Sexually transmitted infections, blood-borne viruses and risk behaviour in an Australian senior high school population—the SHLiRP study
Francis J. Bowden A B C , Elissa J. O’Keefe A , Ruth Primrose A and Marian J. Currie BA Canberra Sexual Health Centre, The Canberra Hospital, PO Box 11, Woden, ACT 2605, Australia.
B Academic Unit of Internal Medicine, Australian National University Medical School, Canberra Clinical School, The Canberra Hospital, PO Box 11, Woden, ACT 2605, Australia.
C Corresponding author. Email: frank.bowden@act.gov.au
Sexual Health 2(4) 229-236 https://doi.org/10.1071/SH05014
Submitted: 18 March 2005 Accepted: 4 July 2005 Published: 16 November 2005
Abstract
Objectives: To determine the feasibility and acceptability of screening for sexually transmitted infections and blood-borne viruses and to study the profile of sexual activity and other risk behaviours in a senior high school population. Methods: In this descriptive study we provided sexual health education and screening to students from two senior high schools in the Australian Capital Territory. We collected behavioural data using a self-administered questionnaire. Urines and swabs were tested for Chlamydia trachomatis (Ct), Neisseria gonorrhoea (Ng), Trichomonas vaginalis (Tv) and human papilloma virus (HPV). Blood specimens were tested for hepatitis B and C, HIV, herpes simplex viruses (HSV-1 and HSV-2) and syphilis. Results: A total of 795 students participated (31% of the enrolled population; female to male ratio 60 : 40) and 67.0% were sexually active. Of 795 students, 644 (81.0%) were screened. Rates of infection were Ct 1.1% (95% CI: 0.4–2.6), HPV 11.7% (95% CI: 7.4–17.3), HSV-1 32.5% (95% CI: 28.9–36.3), HSV-2 2.4% (95% CI: 1.3–3.9), hepatitis B surface antigen 0.3% (95% CI: 0.04–1.1) and hepatitis C antibodies 0.7% (95% CI: 0.07–1.6). Only 22.3% (95% CI: 19.3–25.7) of students had immunity to hepatitis B. There were no cases of HIV, gonorrhoea, trichomoniasis or syphilis. Of the sexually active students, 49.2% (95% CI: 38.9–59.2%) reported never or only sometimes using condoms, 41.5% (95% CI: 32.2–52.3%) reported unsafe drinking, 33.3% (95% CI: 23.9–43.1%) were smokers and 1.9% (95% CI: 0.2–7.0%) reported injecting drug use. Conclusions: Rates of STI and blood-borne viruses and immunity to hepatitis B were low in this population, but unsafe sex and other risk behaviours were common. We have demonstrated that STI screening, including serological testing, was well accepted in a senior high school population.
Additional keywords: adolescent(s), screening, sexual health.
Acknowledgements
This work was supported by a project grant from The Canberra Hospital Private Practice Fund. The authors gratefully acknowledge the assistance of the following individuals: Sophie Bertram, Debbie Miller, Suzie Brook, Jane Keany, Denise Fairall, Christine Golds, Di Pratt, Cassandra Beaumont-Brown, Susie Begbie, Vanita Parekh, Sarah Martin, Alex Tyson, Philip Habel, Melinda Bower, Monica Brady, Michelle McNiven, Anita Campbell and Jenny Ridgway. The project would not have been possible without the enthusiasm and cooperation of the students and staff of the participating senior high schools, in particular staff members Barry Woolacott, John Stenhouse, Peter Clayden, Sue Hanley, Richard Powell and Margaret Riley. We would also like to thank Professor Anthony Smith, Australian Research Centre in Sex Health and Society in Melbourne for permission to use the questionnaire and Professor Anthony Cunningham for assistance in validation of herpes serology testing. Ethics approval was obtained from the ACT Health and Community Care Human Research Ethics Committee and from the ACT Department of Education and Training.
[1] Rosenthal D, Smith AM, de Visser R. Personal and social factors influencing age at first sexual intercourse. Arch Sex Behav 1999; 28(4): 319–33.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[2]
[3]
[4] Corwin P, Abel G, Wells JE, Coughlan E, Bagshaw S, Sutherland M, et al. Chlamydia trachomatis prevalence and sexual behaviour in Christchurch high school students. NZ Med J 2002; 115(1158): U107.
[5] Marrazzo JM, White CL, Krekeler B, Celum CL, Lafferty WE, Stamm WE, et al. Community-based urine screening for Chlamydia trachomatis with a ligase chain reaction assay. Ann Intern Med 1997; 127(9): 796–803.
| PubMed |
[6] Debattista JL, Patten D, Latham JS. Early detection of Chlamydia trachomatis in senior high school student populations: a pilot study. Venereology 1998; 11(2): 19–23.
| PubMed |
[7] Burstein GR, Gaydos CA, Diener-West M, Howell MR, Zenilman JM, Quinn TC. Incident Chlamydia trachomatis infections among inner-city adolescent females. JAMA 1998; 280(6): 521–6.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[8] Nsuami M, Cohen DA. Participation in a school-based sexually transmitted disease screening program. Sex Transm Dis 2000; 27(8): 473–9.
| PubMed |
[9] Kacena KA, Dohnal K, Beneova V, Grivna M, Deliopolu J, Tryzna R, et al. Chlamydia, gonorrhea, and HIV-1 prevalence among five populations of women in the Czech and Slovak Republics. Sex Transm Dis 2001; 28(6): 356–62.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[10] Debattista J, Martin P, Jamieson J, Crane K, Dolton I, Russell-Hall S, et al. Detection of Chlamydia trachomatis in an Australian high school student population. Sex Transm Infect 2002; 78(3): 194–7.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[11]
[12] Paterson BA, Tabrizi SN, Garland SM, Fairley CK, Bowden FJ. The tampon test for trichomoniasis: a comparison between conventional methods and a polymerase chain reaction for Trichomonas vaginalis in women. Sex Transm Infect 1998; 74(2): 136–9.
| PubMed |
[13] Garland SM, Tabrizi SN, Chen S, Byambaa C, Davaajav K. Prevalence of sexually transmitted infections (Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and human papillomavirus) in female attendees of a sexually transmitted diseases clinic in Ulaanbaatar, Mongolia. Infect Dis Obstet Gynecol 2001; 9(3): 143–6.
| PubMed |
[14]
[15] Vuylsteke B, Vandenbruaene M, Vandenbalcke P, Van Dyck E, Laga M. Chlamydia trachomatis prevalence and sexual behaviour among female adolescents in Belgium. Sex Transm Infect 1999; 75(3): 152–5.
| PubMed |
[16] Cohen DA, Nsuami M, Martin DH, Farley TA. Repeated school-based screening for sexually transmitted diseases: a feasible strategy for reaching adolescents. Pediatrics 1999; 104(6): 1281–5.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[17] Prinstein MJ, Meade CS, Cohen GL. Adolescent oral sex, peer popularity, and perceptions of best friends’ sexual behavior. J Pediatr Psychol 2003; 28(4): 243–9.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[18] Halpern-Felsher BL. Oral versus vaginal sex among adolescents: perceptions, attitudes, and behavior. Pediatrics 2005; 115(4): 845–51.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[19] Ludicke F, Stalberg A, Vassilakos P, Major AL, Campana A. High- and intermediate-risk human papillomavirus infection in sexually active adolescent females. J Pediatr Adolesc Gynecol 2001; 14(4): 171–4.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[20] Shew ML, Fortenberry JD, Miles P, Amortegui AJ. Interval between menarche and first sexual intercourse, related to risk of human papillomavirus infection. J Pediatr 1994; 125(4): 661–6.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[21] Bowden FJ, Paterson BA, Mein J, Savage J, Fairley CK, Garland SM, et al. Estimating the prevalence of Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and human papillomavirus infection in indigenous women in northern Australia. Sex Transm Infect 1999; 75(6): 431–4.
| PubMed |
[22] Fleming D, McQuillan GM, Johnson RE, Nahmias AJ, Aral SO, Lee FK, et al. Herpes simplex virus type 2 in the United States, 1976 to 1994. N Engl J Med 1997; 337(October): 1105–11.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[23] Stanberry L, Rosenthal S. The epidemiology of herpes simplex virus infections in adolescents, herpes. Herpes 1999; 6 12–5.
[24] Sucato G, Celum C, Dithmer D, Ashley R, Wald A. Demographic rather than behavioural risk factors predict herpes simplex virus type 2 infection in sexually active adolescents. The Paediatric Infectious Disease Journal 2001; 20(April): 422–6.
| Crossref | GoogleScholarGoogle Scholar |
[25] Wald A, Koutsky L, Ashley RL, Corey L. Genital herpes in a primary care clinic: demographic and sexual correlates of herpes simplex type 2 infections. Sex Transm Dis 1997; 24(March): 149–55.
| PubMed |
[26] Tideman RL, Taylor J, Marks C, Seifert C, Berry G, Trudinger B, et al. Sexual and demographic risk factors for herpes simplex type 1 and 2 in women attending an antenatal clinic. Sex Transm Infect 2001; 77(6): 413–5.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[27] Roberts CM, Pfister JR, Spear SJ. Increasing proportion of herpes simplex virus type 1 as a cause of genital herpes infection in college students. Sex Transm Dis 2003; 30(10): 797–800.
| PubMed |
[28] Stanberry LR, Spruance SL, Cunningham AL, Bernstein DI, Mindel A, Sacks S, et al. Glycoprotein-D-adjuvant vaccine to prevent genital herpes. N Engl J Med 2002; 347(21): 1652–61.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
