EXECUTIVE SUMMARY
Researchers at Johns Hopkins University say an online “pop quiz” they developed in 2009 shows promising accuracy in predicting sexually transmitted infections in young women, although not apparently in young men.
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The quiz is a simple six-question survey designed to evaluate behaviors linked to STI risk. The questions ask about the number of sex partners, the frequency of condom use, and the age and past infection status of a respondent.
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The Centers for Disease Control and Prevention estimates that youth ages 15-24 make up just more than one-quarter of the sexually active population, but they account for half of the 20 million new sexually transmitted infections that occur in the United States each year.
Researchers at the Baltimore-based Johns Hopkins University say an online “pop quiz” they developed in 2009 shows promising accuracy in predicting sexually transmitted infections (STIs) in young women, although not apparently in young men.1
The quiz is a simple six-question survey designed to evaluate behaviors linked to STI risk. It was developed with the help of specialists in adolescent sexual healthcare and data from previously published research as a supplement to the home STI testing kit campaign, www.iwantthekit.org. The questions ask about the number of sex partners, the frequency of use of condoms, and the age and past infection status of a respondent. A mobile-friendly version of the site is available to accommodate frequent users of smart devices; the risk quiz is being updated so it also is mobile-friendly. (See the quiz questions at http://bit.ly/1X9UVS1. Also read Contraceptive Technology Update’s coverage of the kit in the December 2011 article, “Testing program to reach at-risk women,” available in the STI Quarterly supplement at http://bit.ly/1qA6IhU.)
Since the “I Want the Kit” campaign launched in 2004, more than 6,500 women and 3,500 men have self-screened in Maryland and Washington, DC, says author Charlotte Gaydos, DrPH, MPH, MS, professor of medicine in the Division of Infectious Diseases at the Johns Hopkins University School of Medicine. For the new study, nearly 3,200 people ages 14 and older from Maryland and Washington, DC, who accessed the kit website were invited to take a mailed or online risk quiz and order a free home testing kit. About one-half of those invited to take the quiz took it (830 females and 550 males, age average 20-24.)
Researchers scored the quizzes on a 0-10 point scale. Participants were categorized as high risk if they scored 8-10 points for women and 7-10 for men; medium risk if they scored 5-7 points for women and 3-6 for men; and low risk if they scored 0-4 points for women and 0-2 for men. Women were categorized differently, due to the higher rates of STIs in young women, say researchers.
For the quiz, scientists believed the higher the score, the more likely a respondent would be to screen positive for an STI using the home test kit.
Results showed a higher rate of STIs in women compared to men, at 14% versus 7%, respectively. The quiz also was able to predict that women who scored in the high-risk or medium-risk categories were four times and two times more likely to have an STI, respectively, than those who scored lower. In absolute numbers, 117 women and 39 men had at least one of three STIs, Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis.1
While the “pop quiz” accurately predicted STI status in women, it did not do so for men. Gaydos, who served as lead author of the current study, says researchers are unsure why this difference occurred. Follow-up research is planned to increase accuracy of the quiz for men and women.
While STIs affect individuals of all ages, they take a particularly heavy toll on young people. The Centers for Disease Control and Prevention (CDC) estimates that youth ages 15-24 make up just more than one-quarter of the sexually active population, but they account for half of the 20 million new STIs that occur in the United States each year, states Melissa Kottke, MD, MPH, MBA, associate professor in family planning and adolescent reproductive health in the Department of Obstetrics and Gynecology at the Emory University School of Medicine in Atlanta. Kottke presented on adolescent health at the March 2016 Contraceptive Technology conference in San Francisco.2
A pelvic exam is not necessary for chlamydia/gonorrhea screening, notes Kottke. Nucleic acid amplification tests are very sensitive and specific, and they can be conducted on such non-invasive specimens as urine and self-collected vaginal swabs. The CDC advises annual testing for both STIs for all sexually active women younger than age 25.3
Any discussion about STIs should include the added protection provided by condoms against STDs, including HIV infection. Kottke suggests the following instructions:
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Use a new, non-expired condom each time.
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Don’t open a condom package with scissors.
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Put on the condom before any genital contact.
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Do not use oil-based lubricants.
Provide free condoms or have resources available to direct young people to where they can find free condoms, Kottke advises.
REFERENCES
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Gaydos CA, Jett-Goheen M, Barnes M, et al. Use of a risk quiz to predict infection for sexually transmitted infections: A retrospective analysis of acceptability and positivity. Sex Transm Infect 2016; 92(1):44-48.
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Kottke M. Adolescent health: Case discussions. Presented at the 2016 Contraceptive Technology conference. San Francisco; March 2016.
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Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64(No. RR-3): 1-137.
