Young Adults Reporting Abstinence May Test Positive for STDs

Laurie Barclay, MD

January 11, 2011

January 11, 2011 — Young adults reporting abstinence may test positive for sexually transmitted diseases (STDs), suggesting that routine STD screening may be needed, according to the results of a study published online January 3 and in the February print issue of Pediatrics.

"Self-reported behavior has been the cornerstone of sexual health research and clinical practice, yet advances in [STD] screening provide researchers with the opportunity to objectively quantify sexual risk behaviors," write Ralph J. DiClemente, PhD, from the Rollins School of Public Health at Emory University in Atlanta, Georgia, and colleagues. "However, the extent to which young adults' laboratory-confirmed STD results and self-reported sexual behaviors are consistent has not been assessed in a nationally representative sample."

The main study goal was to examine whether young adults' reports of penile/vaginal sex in the previous 12 months corresponded with the presence of laboratory-confirmed nonviral STDs, as determined by nucleic acid amplification testing. The study cohort consisted of 14,012 young adults who completed wave 3 in the National Longitudinal Study of Adolescent Health. Testing included an audio computer-assisted self-interviewing survey, urine testing for Chlamydia trachomatis and Neisseria gonorrhoeae, and polymerase chain reaction assay for Trichomonas vaginalis.

Among young adults who tested positive for an STD, more than 10% reported abstaining from sexual intercourse in the previous year. Compared with those who reported abstinence in the previous 12 months, those who reported having sexual intercourse were significantly more likely to test positive for an STD. However, after controlling for several sociodemographic factors, the odds of testing positive were only slightly more than 2-fold, with adjusted odds ratio of 2.11 (95% confidence interval, 2.097 - 2.122; P = .0001).

"Findings indicate discrepancy between young adults' positive STD status and self-reported sexual behavior," the study authors write. "No significant correlates of discrepant reporting were identified. From a clinical standpoint, the discrepancies between STD positivity and self-reported sexual behavior observed in this nationally representative sample suggest that routine STD screening may be beneficial and necessary to reduce STD morbidity among young adults."

Limitations of this study include the lack of a baseline measure of STD status, collection only of urine specimens for STD testing, imperfect accuracy of STD tests, and lack of data about anal sex.

"The implications of the findings suggest that although self-report remains necessary, it may not be sufficient to provide a precise estimate of STD-positive young adults' sexual risk behavior," the study authors conclude. 'When appropriate, other objective and quantifiable nondisease biological markers are needed to more precisely gauge young adults' sexual behavior as well as corroborate their self-report of sexual behaviors.... [I]f pediatricians and adolescent medicine physicians do not test all young people, there are likely a substantial number of missed cases of STDs that will go undiagnosed, untreated, and spread to future sex partners."

This study was supported in part by the Emory Center for AIDS Research, Social and Behavioral Sciences Core. The study authors have disclosed no relevant financial relationships.

Pediatrics. 2011;127:208-213.

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