P1-S5.22 Gender differences in behavioural correlates of biologically-confirmed sexually transmitted infections
Authors: Berger A , Khan M 
Published: July 2011

BackgroundSince sexually transmitted infection (STI) testing may not be feasible in all clinical and research settings, clinicians and researchers rely on self-reported sexual risk behaviours to serve as indicators of STI. The reported behaviours that are the strongest indicators of infection may differ for men and women.MethodsUsing Wave III (2001–2002, young adulthood) of the National Longitudinal Study of Adolescent Health, we conducted analyses among white, black, and Hispanic participants (N=7185) to estimate gender-specific age-, race-, and poverty-adjusted associations between biologically-confirmed STI (gonorrhoea, chlamydia, and trichomoniasis) and indicators of sexual risk behaviour including young age of sexual initiation (less than 16 years), multiple (two or more) partnerships in the past year, lifetime number of partners, failure to use a condom at the most recent sex act, report of sex in the past year with an STI-infected partner, sex trade defined as paying or getting paid for sex, and report of past year diagnosis with gonorrhoea, chlamydia, and trichomoniasis, syphilis, herpes simplex virus, or HIV. We tested the significance and, when identified, report gender-specific race differences in the associations between sexual risk behaviour and STI.ResultsOverall, most sexual risk behaviours were not good indicators of biologically confirmed STI. Identified correlates of infection differed for men and women. Among men, STI was associated with young age at first sex (adjusted OR 1.96, 95% CI 1.27 to 3.01) and failure to use a condom at the most recent sex act (adjusted OR: 1.84, 95% CI 1.12 to 3.01), though these indicators were not associated with STI among women. Among women, STI was moderately associated with multiple partnerships (adjusted OR: 1.64, 95% CI 1.18 to 2.72) and lifetime number of partners (adjusted OR: 1.03, 95% CI 1.01 to 1.06), though these were not STI indicators for men. Among white women only, report of sex with an STI-infected partner was associated with STI (adjusted OR: 2.22, 95% CI 1.03 to 4.74). Indicators of sex trade and self-reported STI were not indicators biologically-confirmed STI for any population see Abstract P1-S5.22 Table 1.Abstract P1-S5.22 Table 1Unadjusted and Adjusted ORs and 95% CIs for Associations between Risky Sexual Behaviour and Biologically-Confirmed Chlamydia, Gonorrhoea, or Trichomoniasis among 7185 White, Black, and Hispanic Young Adults in the USAMales (N=3252)Females (N=3933)Unadjusted OR (95% CI)Adjusted OR (95% CI)*Unadjusted OR (95% CI)Adjusted OR (95% CI)*Age of sexual initiation Age at first sex†0.85 (0.78 to 0.92)0.90 (0.83 to 1.00)0.92 (0.86 to 0.99)0.95 (0.87 to 1.03) Sex younger than 162.47 (1.64 to 3.71)1.96 (1.27 to 3.01)1.30 (0.91 to 1.85)1.26 (0.86 to 1.84)Multiple partnerships 2+ partners in past year1.23 (0.79 to 1.91)0.99 (0.64 to 1.55)1.89 (0.38 to 2.58)1.64 (1.18 to 2.72) 4+ partners in past year1.04 (0.61 to 1.77)0.80 (0.44 to 1.44)1.66 (0.98 to 2.81)1.47 (0.84 to 2.57) 6+ partners in past year1.16 (0.56 to 2.41)0.89 (0.41 to 1.94)1.48 (0.68 to 3.21)1.37 (0.57 to 3.31) 8+ partners in past year1.97 (0.86 to 4.48)1.68 (0.77 to 3.67)1.52 (0.44 to 5.24)1.48 (0.35 to 6.32) 10+ partners in past year1.61 (0.56 to 4.62)1.31 (0.46 to 3.78)0.94 (0.27 to 3.24)0.86 (0.22 to 3.30) Total number of partners in past year†1.03 (0.96 to 1.11)1.01 (0.92 to 1.10)1.04 (0.97 to 1.09)1.01 (0.96 to 1.07) Lifetime number of partners†1.02 (1.00 to 1.04)1.01 (0.99 to 1.03)1.03 (1.01 to 1.05)1.03 (1.01 to 1.06)Risky sexual partners Sex with an infected partner in past year1.87 (0.93 to 3.77)1.20 (0.62 to 2.31)1.78 (1.14 to 2.79)1.31 (0.78 to 2.20)Condom Use Inconsistency Condom use inconsistency in past year1.07 (0.67 to 1.70)1.20 (0.75 to 1.92)0.93 (0.69 to 1.26)1.07 (0.78 to 1.46) Non-condom use at most recent sex1.58 (0.97 to 2.57)1.84 (1.12 to 3.01)0.99 (0.70 to 1.40)1.13 (0.79 to 1.62)Sex trade Ever paid for sex1.81 (0.79 to 4.18)1.03 (0.41 to 2.55)1.77 (0.39 to 8.07)1.30 (0.30 to 5.62) Ever got paid for sex1.69 (0.74 to 3.88)0.94 (0.38 to 2.36)2.95 (1.62 to 5.36)1.34 (0.70 to 2.56) Ever paid or got paid for sex1.76 (0.92 to 3.36)1.04 (0.50 to 2.17)2.73 (1.50 to 4.99)1.32 (0.69 to 2.55)Self-Reported STI Self-reported STI in the prior year2.72 (0.89 to 5.81)1.36 (0.57 to 3.28)1.77 (1.08 to 2.89)1.20 (0.70 to 2.06)*Controlling for age, poverty, and race/ethnicity.†Continuous variable.ConclusionsIndicators of sexual risk used in clinical and research settings should consider gender differences in markers of infection. Further, there is a need to identify more specific behavioural and social indicators of infection.