Gaps in the Knowledge of Sexually Transmitted Infections in Young Adults: A Review of the Literature

Purpose Almost half of the 26 million sexually transmitted infections (STI) occur in young adults, although they are only 25% of the sexually active population in the US. Common STIs include chlamydia, gonorrhea, syphilis, genital herpes, Hepatitis B (HBV), Human Immunodeficiency Virus (HIV), and Human Papillomavirus (HPV). STIs are often associated with adverse health outcomes if left untreated, such as pelvic inflammatory disease, infertility, and ectopic pregnancies in women. The high rates of STIs in young adults, ages 18-25, may be due in part to a lack of knowledge about screening recommendations, symptoms, and available services for care. Because knowledge is a key factor associated with the prevention of STIs, the purpose of this study is to explore the current literature related to STI knowledge among young adults and identify the gaps in knowledge. Methods A literature review process was conducted using the following electronic databases: PubMed, Scopus, Medline, ScienceDirect, WILEY, EbscoHost. In addition to database search, the reference lists of the relevant articles were screened for titles and abstracts containing the keywords. The keywords used included: STI, STD, sexually transmitted infection, sexually transmitted diseases, knowledge, awareness, health literacy, health attitudes, information literacy, primary prevention, and secondary prevention. This retrospective search was limited to: (i) articles written in English, (ii) studies conducted in the United States, (iii) articles addressing genital herpes, HBV, HIV, HPV, chlamydia, or gonorrhea in the title or abstract, and (iv) included young adults 18-25 years old as participants. We excluded syphilis in the STI category, and the final search resulted in 41 articles that included qualitative and quantitative studies and systematic reviews. Results Gaps in the knowledge of STIs in young adults was subset into five categories: prevalence, transmission, symptoms, treatment and prevention, and testing services. Young adults lack awareness about the high STI rate in their age group, transmission factors such as skin-skin contact, or oral/genital sex, and that STIs can be asymptomatic. Many young adults have misconceptions about HPV vaccines, pre-exposure prophylaxis for HIV prevention, and condom use. Two of the most important factors to the success of STI prevention in programming are the promotion of self-efficacy and the reduction of stigma around STIs. Self-efficacy is defined as the "belief in one’s own ability to execute a particular behavior related to a specific domain of functioning.” A high level of self-efficacy in college students is one of the best predictors of STI and HIV testing and condom use. Additionally, higher levels of STI knowledge have been correlated with less stigma surrounding the diseases. Conclusion Understanding what the specific gaps are in young adults’ STI knowledge can guide college and community programs in narrowing their focus to provide complete education concerning STIs. Specifically, more programs should implement effective theory-based approaches, including those that focus on improving self-efficacy of STI prevention and treatment and decreasing the stigma around these diseases. Addressing these specific points among young adult populations may have a role in reducing the rates of STIs and preventing the adverse health outcomes.