A small study of women who responded to a study recruitment flier that offered a free, rapid HIV test revealed the participants knew very little about sexually transmitted infections (STIs).1

The women were randomly selected based on their response to a flier posted at a clinic in Mississippi, says Marqueta Abraham, DNP, MSN, first vice president for the American Federation of Government Employees Union, VA Hospital, Memphis, TN.

Enrollees completed the Sexually Transmitted Disease Knowledge Questionnaire (STD-KQ), which included questions on the validity of various statements about STIs. The STD-KQ, published in 2007, was developed with 27 items that measure knowledge about these diseases.2

The questionnaire asks for “true,” “false,” and “don’t know” as responses to each statement.

  • Genital herpes is caused by the same virus as HIV.
  • Soon after infection with HIV, a person develops open sores on his or her genitals (penis or vagina).
  • Human papillomavirus (HPV) can lead to cancer in women.
  • A woman can tell she has chlamydia if she has a bad-smelling odor from her vagina.
  • There is a vaccine that prevents a person from getting chlamydia.
  • If a person had gonorrhea in the past, he or she is immune (protected) from getting it again.2

The study’s enrollees, all of whom were African American women, demonstrated low knowledge about STIs, frequently answering “don’t know” when they first completed the STD-KQ, Abraham says. The pre-test mean score was 7.7, meaning about eight questions correct out of 27. After the seminar, they scored 22 correctly.

“The women said, ‘We haven’t heard [about STDs] from my doctors or nurses; we haven’t heard about it from education in school,’” she explains. “The topic was too taboo to talk about, and that was the conclusion: They honestly didn’t know the answers.”

Abraham presented a 45-minute educational seminar about STIs, then the women talked about it for nearly two additional hours.

“I showed them YouTube videos on sexual hygiene and showed them the different types of STDs in case they didn’t know how those looked on their bodies,” Abraham says. “They seemed enlightened and told me it helped.”

Women appeared surprised by some of the STI information because they had never discussed these facts before attending the seminar. “We veered off a little bit from the education provided,” Abraham says.

For example, the women discussed what to do before and after sex, including using a condom, having another form of contraception (if that is a priority), and taking personal hygiene measures post-sex. The women explained how they did not feel comfortable asking questions about STIs when seeing their doctors.

“They told me how, when they’re with their doctor, they got nervous and didn’t want to mention what they wanted to know — a white coat syndrome,” Abraham explains.

The most surprising finding was the basic lack of education on STIs, she says. People do not talk about the downside to sex, such as contracting an STI and receiving treatment.

“A great thing to happen could be pregnancy, but we don’t talk about how having multiple sexual partners and having unprotected sex could get you an STD if you’re not safe,” Abraham says.

At the educational seminar, the women discussed how important it is to use condoms and make sure they know about their sexual partners’ STI history.

The unmarried women who participated in the study reported that they used condoms, but more as a contraceptive than for STI prevention. One woman wanted to know why she needed STD protection if she only had one sexual partner. Abraham’s response was: “How do you know he’s not doing anything with anyone else, and then both of you are at risk, and so is the other person. Condom use is important even if it’s just one boyfriend.”

Abraham also reinforced the idea that the women should ask their healthcare providers for information and tell them what they want in terms of reproductive care.

“I told them, ‘Don’t be afraid to say what you need to your provider because that’s what they’re there for,’” she says. “If it’s not being done, then just ask for it.”

Reproductive health providers could use the STD-KQ to assess patients’ knowledge about STIs. Asking patients about STIs should be a standard part of every health visit, but it needs to be more than just one yes-or-no question. “Sometimes, you have to dive in to see exactly what’s going on with the patient,” Abraham says. “That goes with taking your time and getting to know them so they can open up.”

The key is to be patient, ask questions in a nonjudgmental way, and provide a safe and trusted place for them to open up. Patients need accurate information from a source they respect.

“Women [in the study] were surprised about how much they didn’t know, and they were very thankful for the seminar,” Abraham says. “They said, ‘We haven’t done this before — been open enough to talk about things like that.’”

REFERENCES

  1. Abraham MV. STD education among African-American women: An educational improvement initiative. J Natl Black Nurses Assoc 2021;32: 18-21.
  2. Jaworski BC, Carey MP. Development and psychometric evaluation of a self-administered questionnaire to measure knowledge of sexually transmitted diseases. AIDS Behav 2007;11:557-574.