Anal sex is proxy for a profile of STD/HIV-associated sexual behaviors and laboratory-Confirmed STDs among African American adolescent females

Background: To determine whether engaging in penile-anal sex is associated with a profile of other HIV/STD behaviors and laboratory-confirmed sexually transmitted diseases (STDs). Methods: Cross-sectional study of 715 African American females, 15 to 21, reporting sexual activity in the previous 60 days. Data collection included a) audio-computer assisted self-interview and self-collected vaginal swab specimens assayed to detect Chlamydia trachomatis and Neisseria gonorrhoeae, and real-time PCR assay to detect Trichomonas vaginalis. Results: Approximately 10.5% reported anal sex during the 60 days prior to completing baseline ACASI. The prevalence of “any STD” was significantly greater among adolescents reporting recent anal sex (40%) relative to those adolescents not reporting anal sex (27.5%). In multivariable controlled analyses, adjusting for potential confounders, adolescents reporting recent anal sex were almost twice as likely (OR=1.89; 95% CI 1.15 – 3.11, P= .01) to be diagnosed with an STD. In addition, 6 of 7 other measures of HIV-related risk behaviors retained statistical significance. Conclusions: African American adolescent females who engage in penile-anal sex may experience an elevated risk of vaginally-acquired STDs and other HIV risk behaviors. Thus, penile-anal sex may be an important proxy of overall sexual risk behaviors and can be readily assessed during pediatrician visits as part of a sexual history and provided with sexual risk prevention counseling, medical screening for STDs, and referral to appropriate services. Community-based HIV prevention programs also need to assess and intervene to reduce the risk of anal sex among adolescent females.