blurred vision, night sweats, dyspnea, and permanent tiredness, rapid weight loss, spots on the tongue or mouth.

AIDS is treated by blood tests which show the presence of HIV in the body. HIV is incurable and with no vaccines against it but medical practitioners have had great advancements in its treatment. The development of antiretroviral drugs that control the development of the virus hence delaying the aids stages. This helps people with HIV to be free of many symptoms for a prolonged period. Another advancement is the invention of drugs that lower the risk of HIV transmission from an infected mother to a baby.

A study in China by Manchester indicated that more than 93%of the city residents and over 83%of the people residing in small towns had heard about HIV/AIDS.62%of the residents in small towns as compared to 73%of city residents were knowledgeable of the main ways of transmission .i.e. body fluids, sex and blood.only23%of the small town residents and 31%of the city residents felt that condoms can protect them from HIV infection.27%of men compared to 19%of women felt the need of using the condom as a protective measure. There was a positive attitude towards spending time and money in order to acquire more information and knowledge about HIV/AIDS. Though there is high awareness of the disease, residents of the town with high salaries were actually less knowledgeable on protective measures as compared to those with little monthly salaries. Very few people were willing and ready to change their risky sexual behaviours. A good percentage of the participants confessed to having sex with no condoms and have a number of sex partners. Many of them also believed that maintaining one sex partner was safe compared to using condoms to protect themselves from HIV/AIDS. Most of them had a very positive attitude towards keeping one sex partner (Kortekangas et al 2014).

Syphilis Symptoms and Diagnosis

Chlamydia

Chlamydia is a common sexually transmitted disease whose causative agent is Chlamydia trichromats. Chlamydia has no exposed symptoms. Some of the mild symptoms may take a few weeks before they start appearing. These symptoms start to show on your body at late stages when the disease is severe. In women, the symptoms include, discharge from the vagina and pain while urinating. In men, there is swelling of testicles, pain while urinating and discharge from the penis. If not treated at the early stages, chlamydia may result in fatal complications like pelvic inflammatory and trachoma that cause blindness.

The diagnosis of this disease is done through the collection of samples from vaginal, urethral discharge, urine or fluid from the cervix for testing. Chlamydia is transmitted from one person to another through oral, vaginal, and anal sex.  It can also be transmitted from mother to child during delivery. In some areas of low hygiene, the eye infection is spread through personal contact with an infected person or by flies. The screening and diagnosis of the disease are recommended at early stages for the sexually active youth. If one is infected he/she should quit sex activities for at least seven days. Around 70% to 80% cases of women infected with chlamydia, may not manifest any symptoms for several months or even years. Approximately 50% of men infected with chlamydia do show the symptoms. Further, severe complications in men result in epididymitis that causes sterility. The world health organization (WHO) has contributed a lot to ensure elimination of trachoma that causes the eye infection. In young men, the disease may result in the triad of arthritis, urethra inflammation and conjunctivitis (Stephens et al 2014).  

Many youths have the negative attitude towards STIs tests. Some have fears of their friends knowing their chlamydia status. Other young adults avoid sites involving such tests due to fear of their relationship breakages. Some youth feel embarrassed to go for STDs test. There is the need for motivation and encouragements to the youth to go for STIs testing to know their status. They should be taught about benefits good health. The young men and women should be educated on the dangers of living with the sexually transmitted disease so that they may acquire interest towards knowing their status. Stigmatization should be avoided in the society. If stigmatization cases cease in the society and motivation increased, the number of volunteer youths taking the STIs test will improve. Tutors and lectures should also be encouraged to educate the youths, especially in the learning institution the need for taking precautions. These activities will give a relevant way of eliminating and minimizing the cases sexually transmitted disease (Alexander et al 2018).

Human papillomavirus

The disease is common in the United State of America. Human papillomavirus (HPV) infection is a sexually transmitted disease that has been noted to have infected about 76 million Americans in late teens and early 20s. HPV is of several different types of viruses. These viruses have been found to cause fatal complications in the human health such as cancers and genital warts.

Engaging in unprotected sex either oral, anal and vaginal sex with an infected person is the main way of spreading the disease. Once one has been infected, symptoms can take years to develop. HPV condition in the body causes serial problems like genital warts around the genital area. Diagnosis of warts can be done by observing the genital area. HPV condition can become worse to an extent of causing cancers to several parts and organs of the body; cervical, vulva, vagina, penis, anus, throat and also at the base of the tongue and tonsils. There exists a specialization in the viruses of HPV. The virus that causes genital warts or human papillomavirus is not responsible for causing HIV/AIDS. People with compromised immune systems are more prone to HPV. These people include those living with HIV/AIDS whose health is weak (Chernesky et al 2017).

There is a vaccine that is safe and effective to protect one from HPV. Young men and women should be vaccinated to protect them from this disease. It has been found that many youths at active sex stage try to avoid places that involve education or testing of STDs. This is probably due to stigma among their fellow youth. Some of the young adults who get tested and turns positive have self-denial and assume the result. It is the role of the senior adults in the community to show the youth the importance having self-drive and also self-respect so as to improve and maintain their good health status. There is need to create awareness to the young adult about the risk of all sexually transmitted infections in order to maintain the health and to control the spread of the disease. Frequent encouragement and showing the youths the fatal effects that are associated with these sexually transmitted infections is a key in trying to reduce the rate of transmission among them (Schechter et al 2017).

The aim and objective of the study

The main objective of this study was to investigate the knowledge of young people aged 17-30 years about sexually transmitted infections and research on their perceptions towards sexually transmitted infections.

Thesis questions

1.What knowledge based on young people aged 17-30 years have about sexually transmitted infections?

1. What perceptions do young people age 17-30 have about sexually transmitted infections?

The research was conducted using both qualitative and quantitative methods of research in one of the clinics in Washington DC. In the quantitative method of study, the researchers used questionnaires to get the information and knowledge about sexually transmitted infections from the participants. The questionnaires provided privacy and the best environment to the participants to give authentic answers. A total of 10 questions were prepared in questionnaires and issued to the patients who visited the clinic. The participants aged between 17 to 30 years. They were required not include their names in the questionnaires but gave their age and sex. After all the participants had filled the questionnaires and summary of their answers recorded, the questionnaires were then destroyed. In order to understand the whole data in the quantitative analysis, the data was broken down into small portions. The data collected was then quantified through numerical figures. The questionnaires contained closed questions of ‘yes or no’ answers. The number of participants that had given particular answers to different questions was tabulated in table A. this eased the analysis of data collected through the questionnaires (Barbee et al 2014).  

Qualitative method is majorly focused on the opinions of the participants and their interpretations, meaning and their perceptions to a certain setting. The researcher’s interest is to get an honest overview of the subject under study. The main objective of using the qualitative method in the study was to understand the knowledge of the participants through surveying their altitudes on different sexually transmitted diseases. One essay question was used to allow the individuals express their views and perception towards different sexually transmitted infections. This research technique was to objectively evaluate the descriptions of the content by participants. The concept altitudes and the views of the participants manifested in a great way the aim of the research. After all the data was gathered from the participants the researchers sat down discussed it in details. In case something was not clear they had to agree on the best to approach it. The researchers then came up with one point of view that helped them analyze the data (Bolan et al 2015).

According to the data collected from the informant group, all the participants agreed that sexually transmitted diseases could be spread through vaginal, oral and anal sex. The main way of transmitting STIs is through having unprotected sex. More than 80% of the participants had the correct information about different STIs. A larger percentage of the participants shown a good understanding of diseases like HIV/AIDS, Chlamydia and Gonorrhea compared to diseases like Human papillomavirus and genital herpes. Most of the participants had a lot of information about HIV/AIDS than any other infection .out of the fifty youths interviewed, twelve of them confessed to being HIV/AIDS positive. Seven were found to have been infected with other STDs at one point in their lives. More than twenty percent of the participants had friends or relatives who ever suffered at least one of the STDs (Friedman et al 2014).

The researchers also wanted to know how active the youths were sexual. An average of eighty-one percent confessed to being active and had more than one sexual partner. A good number of them suggested keeping one sexual partner as the best way to be saved. The males seemed to embrace the idea of condom compared to the female participants. Three of the participants were against the idea of using the condom on the bases of religion while the rest were very positive about it. Use of condoms, abstinence, keeping one sexual partner were the most discussed preventive measures.

 In the recent years, the rate of STIs transmission among the youths has increased rapidly. Though people may like to associate this increase with lack of knowledge, our research revealed that young people have a lot of information and knowledge about different STIs. Most of the participants were aware of different methods of transmission as well as different preventive measures that can be used to avoid contracting the infections (Newman et al 2015).  

According to the collected data, most of the young people both male and female are much informed about HIV/AIDS than any other STI infection. Majority of those involved in the research suggested the use of condom as the best and most convenient preventive method. The results contradict those of a research done in China, where most of the participants thought keeping one sexual partner is the best method to prevent HIV and other STD infections. The attitude of youth towards different STIs also plays a big role in reducing the rate of their spread. A good percentage of the participant showed a positive attitude towards having the knowledge on STIs compared to the few who had a negative attitude. This positive attitude suggests that a large number of young people have a good understanding of the STIs.

The informants revealed to have gained a lot of knowledge on STDs through education. They suggested that education on STDs be introduced in the syllabus to allow the youth get knowledge on different diseases as well as know the best preventive methods. According to them, education is the best way to create awareness to the youth at an early stage. Through education, the youth are able to meet experienced personnel like teachers, doctors and senior counsellors on the matters of youth and health. The media can also be well utilized as a way of informing the general public about the causes, symptoms effects and prevention of different STIs (Ling et al 2015).  

STRENGTHS AND LIMITATIONS

The management of the two clinics allowing us to conduct our research on their premises was a big boost for us. The youth turned out in both clinics was a good start and an encouragement to go on with the research. There was a good cooperation between the clinicians and the patients who participated in the research. This is because the filling of the questionnaires was voluntary since the clinicians did not force anybody to fill them. Most the youths who filled the questionnaires had relatives or friends who were ever infected with an STI making it easier for them to fill the details.

 The research was not without soma challenges and shortcomings. Some of the participants failed to give some answers either because they lacked the correct information or out of ignorance. There were a few cases of exaggerated information from some of the participants while some answered out of knowledge about some diseases. Some gave the general information they had about a certain disease to apply to all other STIs. The clinicians had a challenge of convincing some of the patients to assist in filling the questionnaires and some refused to give different reasons.

Conclusion

The knowledge of sexually transmitted disease among the youths has been lightly researched. The phenomena of STDs have been based mainly on HIV/AIDS and fewer studies on other STDs which put more danger to the youths. Much of research has been done on the young adult than early adolescence. A good number of researchers have concluded that promoting more education to the young people on STIs will give more positive health results in their later adulthood. Social and culture education was used to examine whether the demographic values influence and determine the STDs among the youths. Age was found to play an important role in understanding STDs. The research shows that more emphasis is to evaluate the importance of delivering more knowledge on other STIs as in HIV/AIDS. In order to achieve good health and low cases of STIs, much cooperation and efforts are required to improve STI education to the youths. The education about STDs should be taught to the youths from early adolescent to their young adulthood. If this is done in a proper manner within institutions of learning, it can have the great impact in helping reduce the spread of different STDs.

References

Barbee, L. A., Dombrowski, J. C., Kerani, R., & Golden, M. R. (2014). Effect of nucleic acid amplification testing on detection of extragenital gonorrhea and chlamydial infections in men who have sex with men sexually transmitted disease clinic patients. Sexually transmitted diseases, 41(3), 168-172.

Chesson, H. W., Dunne, E. F., Hariri, S., & Markowitz, L. E. (2014). The estimated lifetime probability of acquiring human papillomavirus in the United States. Sexually transmitted diseases, 41(11), 660-664.

Carter Jr, J. W., Hart-Cooper, G. D., Butler, M. O., Workowski, K. A., & Hoover, K. W. (2014). Provider barriers prevent recommended sexually transmitted disease screening of HIV-infected men who have sex with men. Sexually transmitted diseases, 41(2), 137-142.

Drainoni, M. L., Sullivan, M., Sequeira, S., Bacic, J., & Hsu, K. (2014). Health reform and shifts in funding for sexually transmitted infection services. Sexually transmitted diseases, 41(7), 455-460.

Friedman, A. L., Brookmeyer, K. A., Kachur, R. E., Ford, J., Hogben, M., Habel, M. A., … & McFarlane, M. (2014). An assessment of the GYT: Get Yourself Tested campaign: An integrated approach to sexually transmitted disease prevention communication. Sexually transmitted diseases, 41(3), 151-157.

Jones, K., Eathington, P., Baldwin, K., & Sipsma, H. (2014). The impact of health education transmitted via social media or text messaging on adolescent and young adult risky sexual behavior: a systematic review of the literature. Sexually transmitted diseases, 41(7), 413-419.

Kortekangas-Savolainen, O., Orhanen, E., Puodinketo, T., & Vuorinen, T. (2014). Epidemiology of genital herpes simplex virus type 1 and 2 infections in southwestern Finland during a 10-year period (2003–2012). Sexually transmitted diseases, 41(4), 268-271.

Llata, E., Stenger, M., Bernstein, K., Guerry, S., Kerani, R., Pugsley, R., … & SSuN GW Working Group. (2014). Prevalence of genital warts among sexually transmitted disease clinic patients—Sexually Transmitted Disease Surveillance Network, United States, January 2010 to December 2011. Sexually transmitted diseases, 41(2), 89-93.

Muzny, C. A., Austin, E. L., Harbison, H. S., & Hook III, E. W. (2014). Sexual partnership characteristics of African American women who have sex with women; impact on sexually transmitted infection risk. Sexually transmitted diseases, 41(10), 611-617.

Oster, A. M., Sternberg, M., Nebenzahl, S., Broz, D., Xu, F., Hariri, S., … & Paz-Bailey, G. (2014). Prevalence of HIV, sexually transmitted infections, and viral hepatitis by Urbanicity, among men who have sex with men, injection drug users, and heterosexuals in the United States. Sexually transmitted diseases, 41(4), 272-279.

Silver, B. J., Guy, R. J., Kaldor, J. M., Jamil, M. S., & Rumbold, A. R. (2014). Trichomonas vaginalis as a cause of perinatal morbidity: a systematic review and meta-analysis. Sexually transmitted diseases, 41(6), 369-376.

Stephens, S. C., Cohen, S. E., Philip, S. S., & Bernstein, K. T. (2014). Insurance among patients seeking care at a municipal sexually transmitted disease clinic: implications for health care reform in the United States. Sexually transmitted diseases, 41(4), 227-232.

Bolan, R. K., Beymer, M. R., Weiss, R. E., Flynn, R. P., Leibowitz, A. A., & Klausner, J. D. (2015). Doxycycline Prophylaxis to Reduce Incident Syphilis among HIV-Infected Men who have Sex with Men Who Continue to Engage in High Risk Sex: A Randomized, Controlled Pilot Study. Sexually transmitted diseases, 42(2), 98.

Centers for Disease Control and Prevention. (2015). Sexually transmitted diseases treatment guidelines, 2015. Annals of Emergency Medicine, 66(5), 526-528.

Flagg, E. W., Weinstock, H. S., Frazier, E. L., Valverde, E. E., Heffelfinger, J. D., & Skarbinski, J. (2015). Bacterial sexually transmitted infections among HIV-infected patients in the United States: estimates from the Medical Monitoring Project. Sexually transmitted diseases, 42(4), 171-179.

Ling, D. I., Janjua, N. Z., Wong, S., Krajden, M., Hoang, L., Morshed, M., … & Ogilvie, G. (2015). Sexually transmitted infection trends among gay or bisexual men from a clinic-based sentinel surveillance system in British Columbia, Canada. Sexually transmitted diseases, 42(3), 153-159.

Liu, G., Hariri, S., Bradley, H., Gottlieb, S. L., Leichliter, J. S., & Markowitz, L. E. (2015). Trends and patterns of sexual behaviors among adolescents and adults aged 14 to 59 years, United States. Sexually transmitted diseases, 42(1), 20-26.

Moodley, D., Moodley, P., Sebitloane, M., Soowamber, D., McNaughton-Reyes, H. L., Groves, A. K., & Maman, S. (2015). High prevalence and incidence of asymptomatic sexually transmitted infections during pregnancy and postdelivery in KwaZulu Natal, South Africa. Sexually transmitted diseases, 42(1), 43-47.

O’Leary, A., Jemmott III, J. B., Jemmott, L. S., Teitelman, A., Heeren, G. A., Ngwane, Z., … & Lewis, D. A. (2015). Associations between psychosocial factors and incidence of sexually transmitted disease among South African adolescents. Sexually transmitted diseases, 42(3), 135.

Pathela, P., Klingler, E. J., Guerry, S. L., Bernstein, K. T., Kerani, R. P., Llata, L., … & SSuN Working Group. (2015). Sexually transmitted infection clinics as safety net providers: Exploring the role of categorical sexually transmitted infection clinics in an era of health care reform. Sexually transmitted diseases, 42(5), 286-293.

Park, I. U., Introcaso, C., & Dunne, E. F. (2015). Human papillomavirus and genital warts: a review of the evidence for the 2015 centers for disease control and prevention sexually transmitted diseases treatment guidelines. Clinical Infectious Diseases, 61(suppl_8), S849-S855.

Llata, E., Bernstein, K. T., Kerani, R. P., Pathela, P., Schwebke, J. R., Schumacher, C., … & Weinstock, H. S. (2015). Management of pelvic inflammatory disease in selected US sexually transmitted disease clinics: Sexually Transmitted Disease Surveillance Network, January 2010–December 2011. Sexually transmitted diseases, 42(8), 429-433.

Newman, L., Rowley, J., Vander Hoorn, S., Wijesooriya, N. S., Unemo, M., Low, N., … & Temmerman, M. (2015). Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PloS one, 10(12), e0143304.

Workowski, K. A., & Bolan, G. A. (2015). Sexually transmitted diseases treatment guidelines, 2015. MMWR Recommendations and Reports, 64(3), 1-137.

Bollerup, S., Baldur-Felskov, B., Blomberg, M., Baandrup, L., Dehlendorff, C., & Kjaer, S. K. (2016). Significant reduction in the incidence of genital warts in young men 5 years into the danish human papillomavirus vaccination program for girls and women. Sexually transmitted diseases, 43(4), 238-242.

Davey, D. J., Shull, H. I., Billings, J. D., Wang, D., Adachi, K., & Klausner, J. D. (2016). Prevalence of curable sexually transmitted infections in pregnant women in low-and middle-income countries from 2010 to 2015: a systematic review. Sexually transmitted diseases, 43(7), 450-458.

Friedman, A. L., Kachur, R. E., Noar, S. M., & McFarlane, M. (2016). Health communication and social marketing campaigns for sexually transmitted disease prevention and control: What is the evidence of their effectiveness?. Sexually transmitted diseases, 43(2S), S83-S101.

Hogben, M., Collins, D., Hoots, B., & O’Connor, K. (2016). Partner services in STD prevention programs: a review. Sexually transmitted diseases, 43(0 0 1), S53.

Jordan, J. A. (2016). Sexually transmitted diseases. Molecular Pathology in Clinical Practice: Second Edition.

Krieger, N., Waterman, P. D., Chen, J. T., Soobader, M. J., & Subramanian, S. V. (2016). Monitoring socioeconomic inequalities in sexually transmitted infections, tuberculosis, and violence: geocoding and choice of area-based socioeconomic measures—the public health disparities geocoding project (US). Public health reports.

Ward, J., Wand, H., Bryant, J., Delaney-Thiele, D., Worth, H., Pitts, M., … & Kaldor, J. M. (2016). Prevalence and correlates of a diagnosis of sexually transmitted infection among young Aboriginal and Torres Strait Islander People: A national survey. Sexually transmitted diseases, 43(3), 177-184.

Dean, B. B., Scott, M., Hart, R., Battalora, L., Novak, R. M., Durham, M. D., … & HIV Outpatient Study (HOPS) Investigators. (2017). Sexually Transmitted Disease Testing of Human Immunodeficiency Virus–Infected Men Who Have Sex With Men: Room for Improvement. Sexually transmitted diseases, 44(11), 678-684.

Duncan, M. E., Tibaus, G., Pelzer, A., Mehari, L., Peutherer, J., Young, H., … & Piot, P. (2017). Prevalence and significance of sexually transmitted diseases among Ethiopian women attending antenatal clinics in Addis Ababa. The Ethiopian Journal of Health Development (EJHD), 9(1).

Kreisel, K., Weston, E., Braxton, J., Llata, E., & Torrone, E. (2017). Keeping an Eye on Chlamydia and Gonorrhea Conjunctivitis in Infants in the United States, 2010–2015. Sexually transmitted diseases, 44(6), 356-358.

Schechter, S. B., Romo, D. L., Cohall, A. T., & Neu, N. M. (2017). Approach to Human Immunodeficiency Virus/Sexually Transmitted Infection Testing for Men at an Urban Urgent Care Center. Sexually transmitted diseases, 44(4), 255-259.

Chernesky, M., Jang, D., Smieja, M., Arias, M., Martin, I., Weinbaum, B., & Getman, D. (2017). Urinary meatal swabbing detects more men infected with Mycoplasma genitalium and four other sexually transmitted infections than first catch urine. Sexually transmitted diseases, 44(8), 489-491.

Rhea, S., Seña, A. C., Hilton, A., Hurt, C. B., Wohl, D., & Fleischauer, A. (2018). Integrated Hepatitis C Testing and Linkage to Care at a Local Health Department Sexually Transmitted Disease Clinic: Determining Essential Resources and Evaluating Outcomes. Sexually Transmitted Diseases, 45(4), 229-232.

Alexander, K. A., Perrin, N. A., Butz, A., Perin, J., & Trent, M. (2018). Reproductive Coercion and Childbearing Motivations among Adolescent and Young Adult Women Recently Diagnosed with Pelvic Inflammatory Disease. Journal of Adolescent Health, 62(2), S82-S83.

Francis, S. C., Mthiyane, T. N., Baisley, K., Mchunu, S. L., Ferguson, J. B., Smit, T., … & Seeley, J. (2018). Prevalence of sexually transmitted infections among young people in South Africa: A nested survey in a health and demographic surveillance site. PLoS medicine, 15(2), e1002512.

Pinto, C. N., Dorn, L. D., Chinchilli, V. M., & Du, P. (2018). Chlamydia and gonorrhea acquisition among adolescents and young adults in Pennsylvania: A rural and urban comparison. Sexually transmitted diseases, 45(2), 99-102