Knowledge and attitude about sexually transmitted infections among paramedical 1st year students in a tertiary care teaching institute in Pondicherry

INTRODUCTION

Sexually transmitted infections (STI’s) are transmitted through sexual contact. Young individuals of 16-24 yr age group are more prone to STIs than older individuals because they tend to practice unprotected sex and are likely to have multiple sexual partners. Thus it becomes important to assess the knowledge level about STIs among this age group. The earlier studies were mainly among school children.¹ Although few studies were done among university students, they were from different socio-cultural background from other countries.^2,3 So far no study on knowledge and attitude about STIs has been conducted among para medical students from India.

The main objective of this study was designed to evaluate the knowledge, awareness, perception and attitude about STIs among paramedical 1st year students in a tertiary care teaching institute.

METHODS

The study was a descriptive cross sectional study done for a period of one month from 1st September 2017 to 30th September 2017 among the paramedical 1st year students of Allied Health Sciences in Aarupadai Veedu Medical College, Pondicherry. Self adminstered pre tested and pre validated questionnaire was used for data collection. Questionnaire consist of questions regarding knowledge, awareness and perception of the respondents like types of STIs, modes of transmission, symptoms and signs, complications, preventions and attitude towards STIs and sexual health. Totally 227 para medical 1st year students who were willing to participate in this study were included. Ethical clearance was obtained from institutional ethical committee. Data was entered and analysed in MS excel. The results are expressed in numbers and percentages.

RESULTS

Total of 227 paramedical first year students, including 103 (45%) males and 124 (55%) females were enrolled in the study.

The mean age of the study population was 19±2 yr (16-24 yr). The male to female ration is 1:1.24. 227 students filled out the questionnaire and written response rate is 100%.

Education in schools and colleges was the main source of information in more than half of the study population i.e., 67.8%, followed by internet in 56.8% students, books, magazine and newspaper in 49%, friends in 41.4%, TV and radio in 36.5% and movies and serials in 31.1%. The least common source of information was obtained from doctors by 50 participants 22.0% and from relatives by 18.5% (Table 1).

Regarding knowledge about types of STIs, 59.9% and 40.9% of them knew HIV and syphilis as a type of STIs respectively. 24.6% knew herpes simplex, 23.8% gonorrhea and 20% hepatitis B and C as a type of STIs. Only 15.8% knew about anogenital warts, 13.2% about lymphogranuloma venereum, 12.7% about trichomoniasis and 12.3% about chancroid as a type of STIs. Incorrect knowledge about the type of STIs was also prevailing among the students. 30.8% of them marked tuberculosis as STIs, 28.6% sickle cell anemia and 28.6% marked asthma as STIs (Table 2).

Regarding knowledge about the route of transmission, majority of students have correct information about different modes of transmission. 62.5% mentioned sex with multiple partners, 51.1% mother to child transmission, 50.2% sharing of needles and syringes, 46.3% unprotected sex and 39.2% mentioned sex with prostitutes as the routes of transmission. Misconceptions about the route of transmission of STIs were also prevailing among these students. 21.6% marked kissing as mode of transmission, followed by 21.1% sharing of cloths and food, 20.3% cough and sneezing and 17.6% hugging and shaking hands as modes of transmissions (Table 3).

Regarding awareness about signs/symptoms of STIs, half of the study population (50.7%) considered discharge from penis/vagina as symptom of STIs whereas 49.8% of students considered weakness, 47.6% loss of weight and 37.6% students considered ulcer/warts in the genital area as symptoms/signs. 25.6% of the students did not know anything about signs/symptoms of STIs (Table 4).

Cervical cancer, infertility, still births and abortions were the options given to the students to assess the knowledge about the complications of STIs. Most of the students 59.5% had no knowledge about the complications and they marked “Don’t Know” as the response. 6.6% of them marked “None of the above” as answer. Hence (59.5% + 6.6% = 66.1%) 66.1% of the students were not aware about complications of STIs. Only 13.2% of students had correct knowledge about the complications of STIs as they marked “All of the above” choice (Table 5).

Majority of the students had correct knowledge about methods of prevention. More than half of the students (56.4%) agreed ‘use of condoms’ as a method of protection against STIs, 51.9% of them opined ‘counseling center’ for prevention, 48.5% of them agreed ‘not sharing needles and syringes’, 44.9% opined ‘remaining faithful to single partners’, 43.6% ‘doing blood test before marriage/ child birth’ and 31.7% of them ‘banning prostitution’ as prevention method. Only very few students (7.1%) did not know any of the prevention methods mentioned (Table 6).

Regarding attitude only 27.3% of students agreed masturbation to be harmful to health, where as 14.9% students disagreed with it and 55.5% students did not know its ill effects on health. 45.3% students agreed sex education should be given to students whereas 14.1% students disagreed for the need for sex education and 38.7% students were unsure. Only 15.4% students agreed that STIs can be curable, where as 31.3% disagreed and 50.6% did not know whether STIs can be cured or not. 43.2% students agreed that infected persons must get treatment whereas 12.3% disagreed with it and 44.1% students were not sure whether the infected person should get treatment or not. 26.4% of students agreed that watching/reading pornographic materials can lead to risky sexual practices, whereas 19.4% disagreed with it. More than half of the study population (52.8%) were not sure whether watching/ reading pornographic materials can contribute to risky sexual practices. 23.8% students thought use of emergency contraceptive pills could prevent STIs, while 57.3% students had no idea about it. Only 17.2% students disagreed with that statement (Table 7).

DISCUSSION

Inadequate knowledge about STIs and fear of patients affected with STIs may cause a serious problem among health care professionals because they consider themselves to be at risk of contracting the infection. Wrong knowledge and fear of STIs among health care professionals may result in derogatory behavior towards patients infected with STIs.

The main objective of our study was to assess the knowledge, awareness, perception and attitude among paramedical 1st year students regarding STIs. Our study showed 67.8% of students came to know about STIs through school and college education. This is good news because the information given in school and college would be correct and complete. Most of the students gained their knowledge about STIs through internet, books/magazine, friends, TV/ radio, movies/serials and relatives. The knowledge gained by these media might not be correct, complete and also might mislead the student since not all the contents is scrutinized by qualified health professionals. Only 22% gained their knowledge through doctors.

HIV and Syphilis were the well-known types of STIs in our study. This is in consistent with the studies of Nagesh et al, Uike et al and Zubeyde et al.^1,4,5 And the least known STIs were anogenital wart, LGV, trichomoniasis and chancoroid. Further there were 30% of students who thought tuberculosis, sickle cell anemia and asthma to be type of sexually transmitted infections.

The low level of knowledge about anogenital warts, LGV, trichomoniasis and chancoroid compared to HIV and syphilis among the students could be attributed to frequent common education programs on HIV and not emphasizing the issues about other STIs.

The knowledge about transmission of STIs was fairly good in our study (39-62%). The routes of transmission considered by most of the students (50-62%) were sex with multiple partners, infection from mother to child and sharing needles and syringes.

Similar to other studies certain misconceptions about transmission of STIs were also prevalent in our study.^1,2 Commonest misconceptions in our study were transmission through kissing, sharing of cloths/food, cough and sneezing, sharing toilets and hugging/shaking hands with infected person (17-21%).

Regarding sign/symptoms half of the students (50.7%) considered discharge from penis/vagina as the most suspicious feature of STIs. Other signs/symptoms were less well known. 37.6% of students considered ulcer and warts in genital area as symptoms and signs. Nearly half of the students i.e., 49.8% thought loss of weight and weakness as symptoms. 25.6% of students did not know any of the signs/symptoms given. Thus students did not have indebt knowledge about the presentation of STIs. A similar finding has been published by Amu and Adegn, and by many other studies conducted at different geographical locations.^6-10

Regarding complications of STIs, 66.1% of the students were not aware about complications of STIs. Only 13.2% students considered cervical cancer, infertility, still births and abortions as complications. This means most of our study population was not aware of the complications of STIs.

Majority of the students had correct knowledge about methods of prevention. More than half of the students (56.4%) agreed ‘use of condoms’ as a method of protection against STIs, 51.9% of them opined ‘counseling center’ for prevention, 48.5% of them agreed ‘not sharing needles and syringes’, 44.9% opined ‘remaining faithful to single partners’, 43.6% ‘doing blood test before marriage/child birth’ and 31.7% of them ‘banning prostitution’ as prevention method. Only very few students (7.1%) did not know any of the prevention methods mentioned. So our students had fair knowledge about the prevention of STIs.

The attitude of the students about sexual health was variable. Only 27.3% of students felt masturbation to be harmful to health whereas 55.5% of students did not know about its ill effect on health.

45.3% of students agreed that sex education should be given for students, whereas only 14.1% students disagreed with it and 38.7% students did not know whether sex education should be given or not.

Only 26.4% students agreed that watching and reading pornography material could contribute to risky sexual practices.

About 40.5% students answered that they would wait until marriage to have sex. 43.2% student felt infected person should get treatment whereas 44.1% students did not know whether treatment is to be given or not.

23.8% students thought use of emergency contraceptive pills could prevent STIs, while 57.3% students had no idea about it. Only 17.2% students disagreed with that statement. In the study by Nagesh et al almost 1/3 of the students felt emergency contraceptive pills could prevent STIs.¹ This point has not been discussed much in earlier studies.^9-12

CONCLUSION

Our study group though had fair knowledge about the routes of transmission and prevention of STIs, did not have enough information regarding types, signs/ symptoms, complications of STIs and right attitude towards these infections. Our study suggested that organizing training sessions on STIs at regular intervals and conducting awareness programs in the form of lectures and quiz programs will promote a good delivery of correct information to para medical students. This is important because they will be dealing with the patients affected with various STIs in future and they are the major work force present in the health sector globally.

ACKNOWLEDGEMENTS

I express my profound gratitude to my respected teacher and guide Prof. Dr. P. Oudeacoumar MD, Professor and HOD, Department of Dermatology Venereology and Leprosy, Aarupadai Veedu Medical College, Pondicherry for his exemplary guidance, monitoring and constant encouragement throughout the course of the study and in the preparation of this study. I express my immense gratitude to my parents Mr. Kaushlendra Prasad Misra (Father), Dr. Neena Misra (Mother) and Brothers Mr. Rohit Krishna Misra and Mr. Mohit Krishna Misra for their constant love, support and encouragement throughout. I would like to specially express my deepest indebtness to my wife Dr. Richa Dokania, for her abundance patience, unwavering support, valuable suggestions and assistance in every step of the way.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the institutional ethics committee

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