Treatment-seeking and Sexual Behavior among African-American Adolescent Females with STD Symptoms

Context: Delayed STD treatment increases the likelihood of adverse health complications and secondary transmission.

Objective: To investigate treatment-seeking among African-American adolescent females presenting to reproductive health clinics with STD symptoms and sexual behavior after noticing symptoms.

Methods: Sociodemographic, psychosocial, sexual behavior and STD history data were collected via ACASI from 715 African-American adolescent females, 15-21 years, presenting to reproductive health clinics. Data were obtained prior to randomization in an HIV prevention intervention. Treatment-seeking and sexual behaviors were assessed among participants reporting STD symptoms. Logistic models assessed the correlates of delayed presentation ( ≥5 vs. <5 days) after noticing symptoms.

Results: A total of 155 (22%) participants reported STD symptoms. The median time since first noticing symptoms was 5 days (range: 0-200 days). Attempting treatment without medical assistance (22%) or with douching (25%) was common. Over half (59%) reported sex without a condom after noticing symptoms. Correlates of delayed presentation included: higher condom self-efficacy (OR: 1.05, p=.04), greater peer norms for risky behavior (OR: 1.07, p=.04), greater commitment to a future relationship with their main partner (OR: 1.07, p=.02); discussing symptoms with a female friend vs. someone else (OR: 2.15, p=.05) and douching to treat symptoms (OR: 2.82, p=.01). In multi-variable analyses, douching (AOR: 3.40, p=.01) and peer norms (AOR: 1.09, p=.05), remained statistically significant.

Conclusions: A substantial proportion of African-American female adolescents have unprotected sex between noticing STD symptoms and presenting for diagnosis and treatment. STD prevention and treatment programs may benefit by highlighting the risks of douching.